Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients.

BACKGROUND: The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. METHODS: An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. RESULTS: A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52-4.17), fever OR 2.98 (95% CI; 2.47-3.58), dyspnea OR 2.9 (95% CI; 2.39-3.51]) and cough OR 2.73 (95% CI: 2.27-3.28). CONCLUSION: The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. TRIAL REGISTRATION: Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082 .

[Actualidades en la inmunopatología de la esclerosis múltiple].

Multiple sclerosis is a demyelinating inflammatory disease that affects the central nervous system. Its etiology is the result of a complex interaction between genetic and environmental factors that trigger a deregulated immune response, with the resulting inflammation and neuronal/axonal degeneration. Neuroinflammation is triggered when peripheral leukocytes migrate to the central nervous system and release cytokines such as interleukins 1 and 6 (IL-1 and 6) and tumor necrosis factor (TNF), which act on dwelling cells. The innate immune system plays an important role in the onset and progression of the disease by identifying molecular patterns associated with pathogens and damage, which modulate effector and regulatory functions of the cells where they are expressed, in order to direct the specific immune response. Th17 cells favor the disruption of the blood-brain barrier, which enables the migration of leukocytes to the central nervous system and the triggering of the inflammatory cascade; the Th1 profile (IL-1, IL-6) collaborates to perpetuate it. B-cell function is to produce antibodies and cytokines (IL-6, IL-12 and TFN). Knowledge on multiple sclerosis pathophysiology will enable the development of new therapeutic options that impact on natural history of the disease and its prognosis.

La esclerosis múltiple es una enfermedad inflamatoria desmielinizante que afecta el sistema nervioso central. Su etiología es el resultado de una compleja interacción entre factores genéticos y ambientales que desencadenan una respuesta inmune desregulada, con la consiguiente inflamación y degeneración neuronal/axonal. La neuroinflamación se desencadena cuando los leucocitos periféricos migran al sistema nervioso central y liberan citocinas como interleucinas 1 y 6 (IL-1, IL-6) y factor de necrosis tumoral (TNF), que actúan sobre células residentes del mismo. El sistema inmune innato desempeña un papel importante en el inicio y progresión de la enfermedad, mediante la identificación de patrones moleculares asociados con patógenos y daño, que modulan las funciones efectoras y reguladoras de las células donde se expresan, para dirigir la respuesta inmune específica. Las células Th17 favorecen la disrupción de la barrera hematoencefálica, que permite la migración de leucocitos al sistema nervioso central y desencadena la cascada de la inflamación; el perfil Th1 (IL-1, IL-6) colabora para perpetuarla. La función de las células B es la producción de anticuerpos y citocinas (IL-6, IL-12 y TFN). Conocer la fisiopatología de la esclerosis múltiple permitirá desarrollar nuevas opciones terapéuticas que impacten en la historia natural de la enfermedad y su pronóstico.

Maintaining innovation: How to make sewer robots and innovation policy work in Barcelona.

This article explores how innovation logics infiltrate problem and value definitions in maintenance and repair, and how innovation itself depends on considerable, often invisible care work beyond the seemingly smooth entrepreneurial narratives. We build on a growing body of work in STS that investigates the relationship between innovation and maintenance and repair. This literature argues that the obsession with innovation crowds out attention to maintenance, that innovation creates future obligations of maintenance that are often not factored into technological promises, and that ordinary maintenance and repair practices are often innovative in their own right. Empirically, we explore a case where maintenance and repair become the explicit target of high-level, high-tech innovation initiatives and how, as a result, innovation logics colonize maintenance practices. Conceptually, we explore how repair and maintenance sensitivities can be applied to innovation practices to reveal the invisible work needed to align innovation instruments with socio-material and institutional configurations. Drawing on an in-depth case study of sewer inspection robots in Barcelona, we find that attempts to innovate maintenance require a symmetric effort to maintain innovation. In our case study, innovation processes as deployed by the European Commission, research consortia, and companies required substantial repair work to function reliably in specific settings. Our study shows how divergent understandings of the public good in innovation and maintenance contexts may lead to significant tensions, and that much can be gained analytically from not treating innovation and maintenance as opposites.

Assessment of psychological terror and its impact on mental health and quality of life in medical residents at a reference medical center in Mexico: A cross-sectional study.

