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Alimentación y poder estructural en afromexicanos de la Costa Chica y Veracruz. Hacienda, ranchos, ejido, pueblos
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Saucedo-Arteaga, Gabriel J.

; Ruiz-Ríos, Élida Paola

; Ortiz-Gutiérrez, Salvador

; Flores-Macías, Alejandra

; Aguilar-Salinas, Carlos A.

Estudios sociales. Revista de alimentación contemporánea y desarrollo regional

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Jun 2023, Volume 33 Nº 61 elocation e231286

Resumo: Es En | Texto: Es En | PDF: Es | PDF: En

Resumen Objetivo: Analizar la alimentación habitual de los afromexicanos en el contexto de dos procesos históricos y el ejercicio regional de producción/poder. Metodología: Entrevistas y observación participante en dos regiones con historia de producción hacienda/ejido; referencias socioeconómicas, dieta de recordatorio de 24 horas, lactancia y alimentación complementaria. Resultados: Las listas de alimentos reflejan disponibilidad y biodiversidad, pero no acceso y consumo habitual. Quedaron identificados intersticios, espacios con mayor margen de libertad para la manifestación y desarrollo de una cultura alimentaria campesina. Limitaciones: La dieta de 24 horas fue de un día y el consumo fuera del hogar no fue considerado. Conclusiones: La condición sociohistórica de producción determina buena parte del sistema alimentario, con base en alimentos y técnicas reproducidos por la población indígena. Hay diferencias alimentarias regionales, sin embargo, en buena medida corresponde a la alimentación de las poblaciones campesinas. Los alimentos aportan suficiente energía/vitaminas y esta proviene principalmente del maíz, frijol, arroz y las verduras de color verde, blanca y roja.

Abstract Objective: To analyze the habitual food of Afro-Mexicans in the context of two historical processes and the regional exercise of production/power. Methodology: Interviews and participant observation in two regions with a history of hacienda/ejido production; socioeconomic references, 24-hour recall diet, breastfeeding, and complementary feeding. Results: The food lists reflect availability and biodiversity, but not access and habitual consumption. Interstices, spaces with a greater margin of freedom were identified for the manifestation and development of a peasant food culture. Limitations: The 24-hour diet was for one day and consumption outside home was not considered. Conclusions: The sociohistorical condition of production/power determines a major part of the food system, based on foods and techniques reproduced by the indigenous population. There are regional dietary differences, however, to a large extent it corresponds to the diet of rural populations. The food provides enough energy/vitamins, and this comes mainly from corn, beans, rice and green, white and red vegetables.

https://doi.org/10.24836/es.v33i61.1286

Validity and reliability of simple surrogate indexes to evaluate beta-cell function and insulin sensitivity
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Romo-Romo, Alonso

; Aguilar-Salinas, Carlos A.

; Gómez-Díaz, Rita A.

; Brito-Córdova, Griselda X.

; Gómez-Pérez, Francisco J.

; López-Carrasco, M. Guadalupe

; Almeda-Valdés, Paloma

Revista médica de Chile

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Nov 2022, Volume 150 Nº 11 Páginas 1458 - 1466

Resumo: Es En | Texto: Es En | PDF: Es | PDF: En

Antecedentes: Los índices simples subrogados (ISS) que evalúan la función de célula beta, sensibilidad a la insulina (SI) y resistencia a la insulina (RI) son herramientas sencillas y económicas que se usan en la práctica clínica para identificar alteraciones del metabolismo de la glucosa. Objetivo: Evaluar la validez y confiabilidad de ISS para estimar la función de célula beta, SI y RI usando como referencia los parámetros de la prueba de tolerancia a la glucosa intravenosa con muestreo frecuente (FSIVGTT). Material y Métodos: Se incluyeron 62 sujetos de 20-45 años, con índice de masa corporal normal y sin diabetes mellitus o prediabetes. Los ISS se compararon con la respuesta aguda de la insulina a la glucosa (AIRg), índice de sensibilidad a la insulina (Si) e índice de disposición (DI) obtenidos de la FSIVGTT en base al modelo mínimo. La mitad de los participantes (n = 31) se seleccionaron aleatoriamente para acudir dos semanas después y evaluar la confiabilidad de todas las variables. Resultados: HOMA1-%B y HOMA2-%B presentaron una correlación significativa con AIRg (Rho de Spearman (rs) = 0,33 and 0,37, respectivamente, p < 0,01). Los ISS para evaluar SI/RI que mostraron mayor correlación (rs > 0,50) con Si fueron insulina en ayuno, HOMA1-IR, HOMA2-IR, HOMA1-%S, HOMA2-%S, QUICKI y el índice de McAuley. Los parámetros que tuvieron buena confiabilidad (coeficiente de correlación intraclase > 0,75) fueron AIRg, HOMA1-%S, HOMA2-%S y QUICKI. Conclusiones: La mayoría de los ISS son instrumentos útiles y confiables.

