[Social, demographic and morbimortality characteristics of the cases treated for COVID-19 at the Ignacio Chávez National Institute of Cardiology. A descriptive cross-sectional study]. / Características sociales, demográficas y de morbimortalidad de los casos atendidos por COVID-19 en el Instituto Nacional de Cardiología Ignacio Chávez. Un estudio transversal descriptivo.

Introduction: The COVID-19 pandemic brought with it a large number of adverse consequences for public health with serious socioeconomic repercussions. In this study we characterize the social, demographic, morbidity and mortality conditions of individuals treated for COVID-19 in one of the SARS-CoV-2 reference hospitals in Mexico City. Method: A descriptive cross-sectional study was carried out in 259 patients discharged from the Instituto Nacional de Cardiología Ignacio Chávez, between April 11, 2020 and March 14, 2021. A multivariate logistic regression model was used to identify the association between sociodemographic and clinical variables. An optimization was performed using maximum likelihood calculations to choose the best model compatible with the data. The maximum likelihood model was evaluated using ROC curves, goodnessof-fit estimators, and multicollinearity analysis. Statistically significant patterns of comorbidities were inferred by evaluating a hypergeometric test over the frequencies of co-occurrence of pairs of conditions. A network analysis was implemented to determine connectivity patterns based on degree centrality, between comorbidities and outcome variables. Results: The main social disadvantages of the studied population are related to the lack of social security (96.5%) and the lag in housing conditions (81%). Variables associated with the probability of survival were being younger (p < 0.0001), having more durable material goods (p = 0.0034) and avoiding: pneumonia (p = 0.0072), septic shock (p < 0.0001) and acute respiratory failure (p < 0.0001); (AUROC: 91.5%). The comorbidity network for survival cases has a high degree of connectivity between conditions such as cardiac arrhythmias and essential arterial hypertension (Degree Centrality = 90 and 78, respectively). Conclusions: Given that among the factors associated with survival to COVID-19 there are clinical, sociodemographic and social determinants of health variables, in addition to age; It is imperative to consider the various factors that may affect or modify the health status of a population, especially when addressing emerging epidemic phenomena such as the current COVID-19 pandemic.

Introducción: La pandemia de enfermedad por coronavirus 2019 (COVID-19) trajo aparejadas una gran cantidad de consecuencias adversas para la salud pública con serias repercusiones socioeconómicas. En este estudio caracterizamos las condiciones sociales, demográficas y de morbimortalidad de los casos atendidos por COVID-19 en uno de los hospitales de referencia de coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) en la Ciudad de México. Método: Se llevó a cabo un estudio transversal descriptivo en 259 pacientes egresados del Instituto Nacional de Cardiología Ignacio Chávez, entre el 11 de abril de 2020 y el 14 de marzo de 2021. Se utilizó un modelo de regresión logística multivariante para identificar la asociación entre variables sociodemográficas y clínicas. Se realizó una optimización mediante cálculos de máxima verosimilitud para elegir el mejor modelo compatible con los datos. El modelo de máxima verosimilitud fue evaluado mediante curvas ROC, estimadores de bondad de ajuste y análisis de multicolinealidad. Se infirieron patrones de comorbilidades estadísticamente significativos mediante la evaluación de una prueba hipergeométrica en las frecuencias de coocurrencia de pares de condiciones. Se implementó un análisis de redes para determinar los patrones de conectividad basado en la centralidad de grado, entre algunas comorbilidades y las variables de desenlace. Resultados: Las principales desventajas sociales de la población estudiada se relacionan con la falta de seguridad social (96.5%) y el rezago en las condiciones de vivienda (81%). Las variables asociadas a la probabilidad de sobrevivir fueron tener una menor edad (p < 0.0001), contar con más bienes materiales durables (p = 0.0034) y evitar: la neumonía (p = 0.0072), el choque séptico (p < 0.0001) y la insuficiencia respiratoria aguda (p < 0.0001); (AUROC: 91.5%). Las red de comorbilidades para los casos de supervivencia tienen un alto grado de conectividad entre padecimientos como las arritmias cardiacas e hipertensión arterial esencial (centralidad de grado: 90 y 78 respectivamente). Conclusiones: En vista de que entre los factores asociados a supervivencia existen variables clínicas, sociodemográficas y determinantes sociales de la salud, además de la edad, resulta imperativo considerar los diversos factores que puedan incidir o modificar el estado de salud de una población, sobre todo al abordar los fenómenos epidémicos emergentes como es el caso de la actual pandemia de COVID-19.