BACKGROUND: Mobbing, particularly in medical residencies, can lead to psychological terror with lasting mental and physical health consequences. Its impact on Mexican residents, however, remains underexplored. AIM: This study aimed to investigate the prevalence and associated factors of psychological terror among medical residents at a medical center in Mexico City. METHODS: In a cross-sectional study, medical residents from various specialties were assessed for mobbing domains, quality of life, and anxiety/depression using the Leymann Inventory of Psychological Terror (LIPT), 36-Item Short Form Health Survey, Beck Depression Inventory-II, and Beck Anxiety Inventory, respectively. Psychological terror was defined as a LIPT score ≥ p80. Linear and binomial logistic regression models were used to explore independent predictors of mobbing and psychological terror. RESULTS: Of the 349 participants included (median age: 28; IQR: 27-30 years), 19.5% (95% CI: 15.5%-24.0%) were identified with psychological terror. Furthermore, 39% reported higher-degree trainees as mobbing perpetrators. Women in surgical residencies in their second or fifth year were found to experience higher levels of mobbing. Manifested bullying, workplace stigma, and inappropriate tasks were the most impacted mobbing domains. Anxiety, diminished mental health quality of life, and higher degree of medical specialization were independent predictors of mobbing. Meanwhile, increased anxiety, affiliation to surgical specialties, and being in the second or fifth year of training were identified as predictors of psychological terror. CONCLUSIONS: Mobbing and psychological terror are prevalent conditions among medical residents in Mexico. Identification of occupational conditions and adverse psychological stressors can help to improve quality of life and training of medical residents.

[Anti-SARS-CoV-2 seroprevalence in administrative staff of the Mexican Institute for Social Security]. / Seroprevalencia anti-SARS-CoV-2 en personal administrativo del Instituto Mexicano del Seguro Social.

Background: Asymptomatic subjects, the lack of diagnostic tests and, in countries like Mexico, the epidemiological surveillance method does not allow to establish the real number of infections in the COVID-19 pandemic. Frontline health personnel, as well as other groups related to priority activities are considered of high risk. We included administrative workers in contact with health personnel in the hospital units of the Mexican Institute for Social Security (IMSS, according to its initials in Spanish). Objective: To identify the seroprevalence of antibodies to SARS-CoV-2 in IMSS' administrative staff who does not treat patients. Material and methods: 76 volunteer participating individuals were incluided; IgG antibodies against the SARS-CoV-2 nucleoprotein were measured. A questionnaire was administered to the participants in order to identify possible risk factors. Results: 76 participants were included (39 men, 51.7%), with a median age of 42 years. 29 out of 76 subjects (38.2%), whose median age was 38 years (range 18-69 years); 15 men (51.7%), and 14 women (48.3%). A higher percentage of positive subjects under 45 years of age (n = 20, 84.2%) was observed than those aged 45 or over (n = 9, 25%), with an OR of 3 (95% CI 1.13-7.96, p = 0.03). No statistically significant difference was found regarding the type of comorbidity. Conclusions: The prevalence identified shows an important circulation of the virus in the administrative staff.

Introducción: los sujetos asintomáticos, la falta de pruebas diagnósticas y, en países como México, el método de vigilancia epidemiológica no permiten establecer el número real de contagios en la pandemia de COVID-19. El personal de salud de primera línea y otros grupos con actividades prioritarias son de alto riesgo. Se incluyeron trabajadores administrativos en contacto con personal de salud en las unidades hospitalarias del Instituto Mexicano del Seguro Social (IMSS). Objetivo: identificar la seroprevalencia de anticuerpos contra SARS-CoV-2 en personal administrativo del IMSS que no atiende a enfermos. Material y métodos: se incluyeron 76 individuos a los cuales se les midieron los anticuerpos IgG contra la nucleoproteína del SARS-CoV-2. También se les aplicó un cuestionario para identificar factores de riesgo. Resultados: se incluyeron 76 participantes (39 hombres, 51.7%), con una mediana de 42 años de edad. Fueron positivos 29 de 76 sujetos (38.2%), cuya mediana de edad fue de 38 años (rango 18-69 años); 15 hombres y 14 mujeres. Hubo mayor porcentaje de sujetos positivos menores de 45 años (n = 20, 84.2%) que aquellos de edad ≥ 45 años (n = 9, 25%), con una RM de 3 (IC 95% 1.13-7.96, p = 0.03). No hubo diferencia estadísticamente significativa respecto al tipo de comorbilidad. Conclusiones: la prevalencia identificada muestra una circulación importante del virus en el personal administrativo.

Risk Factors Associated with Mortality among Patients with COVID-19: Analysis of a Cohort of 1213 Patients in a Tertiary Healthcare Center.

The presence of cardio-metabolic and respiratory comorbidities, immunosuppression, and chronic kidney disease have been associated with an increase in mortality from COVID-19. The objective of this study is to establish the risk factors associated with 30-day mortality in a cohort of hospitalized patients with COVID-19. This paper conducts a retrospective and analytical study of patients hospitalized for COVID-19 in a tertiary care center. A Cox proportional hazard analysis was performed to estimate the association of comorbidities with 30-day mortality. A total of 1215 patients with a median age of 59 years were included. In the adjusted Cox proportional hazards regression model, hypothyroidism, D-dimer ≥ 0.8 µg/mL, LHD ≥ 430 IU/L, CRP ≥ 4.83 ng/mL, and triglycerides ≥ 214 mg/dL were associated with an increased risk of death. The presence of a history of hypothyroidism and biomarkers (D-dimer, lactic dehydrogenase, CRP, and triglycerides) were associated with an increase in mortality in the studied cohort.