ABSTRACT Background: Simple surrogate indexes (SSI) to assess beta-cell function, insulin sensitivity (IS) and insulin resistance (IR) are an easy and economic tool used in clinical practice to identify glucose metabolism disturbances. Aim: To evaluate the validity and reliability of SSI that estimate beta-cell function, IS and IR using as a reference the parameters obtained from the frequently sampled intravenous glucose tolerance test (FSIVGTT). Material and Methods: We included 62 subjects aged 20-45 years, with a normal body mass index and without diabetes or prediabetes. SSI were compared with the acute insulin response to glucose (AIRg), insulin sensitivity index (Si) and disposition index (DI) obtained from the FSIVGTT using the minimal model approach. Half of the participants (n = 31) were randomly selected for a second visit two weeks later to evaluate the reliability of all the variables. Results: HOMA1-%B and HOMA2-%B had a significant correlation with AIRg (Spearman Rho (rs) = 0.33 and 0.37 respectively, p < 0.01). The SSI evaluating IS/IR that showed stronger correlation (rs > 0.50) with Si were fasting insulin, HOMA1-IR, HOMA2-IR, HOMA1-%S, HOMA2-%S, QUICKI, and the McAuley index. The parameters that showed good reliability with an intraclass correlation coefficient (ICC) > 0.75 were AIRg, HOMA1-%S, HOMA2-%S, and QUICKI. Conclusions: Our results suggest that most of the SSI are useful and reliable.

Identification of Glucose and Insulin Patterns during A 5-H Glucose Tolerance Test and Association with Cardiometabolic Risk Factors
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Crespo-Morfin, Paulina B.

; Aguilar-Salinas, Carlos A.

; Almeda-Valdés, Paloma

; Alfaro-Pastrana, Raúl

; Bello-Chavolla, Omar Y.

; Cano-Castillo, Jhoana

; Gómez-Pérez, Francisco J.

; Cruz-Bautista, Ivette

Revista de investigación clínica

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Ago 2022, Volume 74 Nº 4 Páginas 193 - 201

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: Insulin resistance is key in the pathogenesis of the metabolic syndrome and cardiovascular disease. Objective: We aimed to identify glucose and insulin patterns after a 5-h oral glucose tolerance test (OGTT) in individuals without diabetes and to explore cardiometabolic risk factors, beta-cell function, and insulin sensitivity in each pattern. Methods: We analyzed the 5-h OGTT in a tertiary healthcare center. We identified classes using latent class trajectory analysis and evaluated their association with cardiometabolic risk factors, beta-cell function, and insulin sensitivity surrogates by multinomial logistic regression analysis. Results: We included 1088 5-h OGTT performed between 2013 and 2020 and identified four classes. Class one was associated with normal insulin sensitivity and secretion. Class two showed hyperglycemia, dysinsulinism, and a high-risk cardiometabolic profile (obesity, hypertriglyceridemia, and low high-density lipoprotein [HDL] cholesterol). Class three included older individuals, a higher proportion of males, and a greater prevalence of hypertension, hyperglycemia, hyperinsulinemia, and postprandial hypoglycemia. Finally, class four showed hyperglycemia, dysinsulinism, and hyperinsulinemia; this class had the worst cardiometabolic profile (a high proportion of males, greater age, hypertension, obesity, hypertriglyceridemia, and low HDL cholesterol, p < 0.001 vs. other classes). Conclusions: The latent class analysis approach allows the identification of groups with an adverse cardiometabolic risk factor, and who might benefit from frequent follow-ups and timely multidisciplinary interventions.

https://doi.org/10.24875/ric.22000039 17 downloads

Triglyceride-Rich Lipoproteins: Their Role in Atherosclerosis
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Castillo-Núñez, Yulino

; Morales-Villegas, Enrique

; Aguilar-Salinas, Carlos A.

