Prevalencia de diabetes tipo 2 e hipertensión arterial en adultos de nivel económico bajo de Monterrey, México

Antecedentes: la hiperglucemia es signo característico de un grupo enfermedades, la diabetes tipo 2 abarca del 90 al 95% de los casos, y provoca alta morbilidad, e incapacidad e incluso muerte prematura. Objetivo: determinar la prevalencia de diabetes mellitus tipo 2, prediabetes y la de HA en adultos en área urbana de bajo nivel económico en Monterrey, México. Método: estudio de corte transversal con selección aleatoria de adultos (hombres y mujeres no embarazadas ni lactando) en una comunidad de bajo nivel económico. Se obtuvo glucemia capilar y plasmática en ayuno y 2h-poscarga oral de 75 g glucosa. Diagnósticos según criterios del American Diabetes Association 2004. Se presenta prevalencia con intervalo de confianza (IC95%) y regresión múltiple en inferencia de factores. Resultados: la prevalencia de diabetes mellitus tipo 2 fue 14.1% (9.6-18.6%), prediabetes 12.8% (8.5-17.1) y de hipertensión arterial 26.24% (20.4-32.4%). La edad, el índice de masa corporal y género justifican 38% de la variación de la hipertensión arterial (r = 0.616, todas p < 0.001); pero sólo 5% (r = 0.23) de la variación glucémica fue explicado por la edad (p < 0.01) y el índice de masa corporal (p < 0.05). Conclusiones: la prevalencia de hipertensión arterial fue la esperada, pero la de diabetes mellitus 2 sugiere ser más alta que en reportes previos. En esta población la adiposidad no justifica la alta prevalencia de diabetes mellitus 2, ni de prediabetes. ABSTRACT Background: Hyperglycemia is a characteristic sign of several diseases. In the case of type 2 diabetes, it has an effect on 90 to 95% of the patients. It produces a high morbidity, incapacity and even death. Objective: To determine the prevalence of type 2 diabetes mellitus, pre-diabetes and hypertension in a low-income urban area in Monterrey, Mexico. Method: A random, cross-sectional study was done in a low-income urban population in Monterrey, Mexico. Patients who had participated in a baseline glycemic study from 1992 to 1993 were re-examined. The concentration of capillary and plasmatic glucose on fasting and two hour post-load oral glucose (75 g) were determined. The diagnoses were established following the criteria of the American Diabetes Association 2004. Multiple regression analyses were done to infer the factors related with glycemia; the confidence interval was 95%. Results: The type 2 diabetes mellitus prevalence was 14.1%, pre-diabetes 12.8% and the one for hypertension was 26.24%. Age, body mass index and gender prognosticated in an independent manner the values of hypertension (p < 0.001). Glycemia was prognosticated based on age (p < 0.01) and body mass index (p < 0.05). Conclusions: Prevalence of type 2 diabetes was higher in low-income adult patients, but hypertension prevalence remained within normal parameters. In this population, the body mass index did not justify the high prevalence of type 2 diabetes nor that of pre-diabetes

Aptitud de los alumnos de pregrado de la carrera de Medicina ante dos modelos de evaluación: El caso de Endocrinología.

Antecedentes: La Facultad de Medicina de la UANL inició en agosto del 2006 un nuevo plan de estudios y un modelo educativo basado en el aprendizaje y en la participación más intensa del alumno. Esta modificación en la estrategia de formar a los futuros médicos requiere ser evaluada científicamente con el propósito de medir si los cambios esperados con la implementación del plan de estudios y del modelo educativo, están ocurriendo. Objetivo: Comparar la aptitud de los alumnos del curso de pregrado de endocrinología ante dos métodos de evaluación. Método: Comparación de dos exámenes como proceso de evaluación ante dos planteamientos académicos: el actual (basado en la aplicación del conocimiento, casos clínicos) y el próximo anterior (basado en la memorización de conocimientos). Se contrastó la aptitud de los alumnos del nuevo plan de estudios (n = 74) vs. los alumnos del plan anterior (n = 137), ante el mismo examen. Resultados: Los alumnos del nuevo plan de estudios tuvieron una aptitud casi idéntica al ser evaluados con el examen actual y con el aplicado en ciclos anteriores (73.4 + 7.8 vs. 72.9 + 10.7, respectivamente) p = 0.2553. El porcentaje de aprobación fue de un 71 vs. 67%. Al comparar la aptitud de los alumnos del plan actual y el anterior ante un mismo examen, la aptitud fue muy favorable en el grupo de alumnos del nuevo plan de estudios (74.7 ± 10.7 vs. 56.0 ± 9.3), p< 0.0001. Conclusiones: La combinación de un modelo educativo centrado en el aprendizaje, en una acentuada participación del alumno en la clase, en una forma de evaluación que incentiva el estudiar la clase diaria y en la aplicación de exámenes dirigidos a evaluar la aplicación del conocimiento como en la vida real de un médico, son los aspectos que debemos fortalecer en el proceso de formación de nuestros futuros médicos