[Neurological manifestations in patients with severe COVID-19 in a tertiary care center]. / Manifestaciones neurológicas en pacientes con COVID-19 severo en un centro de tercer nivel de atención.

Background: The SARS-CoV-2 disease, called COVID-19, emerged in China has acquired pandemic dimensions. According to the WHO situational report of March 15, 2021, the global fatality rate is 2.2%; in Mexico, around 194 944 deaths have been confirmed by COVID-19. Studies in China identified that patients with severe COVID-19, when compared with those who had non-severe COVID-19, presented more severe neurological manifestations. Objective: To determine the frequency of neurological symptoms and manifestations in patients with severe COVID-19 in a tertiary care center. Material and methods: A cross-sectional, observational and analytical study was carried out at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI, in patients hospitalized with severe COVID-19. Results: 183 cases were analyzed, of which 130 were men (71%). The median age was 55 years (IQR: 44-65). The neurological symptoms were: headache, anosmia and dysgeusia. Neurological manifestations occurred in 27 patients (16%), the most frequent was ischemic-type cerebrovascular disease (CVD) in 12 (44%), in patients older than 76.5 years vs. 54 years (p = 0.000), with history of cardiovascular disease. Conclusions: The most frequent neurological symptoms were headache, anosmia and dysgeusia. The most frequent neurological manifestation was ischemic CVD that appeared in older patients with severe COVID-19 with a history of cardiovascular disease.

Introducción: la enfermedad por SARS-CoV-2 denominada COVID-19 originada en China adquirió dimensiones pandémicas. De acuerdo con el reporte situacional de la OMS al 15 de marzo de 2021, la tasa de letalidad global es del 2.2%; en México se han confirmado alrededor de 194 944 defunciones por COVID-19. Estudios en China identificaron que los pacientes con COVID-19 severo, al compararlos con aquellos que cursaron con COVID-19 no severo, presentaron manifestaciones neurológicas más graves. Objetivo: determinar la frecuencia de síntomas y manifestaciones neurológicas en pacientes con COVID-19 severo en un centro de tercer nivel de atención. Material y métodos: estudio transversal, observacional y analítico, llevado a cabo en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI, en pacientes hospitalizados con COVID-19 severo. Resultados: se analizaron 183 casos, de los cuales 130 eran hombres (71%). La mediana de edad fue de 55 años (RIC: 44-65). Los síntomas neurológicos fueron: cefalea, anosmia y disgeusia. Las manifestaciones neurológicas se presentaron en 27 pacientes, la más frecuente fue la enfermedad vascular cerebral tipo isquémica (EVC) en 12 pacientes (44%) en pacientes con mayor edad, 76.5 frente a 54 años (p = 0.000), y con antecedente de enfermedad cardiovascular. Conclusiones: los síntomas neurológicos más frecuentes fueron cefalea, anosmia y disgeusia. La manifestación neurológica más frecuente fue la EVC isquémica que se presentó en pacientes con COVID-19 severo de mayor edad y con antecedente de enfermedad cardiovascular.

[The neurology of COVID-19]. / La neurología de COVID-19.

The clinical manifestations of COVID-19 are reminiscent of those of acute respiratory distress syndrome induced by cytokine release syndrome and secondary hemophagocytic lymphohistiocytosis that is observed in patients with other coronaviruses such as SARS-CoV and MERS-CoV. Neurologists face the challenge of assessing patients with pre-existing neurological diseases who have contracted SARS-CoV-2, patients with COVID-19 who present neurological emergencies, and patients who are carriers of the virus and have developed secondary neurological complications, either during the course of the disease or after it. Some authors and recent literature reports suggest that the presence of neurological manifestations in patients who are carriers of SARS-CoV-2 may be associated with a greater severity of the disease.

Las manifestaciones clínicas de COVID-19 recuerdan las del síndrome de insuficiencia respiratoria aguda inducido por el síndrome de liberación de citocinas y la linfohistiocitosis hemofagocitica observada en pacientes con otros coronavirus como SARS-CoV y MERS-CoV. Los neurólogos tienen el reto de evaluar pacientes con enfermedades neurológicas preexistentes que contraen SARS-CoV-2, pacientes con COVID-19 que presentan emergencias neurológicas y pacientes portadores del virus que desarrollan complicaciones neurológicas secundarias, durante el curso de la enfermedad o posterior a la misma. Algunos autores y reportes en la literatura recientes sugieren que las manifestaciones neurológicas en pacientes portadores de SARS-CoV-2 pueden asociarse con mayor gravedad de la enfermedad.

Biochemical Characteristics of Bone Mineral Metabolism before and throughout the First Year after Kidney Transplantation, Persistent Hyperparathyroidism, and Risk Factors in a Latin Population.