Revista de investigación clínica

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Abr 2022, Volume 74 Nº 2 Páginas 61 - 70

Resumo: En | Texto: En | PDF: En

ABSTRACT The term “triglyceride-rich lipoproteins” (TRLs) includes chylomicrons and their remnants, very low-density lipoproteins (VLDL), and intermediate-density lipoproteins (IDL). In this manuscript, the mechanisms by which atherogenic TRLs contribute to the formation of atheroma plaques are reviewed. Cholesterol from TRLs that can be retained in the subendothelial space (i.e., remnants, IDLs, and small VLDLs) contributes to the genesis of atherosclerosis. Triglycerides of atherogenic TRLs induce inflammation of the arterial wall. Mechanisms that explain the involvement of TRLs in atherosclerosis are the generation of pro-atherogenic changes in high-density lipoproteins and low-density lipoproteins, accumulation of TRLs in plasma, and their passage to the subendothelial space where they cause endothelial dysfunction and inflammation of the vascular wall. Furthermore, plasma accumulation of TRLs causes hyperviscosity and a procoagulant state. Finally, this manuscript summarizes the controversial aspects of the clinical approach and the treatment of cases with dyslipidemia explained by atherogenic TRLs.

https://doi.org/10.24875/ric.21000416 44 downloads

Effect of Tocilizumab in Mortality among Patients with Severe and Critical Covid-19: Experience in a Third-Level Medical Center
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Martínez-Guerra, Bernardo A.

; de-León-Cividanes, Nereyda A.

; Tamez-Torres, Karla M.

; Román-Montes, Carla M.

; Rajme-López, Sandra

; Ortiz-Brizuela, Edgar

; Aguilar-Salinas, Carlos A.

; Sierra-Madero, Juan

; Sifuentes-Osornio, José

; Ponce-de-León, Alfredo

; González-Lara, María F.

Revista de investigación clínica

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Fev 2022, Volume 74 Nº 1 Páginas 40 - 50

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: Trials evaluating safety and efficacy of tocilizumab in coronavirus disease 19 (COVID-19) show contradictory results. Objective: The objective of the study was to evaluate the effect of tocilizumab in hospital mortality among patients with severe COVID-19 in a third-level medical center. Methods: This prospective cohort study included patients with severe and critical COVID-19. Primary outcome was death during hospitalization. Secondary outcomes included invasive mechanical ventilation (IMV), days on IMV, ventilator-free days (VFDs), length of hospital stay (LOS), and development of hospital-acquired infections (HAIs). Bivariate, multivariate, and propensity score matching analysis were performed. Results: During the study period, 99/794 (12%) patients received tocilizumab. Male patients, health care workers, and patients with increased inflammatory markers received tocilizumab more frequently. No difference in hospital mortality was observed between groups (34% vs. 34%, p = 0.98). Tocilizumab was not independently associated with mortality. No significant treatment effects were observed in propensity score analysis. IMV was more frequent (46% vs. 11%, p < 0.01) and LOS was longer (12 vs. 7 days, p < 0.01) in the tocilizumab group, reflecting increased severity. Although HAIs were more frequent in the tocilizumab group (22% vs. 10%, p < 0.01), no difference was seen after adjusting for IMV (38% vs. 40%, p = 0.86). Conclusions: In our study, tocilizumab was not associated with decreased hospital mortality among patients with severe COVID-19.

https://doi.org/10.24875/ric.21000404 27 downloads

Guía de práctica clínica mexicana para el diagnóstico y tratamiento de las dislipidemias y enfermedad cardiovascular aterosclerótica
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Pavía-López, Abel A.

; Alcocer-Gamba, Marco A.

; Ruiz-Gastelum, Edith D.

; Mayorga-Butrón, José L.

; Mehta, Roopa

; Díaz-Aragón, Filiberto A.

; Aldrete-Velasco, Jorge A.

; López-Juárez, Nitzia

; Cruz-Bautista, Ivette

; Chávez-Mendoza, Adolfo

; Secchi-Nicolás, Nikos C.