Guía Mexicana para el Diagnóstico y el Tratamiento de la Urticaria

La urticaria es una enfermedad que padece una quinta parte de la población en algún momento de su vida. Las guías inter- nacionales recientes han propuesto unos cambios de fondo en su diagnóstico y tratamiento, por lo que había la necesidad de crear una guía nacional y multidisciplinaria, con base amplia en los gremios de especialistas y médicos de primer contacto en México. ABSTRACT Urticaria is a disease that a fifth of the population shall suffer once in a lifetime. Recent clinical guidelines have proposed some fundamental changes in the diagnosis and treatment of urticaria, making the development of a national, multidisciplinary guideline, with wide acceptability among different professional groups –both specialists and primary health care workers–, necessary in Mexico

Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry

Aim To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p = 0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.211, 95%CI 0.067-0.667, p = 0.008). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Elaboración e implementación de un plan de mejoramiento al área de facturación de la ESE hospital nuestra señora del Carmen

La salud en Colombia ha mejorado notablemente en los últimos años en el aspecto científico y tecnológico, pero el sector salud continua con graves problemas como el déficit económico de muchos instituciones públicas y privadas del país a partir de la expedición de la ley 100del 93, las entidades de salud, exactamente las entidades prestadora de servicio de salud y las empresas sociales del estado, comenzaron a tener una serie de inconvenientes en su columna financiera lo que llevo a que algunas llegaron, incluso a la quiebra. Debido a que ninguna de ellas estaba preparada para asumir el nuevo modelo de seguridad social, el cual las obligaba a facturar los servicio que ofrecía y de esa manera logran la sostenibilidad financiera. A partir del año 2000, la situación se vuelve un poco más compleja debido a la publicación por parte del gobierno nacional de la resolución 3374, la que obliga a los prestadores a implementar los RIPS (registro individual de prestación de servicio) que de una u otra forman van a todos a la facturación, lo que en sómbrese aún más el panorama financiero de estas instituciones. De otra parte, por ser un nuevo modelo de salud, no se había establecido instituciones ni mucho menos programa que desarrollaron personal capacitado para el manejo de las oficinas de facturación convirtiéndose esto en unos de los problemas más sensible del sistema de salud colombiano en ESE Hospital Nuestra Señora del Carmen a pesar de que es una institución relativamente nueva de estar funcionando o curre lo contrario, ya que se ve con notoria progresividad en la oferta y capacidad instalada un exhaustivo y manejo practico dentro del área de facturación , hemos observado que esa tiene varias dificultades que de no aplicar un adecuado plan de acción para disminuir las debilidades esta puede llegar a convertirse en obstáculo permanente para el crecimiento y sostenibilidad de la empresaPregradoAdministrador(a) en los Servicios de la Salu

Pure Androgen-Secreting Adrenal Adenoma Associated with Resistant Hypertension

Pure androgen-secreting adrenal adenoma is very rare, and its diagnosis remains a clinical challenge. Its association with resistant hypertension is uncommon and not well understood. We present an 18-year-old female with a 10-year history of hirsutism that was accidentally diagnosed with an adrenal mass during the evaluation of a hypertensive crisis. She had a long-standing history of hirsutism, clitorimegaly, deepening of the voice, and primary amenorrhea. She was phenotypically and socially a male. FSH, LH, prolactin, estradiol, 17-hydroxyprogesterone, and progesterone were normal. Total testosterone and DHEA-S were elevated. Cushing syndrome, primary aldosteronism, pheochromocytoma, and nonclassic congenital adrenal hyperplasia were ruled out. She underwent adrenalectomy and pathology reported an adenoma. At 2-month followup, hirsutism and virilizing symptoms clearly improved and blood pressure normalized without antihypertensive medications, current literature of this unusual illness and it association with hypertension is presented and discussed

Comparative Reduction of Egg Yolk Cholesterol Using Anionic Chelating Agents

Egg yolk is used as an emulsifying agent. Nevertheless, its high concentration of cholesterol is linked to chronic degenerative diseases that cause cardiovascular disease. In this study, three methods for reducing the level of cholesterol in egg yolks were studied. The first method consisted of physical separation of the granules contained in the yolk (NaG). The second method applied was the use of anionic chelating biopolymers, such as arabic gum solution (AG) and mesquite gum solution (MG), and the third method was extraction with a solvent (SA). For this purpose, the cholesterol present in egg yolks, the microstructure, particle size, zeta potential, and its emulsifying capacity were determined. The amount of cholesterol removed was 97.24% using 1% mesquite gum (MG1%), and 93.26% using 1% Arabic gum (AG1%). The zeta potential was determined, and the isoelectric point (&#950; = 0) of egg yolk was identified as pH 4.6. While, at this pH, the zeta potential of mesquite gum was &#8722;14.8 mV, the zeta potential for the arabic gum was &#8722;16 mV. The emulsifying capacity of MG1% was 62.95%, while the emulsifying capacity of AG1% was 63.57%. The complex obtained can be used in the development of functional foods reduced in cholesterol