Bone mineral metabolism disease, which included persistent hyperparathyroidism, is common after successful kidney transplantation (KT) and is related with negative outcomes in kidney transplant recipients. There is a lack of information about bone mineral metabolism, persistent hyperparathyroidism, and its risk factors in Latin kidney transplant recipients (KTRs). Material and Methods: A retrospective study was conducted in 74 patients aged 18-50 years with evolution of 12 months after KT and estimated glomerular filtration rate (eGFR) >60 ml/min; biochemical data of bone mineral metabolism before and at 1, 3, 6, and 12 months of KT were registered. Results. Age was 33 (IQR 27-37) years; 54% (n = 40) were men. Before KT, all patients had hyperparathyroidism, 40% (n = 30) hypocalcemia, 86% (n = 64) hyperphosphatemia, and 42% (n = 31) hyperphosphatasemia. After KT, an increase of calcium and a diminution of PTH, phosphorus, and alkaline phosphatase were corroborated (p=0.001). All patients had hypovitaminosis D (deficiency: 91% (n = 67); insufficiency: 9% (n = 7)); 40% (n = 30) had persistent hyperparathyroidism at 12 months. Hyperphosphatasemia before KT (OR = 4.17 (95% CI: 1.21-14.44); p=0.04), hyperparathyroidism at 6 months (OR = 1.84 (95% CI; 1.67-2.06); p=0.02), hypovitaminosis D at 6 months (OR = 3.94 (95% CI: 1.86-17.9); p=0.01), and hyperphosphatasemia at 6 months (OR = 1.47 (95% CI: 1.07-2.86); p=0.03) were risk factors for persistent hyperparathyroidism at 12 months after KT. Conclusion. Persistent hyperparathyroidism at 6 months, hypovitaminosis D, and hyperphosphatasemia are risk factors for persistent hyperparathyroidism at 1 year of KT in Latin population.

Association of mitochondrial variants A4336G of the tRNAGln gene and 8701G/A of the MT-ATP6 gene in Mexicans Mestizos with Parkinson disease.

INTRODUCTION: Sporadic Parkinson's disease (PD) is a neurodegenerative disorder of unknown etiology. In recent years, it has been established that a genetic component underlies different forms of the disease. For instance, mitochondrial genome variants have been implicated in the pathogenesis of the PD. AIM OF THE STUDY: To determine the association of tRNA(Gln) 4336 and 8701A>G (ATP6: Thr59Ala) mitochondrial DNA polymorphisms with the presence of PD in Mexican mestizo patients. MATERIAL AND METHODS: This was a cross-sectional study in which patients were recruited from four tertiary-care level hospitals in Mexico. Genotyping was performed using real-time PCR with TaqMan genotyping assays. Genotypes were confirmed by automated sequencing. RESULTS: The 4336C allele of the tRNAGln gene was present at a low frequency, and the 8701G allele of the MT-ATP6 gene was not associated with PD. CONCLUSIONS: The 4336C variant of the tRNAGln gene was uncommon in the study population, and 8701A/G of MT-ATP6 was not associated with PD in Mexican Mestizos.

BDNF and Tau as biomarkers of severity in multiple sclerosis.

AIM: Determine if serum levels of tau and BDNF can be used as severity biomarkers in multiple sclerosis (MS). PATIENTS & METHODS: Subjects with MS, older than 18 and younger than 55 years old were included; 74 patients with a diagnosis of relapsing-remitting MS, 11 with secondary-progressive MS, and 88 controls were included. Total tau and BDNF were measured by Western blot. RESULTS: Increased tau and decreased BDNF in MS patients compared with controls was found. Total-tau has a peak in relapsing-remitting MS, the second decile of the multiple sclerosis severity score, and in the lowest expanded disability status scale and is no different than controls for secondary-progressive MS patients and the most severe cases of MS. CONCLUSION: BDNF is a good biomarker for diagnosis of MS but not for severity or progression. Tau appears to have a more active role in the progression of MS.

[Multiple sclerosis: current immunological aspects]. / Esclerosis múltiple: aspectos inmunológicos actuales.

Multiple sclerosis is the most common inflammatory, chronic and degenerative condition of the central nervous system, and represents the first cause of disability in young adults. In Mexico, 11 to 20 out of every 100 000 people suffer from this disease. The causes of multiple sclerosis remain unknown, but several theories have been proposed: the interaction of environmental factors, viral infectious factors and genetic and immune susceptibility of each individual patient, which induce an autoimmune response and promote neuronal/axonal degeneration. In this review, the immune reaction main components and neurodegeneration present in multiple sclerosis are analyzed, as well as the inflammatory cascade associated with demyelination. Available treatments' main purpose is to modulate aspects related to the adaptive immune response (B and T cells). The therapeutic challenge will be antigen-specific immune-tolerance induction, for example, with the use of tolerance protocols with peptides or DNA or nanoparticles vaccines. Future therapies should aim to control innate components (microglia, macrophages, astrocytes) and to promote remyelination. To optimize the treatment, a combined therapeutic approach targeting the control of inflammatory and neurodegenerative components of the disease and monitoring of biomarkers will be necessary.