; Guerrero-Martínez, Francisco J.

; Cossio-Aranda, Jorge E.

; Mendoza-Zubieta, Victoria

; Fanghänel-Salmon, Guillermo

; Valdivia-Proa, Martha

; Olmos-Domínguez, Luis

; Aguilar-Salinas, Carlos A.

; Dávila-Maldonado, Luis

; Vázquez-Rangel, Armando

; Pavia-Aubry, Vanina

; Nava-Hernández, María de los A.

; Hinojosa-Becerril, Carlos A.

; Anda-Garay, Juan C.

; Ríos-Ibarra, Manuel O. de los

; Berni-Betancourt, Ana C.

; López-Cuellar, Julio

; Araiza-Garaygordobil, Diego

; Rivera-Reyes, Romina

; Borrayo-Sánchez, Gabriela

; Tapia-Hernández, Mónica

; Cano-Nigenda, Claudia V.

; Guerra-López, Arturo

; Elías-López, Josué

; Figueroa-Morales, Marco A.

; Montaño-Velázquez, Bertha B.

; Velasco-Hidalgo, Liliana

; Rodríguez-Lozano, Ana L.

; Pimentel-Hernández, Claudia

; Baquero-Hoyos, María M.

; Romero-Moreno, Felipe

; Rodríguez-Vega, Mario

Archivos de cardiología de México

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2022, Volume 92 Supl. 1 Páginas 1 - 62

Resumo: Es En | Texto: Es En | PDF: Es | PDF: En

resumen está disponible en el texto completo

Abstract Background: Cardiovascular diseases are the leading cause of mortality worldwide and Mexico is no exception. The epidemiological data obtained in 1990 showed that cardiovascular diseases represented 19.8% of all causes of death in our country. This figure increased significantly to 25.5% for 2015. Some national surveys suggest that more than 60% of the adult population has at least one risk factor for cardiovascular disease (obesity or overweight, hypertension, smoking, diabetes, dyslipidemias). On the other hand, data from the Pan American Health Organization have linked the process of atherosclerosis as the first cause of premature death, significantly reducing life expectancy, which has enormous social repercussions. Objective: This document constitutes the Clinical Practice Guide (CPG) prepared at the initiative of the Mexican Society of Cardiology in collaboration with the Mexican Society of Nutrition and Endocrinology, AC, National Association of Cardiologists of Mexico, AC, Mexican Association for the Prevention of Atherosclerosis and its Complications, AC, National Normative Committee of General Medicine, AC, National College of Geriatric Medicine, AC, College of Internal Medicine of Mexico, AC, Mexican Society of Angiology and Vascular and Endovenous Surgery, AC, Mexican Institute of Research Nephrological, AC and the Mexican Academy of Neurology, A.C.; with the methodological support of the Ibero-American Agency for the Development and Evaluation of Health Technologies, in order to establish recommendations based on the best available evidence and agreed upon by an interdisciplinary group of experts. The objective of this document is to provide evidence-based recommendations to help decision makers in the diagnosis and treatment of dyslipidemias in our country. Material and methods: This document complies with international quality standards, such as those described by the Institute of Medicine of the USA, the Institute of Clinical Excellence of Great Britain, the Scottish Intercollegiate Guideline Network and the Guidelines International Network. A multidisciplinary group of clinical experts and methodologists with experience in systematic reviews of the literature and the development of clinical practice guidelines was formed. A scope document was agreed upon, relevant clinical questions were established, the best available evidence critically evaluated in systematic literature reviews was exhaustively identified, and clinical recommendations were developed. The modified Delphi Panel methodology was used to achieve an adequate level of consensus in each of the recommendations contained in this CPG. Results: 23 clinical questions were agreed upon which gave rise to their respective clinical recommendations. Conclusions: We consider that this document contributes to better clinical decision-making and becomes a point of reference for clinicians and patients in the management of dyslipidemias and this contributes to reducing the morbidity and mortality derived from atherosclerotic cardiovascular events in our country.

https://doi.org/10.24875/acm.m22000081 1458 downloads

Guía de práctica clínica para el diagnóstico y el tratamiento de la otitis media aguda en niños
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Mayorga-Butrón, José L.

; Torre-González, Carlos de la

; Boronat-Echeverría, Nuria

; Aguirre-Mariscal, Héctor

; Montaño-Velázquez, Bertha B.