La esclerosis múltiple es la enfermedad inflamatoria, crónica y degenerativa más frecuente del sistema nervioso central y representa la primera causa de discapacidad en adultos jóvenes. En México, 11 a 20 de cada 100 000 habitantes padecen la enfermedad. Aún se desconocen las causas de su origen, pero se han formulado varias teorías: la interacción de factores ambientales, infecciosos virales y susceptibilidad genética e inmunológica propia de cada paciente, que inducen una respuesta autoinmune y promueven la degeneración neuronal/axonal. En esta revisión se analizan los principales componentes de la respuesta inmune y la neurodegeneración presentes en la esclerosis múltiple, así como la cascada inflamatoria asociada con la desmielinización. Los tratamientos disponibles tienen como objetivo principal modular los aspectos relacionados con la respuesta inmune adaptativa (células B y T). El reto terapéutico será la inducción de tolerancia inmune antígeno-específica, por ejemplo, mediante el uso de protocolos de tolerancia con péptidos, vacunas de ADN o nanopartículas. Las futuras terapias deberán dirigirse a controlar los componentes innatos del sistema inmune (microglías, macrófagos, astrocitos) y a promover la remielinización. Para optimizar el tratamiento será necesario un enfoque terapéutico combinado dirigido al control de los componentes inflamatorios y neurodegenerativos de la enfermedad y al monitoreo de biomarcadores.

Experience of status epilepticus in the Neurology department of a tertiary-level hospital in Mexico / Experiencia del estado epiléptico en 5 años en el servicio de Neurología del Hospital de Especialidades del CMN SXXI

Background: The status epilepticus is a neurological emergency that continues to be little identified early in emergency rooms and hospitalized patients, with significant morbidity and mortality. The aim of this paper was to establish the etiology and evolution of the status epilepticus in hospitalized patients in a tertiary-level hospital. Methodology: Descriptive, cross-analytical study of adult patients hospitalized with the diagnosis of epileptic status at a tertiary-level hospital, between August 2010 and February 2016. Results: 19 patients, mean age 35 years ± 19. With 15 years of convulsive epileptic status, 13 subjects with generalized seizures, 4 with alert alterations and 2 with focal seizures. In 4 cases, structural damage was detected, 4 due to non-specific inflammation, 2 due to Neuroinfection, 2 with anoxoischemic encephalopathy and 3 cases without evident etiology; of the 17 survivors, 10 with Rankin Scale modified from 4-5 points. Conclusions: The status epilepticus is a common diagnosis in third level centers, with significant morbi mortality. After a complete study protocol, the etiological diagnosis is reached in most cases.

Introducción: El estado epiléptico es una emergencia neurológica que continúa siendo poco identificada de manera temprana en salas de urgencias y pacientes hospitalizados, con significativa morbilidad y mortalidad. El objetivo de este trabajo fue establecer la etiología y evolución del estado epiléptico en los pacientes hospitalizados en la UMAE. Métodos: Estudio descriptivo, transversal-analítico, de pacientes adultos que fueron hospitalizados con diagnóstico de estado epiléptico en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI entre agosto del 2010 a febrero del 2016. Resultados: 19 pacientes, con edad media de 35 años ± 19. 15 años con estado epiléptico convulsivo, 13 sujetos con convulsiones generalizadas, 4 con alteraciones de alerta y 2 con convulsión focales. En 4 casos se detectó daño estructural, 4 por inflamación no específica, 2 por neuroinfección, 2 con encefalopatía anoxoisquémica y 3 casos sin etiología evidente; de los 17 sobrevivientes, 10 con escala de Rankin modificado de 4-5 puntos. Conclusiones: El estado epiléptico es un diagnóstico común en centros de tercer nivel, con significativa morbimortalidad. Tras un protocolo de estudio completo se llega al diagnóstico etiológico en la mayoría de los casos.

Risk of lethality due to nosocomial infections in a tertiary-level hospital / Riesgo de letalidad por infección nosocomial en un hospital de tercer nivel de atención

Background: Infections associated with health care, previously known as nosocomial infections, constitute one of the main causes of morbidity and mortality in hospital. The aim of this study is to estimate the lethality of HAI, as well as the risk of dying from HAI versus mortality by other causes. Methods: We analyzed the historical cohort of IAAS of the Epidemiology service of a tertiary-level hospital, from 2012 to 2017. The incidence analysis and the probability of death of IAAS were made against other causes, as well as the analysis of age, period-cohort of lethality of IAAS. Results: The incidence of IAAS ranged from 27.9 to 31.5 IAAS/1000 person-days between 2012 and 2017, the probability of having an IAAS in ICU is 3.51 (CI95%: 2.93-4.20), p < 0.01, NAVM lethality against any other causes of death had a relative risk (RR) of 6.06 (CI95%: 2.91-12.6) in 2016, RR was 4.01 (CI95%: 1.59-10.09) in ITUAC in 2015, no effect of age, cohort or period in the case of IAAS was identified. Conclusions: IAAS remain to be an important public health problem in our country, without excluding our medical unit, it is important to redirect efforts to reduce them in the medium term.

Introducción: Las infecciones asociadas a la atención a la salud, anteriormente conocidas como nosocomiales, constituyen una de las principales causas de morbimortalidad hospitalaria. El objetivo de este trabajo fue estimar el riesgo de fallecer de aquellos pacientes hospitalizados en una Unidad Médica de Alta Especialidad (UMAE) cuando se asocian a infecciones asociadas a la atención en salud (IAAS) más frecuente en nuestro medio. Métodos: Se realizó un análisis de una cohorte histórica de IAAS por la División de Epidemiología de la UMAE, del 2012 al 2017. Se estimó la incidencia y la probabilidad de muerte por IAAS y se comparó con otras causas, analizando las variables de edad, cohorte y periodo de la letalidad. Resultados: La incidencia de IAAS entre 2012 y 2017 fue de 27.9 a 31.5 IAAS/1000 días estancia, la probabilidad de tener una IAAS al estar en la Unidad de Cuidados Intensivos fue de 3.51 (IC95%: 2.93-4.20) p < 0.01, la letalidad por neumonía asociada a ventilación mecánica frente a otras causas en 2016 tuvo un riesgo relativo (RR) de 6.06 (IC95%: 2.91-12.6), y para infección del tracto urinario asociado a cateter el RR fue de 4.01 (IC95%: 1.59-10.09). Conclusiones: Las IAAS siguen siendo un importante problema de salud pública en nuestro medio; es importante redirigir los esfuerzos para abatir las IAAS en el mediano y corto plazo

[The Hospital de Especialidades "Bernardo Sepúlveda Gutiérrez", and the generation of knowledge]. / El Hospital de Especialidades "Bernardo Sepúlveda Gutiérrez" y la generación del conocimiento.

The history of the Hospital de Especialidades "Bernardo Sepúlveda Gutiérrez," formerly called Hospital General del Centro Médico Nacional, has been marked by ups and downs, as well as by the development of cutting-edge medical knowledge. In this supplement we show a series of articles, whose authors belong in their entirety to that hospital.

La historia del Hospital de Especialidades "Bernardo Sepúlveda Gutiérrez", antes denominado Hospital General del Centro Médico Nacional, ha estado marcada por los avatares y por la generación de conocimiento médico de vanguardia. En el presente suplemento se ofrecen una serie de artículos cuyos autores pertenecen en su totalidad a ese hospital.

[Maternal morbidity and mortality in a unit of tertiary care without obstetrics]. / Morbimortalidad materna en una unidad de tercer nivel sin servicio de obstetricia.

BACKGROUND: Maternal morbidity is a health problem for developing countries, the causes of death among obstetric patients varies according to geographic region and other factors, which include health services. The aim of this study was to identify the causes of maternal mortality and morbidity, as well as factors associated with mortality in patients attending on 2011-2012. METHODS: Clinical data of the patients on admission, severity of illness, presence of comorbidity, complications that occurred during treatment and causes of death in pregnant or postpartum patients were analyzed. RESULTS: 137 patients were analyzed, 87 (63.5 %) patients were hospitalized, 36 (41.3 %) cases with severe maternal complication (SMC); most patients with SMC were in the postpartum postcesarean. Eleven patients died, five maternal deaths and 6 late deaths. CONCLUSIONS: SMC and death were more frequent in the postpartum period. The indirect causes of death were more frequent.

Introducción: la morbimortalidad materna representa un problema de salud en los países en desarrollo, las causas de muerte obstétrica dependen de la región geográfica y de otros factores que incluyen la calidad de los servicios de salud. El objetivo de este estudio fue analizar las causas de morbilidad y mortalidad materna en las pacientes atendidas de 2011 a 2012. Métodos: se analizaron los datos de las pacientes en admisión hospitalaria, el diagnóstico y la severidad de la enfermedad, la presencia de comorbilidad y las complicaciones que ocurrieron durante el tratamiento y las causas de muerte de pacientes embarazadas o puérperas. Resultados: fueron atendidas 137 pacientes de las cuales 87 (63.5 %) requirieron ser hospitalizadas, 36 (41.3 %) presentaron criterios para complicación materna severa (CMS); la mayor parte de pacientes con CMS se encontraban en el puerperio postcesárea, Once pacientes fallecieron, cinco se consideraron muertes maternas indirectas y 6 muertes tardías. Conclusiones: las CMS y las muertes fueron más frecuentes en el puerperio. Las causas indirectas fueron las más frecuentes.

[Deep brain stimulation in Parkinson's disease. Preliminary outcomes]. / Estimulación cerebral profunda en la enfermedad de Parkinson. Resultados preliminares.