; Figueroa-Morales, Marco A.

; Aguilar-Gómez, Nancy E.

; Flores-Ruiz, Eric M.

; Solórzano-Santos, Fortino

; Gómez-Barreto, Demóstenes

; Moreno-Espinosa, Sarbelio

; González-Zamora, José F.

; Arredondo-García, José L.

; Xóchihua-Díaz, Luis

; Hernández-Porras, Marte

; Chavolla-Magaña, Rogelio

; Sánchez-Reyes, Blas

; Rodríguez-Carrasco, Carlos A.

; Greenawalt-Rodríguez, Sydney

; Cristerna-Tarrasa, Hernán

; Olvera-Salinas, Jorge

; Ávila-Iglesias, María C.

; Tinajero-Iriarte, Mónica G.

; Ramos-Zúñiga, José A.

; Montes-Narváez, Gabriel

Boletín médico del Hospital Infantil de México

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2022, Volume 79 Supl. 1 Páginas 1 - 31

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract Background: Acute otitis media (AOM) is one of the most prevalent acute conditions in the pediatric population worldwide. This work aimed to elaborate a Clinical Practice Guideline with clinical recommendations systematically developed to assist decision-making of specialists, patients, caregivers, and public policymakers involved in managing patients with AOM in children. Methods: This document was developed by the College of Pediatric Otorhinolaryngology and Head, and Neck Surgery of Mexico (COPEME) in compliance with international standards. The SIGN quality of evidence classification was used. On behalf of the COPEME, the Guideline Development Group (GDG) was integrated, including otolaryngologists, infectologists, pediatricians, general practitioners, and methodologists with experience in systematic literature reviews and the development of clinical practice guidelines. Results: A consensus was reached on 18 clinical questions, covering what was previously established by the GDG in the scope document of the guidelines. Scientific evidence answering each of these clinical questions was identified and critically evaluated. The GDG agreed on the final wording of the clinical recommendations using the modified Delphi panel technique. Specialists and patient representatives conducted an external validation. Conclusions: This Clinical Practice Guideline presents clinical recommendations for the prevention, diagnosis, and management of AOM to assist shared decision-making among physicians, patients, and caregivers and improve the quality of clinical care.

Resumen Introducción: La otitis media aguda (OMA) es uno de los padecimientos agudos más prevalentes en la población pediátrica a escala global. El objetivo de este trabajo fue elaborar una guía de práctica clínica con recomendaciones para asistir la toma de decisiones de médicos especialistas, pacientes, cuidadores de pacientes y elaboradores de políticas públicas involucrados en el manejo de la OMA en niños. Métodos: El documento ha sido desarrollado por parte del Colegio de Otorrinolaringología y Cirugía de Cabeza y Cuello Pediátricas de México (COPEME) en cumplimiento con los estándares internacionales. Se empleó la clasificación de calidad de la evidencia de SIGN. En representación del COPEME, se integró el Grupo de Desarrollo de la Guía (GDG), que incluyó otorrinolaringólogos, infectólogos, pediatras, médicos generales y metodólogos con experiencia en revisiones sistemáticas de la literatura y el desarrollo de guías de práctica clínica. Resultados: Se consensuaron 18 preguntas clínicas que abarcaron lo establecido previamente por el GDG en el documento de alcances de la Guía. Se identificó la evidencia científica que responde a cada una de estas preguntas clínicas y se evaluó críticamente. El GDG acordó la redacción final de las recomendaciones clínicas mediante la técnica Delphi de panel. Se llevó a cabo una validación externa por colegas especialistas y representantes de pacientes. Conclusiones: En esta Guía de Práctica Clínica se presentan recomendaciones clínicas para la prevención, el diagnóstico y el manejo de la OMA, con el fin de asistir la toma de decisiones compartidas entre médicos, pacientes y cuidadores con la intención de contribuir a mejorar la calidad de la atención clínica.

https://doi.org/10.24875/bmhim.21000168

La asociación entre la resistencia a la insulina y la rigidez arterial en pacientes mexicanos sin diabetes mellitus tipo 2
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Mehta, Roopa

; Antonio-Villa, Neftali E.

; Bello-Chavolla, Omar Y.