BACKGROUND: Parkinson's disease justifies the use of deep brain stimulation (DBS) in certain patients who suffer from this condition. We present mid-term and long-term post-surgical outcomes in a cohort of 60 patients, who underwent DBS in the Hospital de Especialidades at Centro Médico Nacional Siglo XXI, in Mexico City. METHODS: Patients underwent conventional stereotactic surgery with FrameLink software (Medtronics Inc). This technique consisted in the presurgical evaluation, the placement of stereotactic frame, imaging studies, preoperative planning procedure, microrecording, macrostimulation, as well as the placement of electrodes and generators in two phases. The variables were included in a data platform for Excel management. It was also included a variety of measurement instruments for data comparison. As a standard measure, it was used the Unified Parkinson Disease Rating Scale (UPDRS) before the surgery and at 3, 12, and 36 months. RESULTS: 60 patients underwent surgery: 41 men and 19 women, with an average age of 56.5 years (39-70). There were good results in the majority of patients with preoperative UPDRS and at 3, 12 and 36 months of 79.57, 66.85, 65.29 and 58.75, respectively (p < 0.0001). There were complications in nine patients (15 %) and they were managed in a conservative manner. CONCLUSIONS: Postsurgical outcomes were from good to excellent in the majority of patients. Complications were minimal and conservatively managed. We propose the use of this procedure in a selected group of Parkinson's patients.

Introducción: la enfermedad de Parkinson puede justificar un procedimiento quirúrgico que consiste en la estimulación cerebral profunda. Se presentan resultados a mediano y largo plazo de una cohorte de 60 pacientes del Hospital de Especialidades del Centro Médico Nacional Siglo XXI. Métodos: los pacientes fueron operados con una metodología estereotáctica convencional a través del protocolo FrameLink (Medtronics Inc.). La técnica consistió en la evaluación preoperatoria de los pacientes, la colocación de marco estereotáctico, la realización de estudios de imagen, la planeación preoperatoria, el microrregistro, la macroestimulación y la colocación de implantes, que estuvo conformada por electrodos y generador en dos fases. La escala unificada para la evaluación de la enfermedad de Parkinson (UPDRS) preoperatoria, a tres, 12, y 36 meses fue utilizada como medida estándar. Se analizaron los resultados y las complicaciones como variables de interés. Resultados: se operaron 60 pacientes (41 hombres y 19 mujeres), con edad promedio de 56.5 años (rango de 39-70). Se obtuvieron de buenos a excelentes resultados en la mayoría de los pacientes con UPDRS promedio en periodo preoperatorio, a 3, 12 y 36 meses de 79.57, 66.85, 65.29 y 58.75, respectivamente (p < 0.0001). Las complicaciones se presentaron en forma mínima (en nueve pacientes: 15 %) y fueron manejadas de forma conservadora. Conclusiones: hubo una mejoría progresiva en el UPDRS durante los 36 meses de seguimiento.

Manifestaciones neurológicas en pacientes con COVID-19 severo en un centro de tercer nivel de atención / Neurological manifestations in patients with severe COVID-19 in a tertiary care center

Introducción: la enfermedad por SARS-CoV-2 denominada COVID-19 originada en China adquirió dimensiones pandémicas. De acuerdo con el reporte situacional de la OMS al 15 de marzo de 2021, la tasa de letalidad global es del 2.2%; en México se han confirmado alrededor de 194 944 defunciones por COVID-19. Estudios en China identificaron que los pacientes con COVID-19 severo, al compararlos con aquellos que cursaron con COVID-19 no severo, presentaron manifestaciones neurológicas más graves. Objetivo: determinar la frecuencia de síntomas y manifestaciones neurológicas en pacientes con COVID-19 severo en un centro de tercer nivel de atención. Material y métodos: estudio transversal, observacional y analítico, llevado a cabo en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI, en pacientes hospitalizados con COVID-19 severo. Resultados: se analizaron 183 casos, de los cuales 130 eran hombres (71%). La mediana de edad fue de 55 años (RIC: 44-65). Los síntomas neurológicos fueron: cefalea, anosmia y disgeusia. Las manifestaciones neurológicas se presentaron en 27 pacientes, la más frecuente fue la enfermedad vascular cerebral tipo isquémica (EVC) en 12 pacientes (44%) en pacientes con mayor edad, 76.5 frente a 54 años (p = 0.000), y con antecedente de enfermedad cardiovascular. Conclusiones: los síntomas neurológicos más frecuentes fueron cefalea, anosmia y disgeusia. La manifestación neurológica más frecuente fue la EVC isquémica que se presentó en pacientes con COVID-19 severo de mayor edad y con antecedente de enfermedad cardiovascular.