; Martagón, Alexandro J.

; Elias-López, Daniel

; Vargas-Vàzquez, Arsenio

; Gómez-Velasco, Donaji V.

; Almeda-Valdés, Paloma

; Muñoz-Hernández, Liliana

; Cruz-Bautista, Ivette

; Aguilar-Salinas, Carlos A.

Gaceta médica de México

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Out 2021, Volume 157 Nº 5 Páginas 539 - 547

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract Introduction: Central aortic arterial stiffness (CAAS) is an independent cardiovascular risk factor. Insulin resistance (IR) contributes to CAAS-associated risk. Objective: To evaluate the association between IR and CAAS in a Mexican population without diabetes. Methods: IR was estimated with Homeostatic Model Assessment 2-Insulin Resistance (HOMA2-IR) and other surrogate markers (Metabolic score for IR [METS-IR], Quantitative Insulin Sensitivity Check Index [QUICKI], triglycerides/glucose index [TyG], TyG*body mass index [TyG*BMI] and triglycerides/high-density lipoprotein cholesterol ratio [TG/HDL-C]). CAAS was evaluated using carotid-femoral pulse wave velocity analysis (PWVcf) and the standardized augmentation index (AI-75). Bivariate correlations were made between surrogate markers and PWVcf. Increased CAAS was defined as PWVcf above the 90th percentile. Thresholds and area under the curve (AUC) were obtained for each surrogate marker in order evaluate their performance in estimating increased CAAS. Results: Three hundred and fifty-eight patients were included. A correlation was found between HOMA2-IR and PWVcf; this correlation was replicated with other surrogate markers. METS-IR and TyG*IMC had the highest degree correlation with PWVcf. When adjustments were made for covariables, the correlations with TyG*IMC, METS-IR, HOMA2-IR and QUICKI maintained significance. HOMA2-IR showed the strongest correlation with AI-75. METS-IR and TyG showed the best AUC. Patients with prediabetes had the highest PWVcf. Conclusions: The relationship between IR and CAAS is present before the onset of diabetes; this association may entail higher cardiovascular risk.

Resumen Antecedentes: La rigidez arterial central aórtica (RACA) es un factor de riesgo cardiovascular independiente. La resistencia a la insulina (RI) contribuye al riesgo asociado a RACA. Objetivo: Evaluar la asociación entre RI y RACA en una población mexicana sin diabetes. Métodos: La RI se estimó con HOMA2-IR y (Homeostatic Model Assessment 2-Insulin Resistance) otros subrogados (METS-IR [Metabolic score for IR], QUICKI [Quantitative Insulin Sensitivity Check Index], TyG [ratio triglicéridos/glucosa], TyG*IMC [TyG*índice de masa corporal] y TG/HDL [ratio TG/lipoproteínas de alta densidad]). Se evaluó la RACA mediante el análisis de velocidad de onda del pulso carotídeo-femoral (VOPcf) y el índice de aumentación estandarizado (AI-75). Se realizaron correlaciones bivariante entre los subrogados y la VOPcf. RACA aumentada se definió como VOPcf arriba del percentil 90. Se obtuvieron puntos de corte y área bajo la curva (ABC) para cada subrogado para estimar RACA aumentada. Resultados: Se incluyó 358 pacientes. Se encontró una correlación entre HOMA2-IR y VOPcf; esta correlación se replicó con los subrogados. METS-IR y TyG*IMC tuvieron el mayor grado de correlación con VOPcf. Al ajustar, las correlaciones con TyG*IMC, METS-IR, HOMA2-IR y QUICKI mantuvieron significancia. La correlación con AI-75 fue mayor para HOMA2-IR. METS-IR y TyG mostraron la mejor ABC. Los pacientes con prediabetes tuvieron mayor VOPcf. Conclusiones: La relación entre la RI y la RACA está presente desde etapas no diabéticas; esta asociación puede conllevar mayor riesgo cardiovascular.

https://doi.org/10.24875/gmm.21000177 44 downloads

Precision Medicine for Metabolic Disorders in Low - and Middle - Income Countries: Areas of Opportunity and Challenges for the Future
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Tusié-Luna, María T.

; Aguilar-Salinas, Carlos A.

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Out 2021, Volume 73 Nº 5 Páginas 316 - 320

Resumo: En | Texto: En | PDF: En

The purpose of this perspective is to analyze the use of precision medicine and its potential for the next few decades with a special focus on the low- and middle-income countries, using diabetes as a paradigm. Precision medicine has improved the diagnosis, prevention, treatment, and prognosis of several malignant neoplasia. Furthermore, this approach is useful in the management of monogenic diabetes. However, its impact in the current practice for the majority of the cases of diabetes is quite limited. Precision medicine has not fulfilled the expectations because it implies a long-term process composed by several feedback loops, and a number of internal and external validations and calibrations to target specific populations. If we want to obtain the expected benefits, the academic community and science agencies should work together to create the budgets and infrastructure that warrant the transfer of knowledge to the whole of society.

https://doi.org/10.24875/ric.21000344 8 downloads

10.

Bioethics in Medical Care Rationing During the Coronavirus Disease-19 Pandemic
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González-Duarte, Alejandra

; Kaufer-Horwitz, Martha

; Gamba, Gerardo

; Rivera-Moscoso, Raúl

; Aguilar-Salinas, Carlos A.

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Fev 2021, Volume 73 Nº 1 Páginas 1 - 5

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ABSTRACT Background: Coronavirus (CoV) disease (COVID)-19 poses difficult situations in which the ethical course of action is not clear, or choices are made between equally unacceptable responses. Methods: A web search was performed using the terms “bioethics; COVID-19; ethics; severe acute respiratory syndrome CoV-2; emergent care; pandemic; and public health emergencies.” Results: Protection from COVID-19 has resulted in the cancellation of necessary medical interventions, lengthened suffering, and potential non-COVID-19 deaths. Prolonged lockdown reduced well-being, triggering or aggravating mental illnesses and violence, and escalated medical risks. Collateral damage includes restrictions on visitations to hospitals, alienation from the deceased relative, or lack of warm caring of patients. Finally, in a public health crisis, public health interest overrides individual rights if it results in severe harm to the community. Conclusion: Balancing ethical dilemmas are one more challenge in the COVID-19 pandemic. (REV INVEST CLIN. 2021;73(1):1-5)

https://doi.org/10.24875/ric.20000385 258 downloads

11.

Bioethics in the COVID-19 Pandemic Research: Challenges and Strategies
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González-Duarte, Alejandra

; Kaufer-Horwitz, Martha

; Aguilar-Salinas, Carlos A.

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Out 2020, Volume 72 Nº 5 Páginas 265 - 270

Resumo: En | Texto: En | PDF: En

As all other aspects in times of the coronavirus disease (COVID)-19 pandemic, carrying-out quality clinical research has been challenging. Many well-established paradigms have shifted as a consequence of the rapid demand for new knowledge. New treatments are fast-moving, informed consent forms are difficult to obtain, a competitive invitation from researchers to participate in different studies is common, and non-COVID-19 research protocols are suffering continuity. However, these challenges should not imply taking shortcuts or accepting deficiencies in bioethical standards, but rather enhance the alertness for rigorous ethical approaches despite these less than ideal circumstances. In this manuscript, we point out some interrogates in COVID-19 research and outline possible strategies to overcome the difficult task to continue with high-quality research without violating the ethical principles. (REV INVEST CLIN. 2020;72(5):265-70)

https://doi.org/10.24875/ric.20000258 343 downloads

12.

Universal Masking during COVID-19 Pandemic – Current Evidence and Controversies
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Quintana-Díaz, Mariana A.

; Aguilar-Salinas, Carlos A.

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Jun 2020, Volume 72 Nº 3 Páginas 144 - 150

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ABSTRACT The emergence of coronavirus disease 19 pandemic and novel research on the high transmissibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised controversies over the use of face masks to prevent community transmission. Specific regulations need to be fulfilled to use a face mask as part of the personal protective equipment and high quality of evidence supporting its use to prevent respiratory viral infections, including SARS-CoV-2, is lacking. However, its widespread use is becoming a standard practice in some countries and discrepancies between health authorities on their policy have led to controversy. The aim of this review is to provide an outlook on recent research in this matter and areas of opportunity.

https://doi.org/10.24875/ric.20000196 314 downloads

13.