Background: The SARS-CoV-2 disease, called COVID-19, emerged in China has acquired pandemic dimensions. According to the WHO situational report of March 15, 2021, the global fatality rate is 2.2%; in Mexico, around 194 944 deaths have been confirmed by COVID-19. Studies in China identified that patients with severe COVID-19, when compared with those who had non-severe COVID-19, presented more severe neurological manifestations. Objective: To determine the frequency of neurological symptoms and manifestations in patients with severe COVID-19 in a tertiary care center. Material and methods: A cross-sectional, observational and analytical study was carried out at the Hospital de Especialidades del Centro Médico Nacional Siglo XXI, in patients hospitalized with severe COVID-19. Results: 183 cases were analyzed, of which 130 were men (71%). The median age was 55 years (IQR: 44-65). The neurological symptoms were: headache, anosmia and dysgeusia. Neurological manifestations occurred in 27 patients (16%), the most frequent was ischemic-type cerebrovascular disease (CVD) in 12 (44%), in patients older than 76.5 years vs. 54 years (p = 0.000), with history of cardiovascular disease. Conclusions: The most frequent neurological symptoms were headache, anosmia and dysgeusia. The most frequent neurological manifestation was ischemic CVD that appeared in older patients with severe COVID-19 with a history of cardiovascular disease.

[Clinical and biochemical characteristics of patients with morbid obesity at the time of hospital admission and one year after undergoing bariatric surgery]. / Características clínicas y bioquímicas de pacientes con obesidad extrema al ingreso y un año después de someterse a cirugía bariátrica.

BACKGROUND: Three percent of Mexicans suffer from morbid obesity. Comorbidities associated to this condition diminish quality of life, increase mortality and health care costs. Despite bariatric surgery has specific indications and risks, it is the only treatment with effective long-term results. The aim of the study was to evaluate biochemical and clinical patient characteristics, both preoperatively and a year after they underwent bariatric surgery. METHODS: We carried out a quasi-experimental study that evaluates a sample of patients in the Clínica de Obesidad at Hospital de Especialidades (a third level hospital) between March 2011 and October 2015. RESULTS: A total of 150 patients were analyzed (60 % were women). Mean age was 41 ± 9 years and mean body mass index (BMI) was 48 kg/m2 (42-53 kg/m2). Before surgery, type 2 diabetes mellitus (T2DM) was present in 31 %, hypertension in 60 % and 30 % of the patients were "metabolically healthy obese". A year after surgery, the percentage of excess body weight loss was 66 %, T2DM and hypertension remission was 70 % and 50 %, respectively. CONCLUSION: Bariatric surgery is an effective treatment to reduce excess weight. It improves biochemical, and clinical parameters in extreme obese patients.

Introducción: el 3 % de la población mexicana padece obesidad extrema. Sus comorbilidades disminuyen la calidad de vida, aumentan la mortalidad y los costos de atención médica. El único tratamiento con resultados a largo plazo es la cirugía bariátrica, aunque tiene indicaciones y riesgos específicos. Buscamos evaluar las características de los pacientes de cirugía bariátrica al inicio y un año después del tratamiento quirúrgico. Métodos: estudio cuasi experimental con los datos antropométricos, clínicos y bioquímicos de una muestra de pacientes operados en la Clínica de Obesidad del Hospital de Especialidades del Centro Médico Nacional de marzo del 2011 a octubre del 2015. Resultados: fueron analizados 150 pacientes (60 % mujeres), la media de edad fue de 41 ± 9 años y el índice de masa corporal (IMC) de 48 kg/m2 (42-53 kg/m2). Previo a la cirugía, 31 % tenía diabetes mellitus tipo 2 (DM2) y 62 % hipertensión arterial (HAS). El 30 % eran obesos "metabólicamente sanos". Un año después de la cirugía el porcentaje del exceso de peso perdido fue de 66 %. La remisión de DM2 y HAS fue de 70 y 50 %, respectivamente. Conclusión: la cirugía bariátrica es efectiva en la pérdida de peso y en la mejoría de parámetros bioquímicos y clínicos en pacientes con obesidad extrema.

Low prevalence of most frequent pathogenic variants of six PARK genes in sporadic Parkinson's disease.

Genetic variants that confer susceptibility to Parkinson's disease (PD) show unbalanced distribution among different populations; genetic predisposition to either familial or sporadic forms of PD in Mexican-mestizo population has not been comprehensively studied. The aim of the present study was to analyze genetic variants in six PARK genes in PD patients. In total 381 individuals (173 patients, 208 controls) were genotyped for p.Gly2019Ser and p.Gly2385Arg variants of LRRK2. The p.Gly2019Ser variant was present in two patients and one healthy control; the p.Gly2385Arg variant was not found. In a subgroup of early-onset PD (EOPD), MLPA analysis was done for PARKIN (PARK2), PINK1 (PARK6), DJ-1 (PARK7), LRRK2 (PARK8), SNCA (PARK1/4) and ATP13A2 (PARK9). We found a heterozygous deletion of exon 2 in PARK2 in the youngest patient of the early-onset group, who showed limited response to antiparkinsonian therapy. Although the changes Gly2019Ser and Gly2385Arg of LRRK2 are associated with PD in different populations; they may be a rare cause of PD in our population. Novel population-specific variants may underlie PD susceptibility in Mexican mestizos. Our study suggests that the heterozygous deletion of exon 2 in the PARK2 gene is a risk factor for EOPD.