Factors Influencing Achievement of Low-Density Lipoprotein Cholesterol Goals in Mexico: the International Cholesterol Management Practice Study
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Bello-Chavolla, Omar Y.

; Aguilar-Salinas, Carlos A.

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Dez 2019, Volume 71 Nº 6 Páginas 408 - 416

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ABSTRACT Background The International Cholesterol Management Practice Study is a multinational collaborative effort to describe the effectiveness of the lipid-lowering therapy (LLT) as well as the main barriers to achieve the low-density lipoprotein cholesterol (LDL-C) goals Objective The objective of the study was to investigate factors associated with the achievement of LDL-C goals in Mexico using real-life data Methods This was a cross-sectional observational study from 18 physicians across different health facilities in Mexico, who provided information about their practices between August 2015 and August 2016. We included patients treated for ≥3 months with any LLT in whom LDL-C measurement on stable LLT was available for the previous 12 months Results We included 623 patients with a mean age of 59.3 ± 12.7 years; 55.6% were women. The mean LDL-C value on LLT was 141.8 ± 56.1 mg/dL. At enrollment, 97.4% of patients were receiving statin therapy (11.3% on high-intensity treatment). Only 24.8% of the very-high cardiovascular (CV) risk patients versus 26.4% of the high risk and 52.4% of the moderate risk patients achieved their LDL-C goals. Independent factors associated with non-achievement of LDL-C goal were statin intolerance, overweight and obesity, abdominal obesity, female sex, high CV risk, use of public health-care service, metabolic syndrome, type 2 diabetes, and hypertriglyceridemia. Higher-level of education was associated with a lower risk of not achieving LDL-C goals Conclusions Achievement of LDL-C goals is suboptimal in Mexico, especially in patients with the highest CV risk. The main barriers to achieve the goal are easily detectable. Implementation of LLT should be adapted to the patient’s needs and profile.

https://doi.org/10.24875/ric.19003156 68 downloads

14.

III. The role of the Research Ethics Committees in the regulation of Pharma-Sponsored studies
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Aguilar-Salinas, Carlos A.

; Pascual-Ramos, Virginia

; Sierra-Madero, Juan G.

; Loria-Acereto, Alvar

; Zambrano-González, Elena

; Kaufer-Horwitz, Martha

; González-Duarte, Alejandra

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Out 2019, Volume 71 Nº 5 Páginas 297 - 305

Resumo: En | Texto: En | PDF: En

Participants of Pharma-sponsored research are exposed to risks, benefits, and uncertainties that do not occur in other forms of clinical studies. Ethics committees represent the subjects’ first line of protection. This responsibility begins with the study review and ends after all study subjects finish the intervention. The objective of this paper is to review the most common controversial issues found in Pharma-sponsored studies. Potential solutions are proposed to prevent or resolve the polemical aspects. However, different challenges will be faced in the near future (e.g., when new therapies reach their late stage of development). All parties involved in research should work together to guarantee the protection of participants, the paramount principle on which clinical investigation is based. Pharma-sponsored research is a crucial driver to develop and implement innovative approaches to improve the informed consent process and the execution of the studies.

https://doi.org/10.24875/ric.19002944 76 downloads

15.

II. The Research Ethics Involving Vulnerable Groups
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González-Duarte, Alejandra

; Zambrano-González, Elena

; Medina-Franco, Heriberto

; Alberú-Gómez, Josefina

; Durand-Carbajal, Marta

; Hinojosa, Carlos A.

; Aguilar-Salinas, Carlos A.

; Kaufer-Horwitz, Martha

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Ago 2019, Volume 71 Nº 4 Páginas 217 - 225

Resumo: En | Texto: En | PDF: En

Abstract Vulnerability in research occurs when the participant is incapable of protecting his or her interests and therefore, has an increased probability of being intentionally or unintentionally harmed. This manuscript aims to discuss the conditions that make a group vulnerable and the tools and requirements that can be used to reduce the ethical breaches when including them in research protocols. The vulnerability can be due either to an inability to understand and give informed consent or to unequal power relationships that hinder basic rights. Excluding subjects from research for the only reason of belonging to a vulnerable group is unethical and will bias the results of the investigation. To consider a subject or group as vulnerable depends on the context, and the investigator should evaluate each case individually.

https://doi.org/10.24875/ric.19002812 544 downloads

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