Incidence of Arterial Hypertension in People With Periodontitis and Characterization of the Oral and Subgingival Microbiome: A Study Protocol.

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. High blood pressure in particular, continues to increase throughout the global population at an increasingly fast pace. The relationship between arterial hypertension and periodontitis has been recently discussed in the context of its origins and implications. Particularly relevant is the role of the periodontal microbiome linked to persistent local and systemic inflammation, along with other risk factors and social determinants of health. The present protocol will investigate/assess the association between periodontal disease and its microbiome on the onset of hypertension, within a cohort from Mexico City. One thousand two hundred twelve participants will be studied during a 60-month period. Studies will include analysis of periodontal conditions, sampling and sequencing of the salivary and subgingival microbiome, interviews on nutritional and lifestyle habits, social determinants of health, blood pressure and anthropometric measurements. Statistical associations and several classic epidemiology and machine learning approaches will be performed to analyze the data. Implications for the generation of public policy-by early public health interventions or epidemiological surveillance approaches-and for the population empowerment-via the establishment of primary prevention recommendations, highlighting the relationship between oral and cardiovascular health-will be considered. This latter set of interventions will be supported by a carefully planned science communication and health promotion strategy. This study has been registered and approved by the Research and Ethics Committee of the School of Dentistry, Universidad Nacional Autónoma de México (CIE/0308/05/2019) and the National Institute of Genomic Medicine (CEI/2020/12). The umbrella cohort was approved by the Institutional Bioethics Committee of the National Institute of Cardiology-Ignacio Chavez (INC-ICh) under code 13-802.

Estructura de comunidades en las redes semánticas de la investigación biomédica sobre disparidades en salud y sexismo / Structure of communities in semantic networks of biomedical research on disparities in health and sexism

Resumen: Introducción. Como una iniciativa para mejorar la calidad de la atención sanitaria, en la investigación biomédica se ha incrementado la tendencia centrada en el estudio de las disparidades en salud y sexismo. Objetivo. Caracterizar la evidencia científica sobre la disparidad en salud definida como la brecha existente entre la distribución de la salud y el posible sesgo por sexo en el acceso a los servicios médicos. Materiales y métodos. Se hizo una búsqueda simultánea de la literatura científica en la base de datos Medline PubMed de dos descriptores fundamentales: Healthcare disparities y Sexism. Posteriormente, se construyó una red semántica principal y se determinaron algunas subunidades estructurales (comunidades) para el análisis de los patrones de organización de la información. Se utilizó el programa de código abierto Cytoscape para el analisis y la visualización de las redes y el MapEquation, para la detección de comunidades. Asimismo, se desarrolló código ex profeso disponible en un repositorio de acceso público. Resultados. El corpus de la red principal mostró que los términos sobre las enfermedades del corazón fueron los descriptores de condiciones médicas más concurrentes. A partir de las subunidades estructurales, se determinaron los patrones de información relacionada con las políticas públicas, los servicios de salud, los factores sociales determinantes y los factores de riesgo, pero con cierta tendencia a mantenerse indirectamente conectados con los nodos relacionados con condiciones médicas. Conclusiones. La evidencia científica indica que la disparidad por sexo sí importa para la calidad de la atención de muchas enfermedades, especialmente aquellas relacionadas con el sistema circulatorio. Sin embargo, aún se percibe un distanciamiento entre los factores médicos y los sociales que dan lugar a las posibles disparidades por sexo.

Abstract: Introduction: As an initiative to improve the quality of health care, the trend in biomedical research focused on health disparities and sex has increased. Objective: To carry out a characterization of the scientific evidence on health disparity defined as the gap between the distribution of health and the possible gender bias for access to medical services. Materials and methods: We conducted a simultaneous search of two fundamental descriptors in the scientific literature in the Medline PubMed database: healthcare disparities and sexism. Subsequently, a main semantic network was built and some structural subunits (communities) were identified for the analysis of information organization patterns. We used open-source software: Cytoscape to analyze and visualize the semantic network, and MapEquation for community detection, as well as an ad hoc code available in a public access repository. Results: The core network corpus showed that the terms on heart disease were the most common among the descriptors of medical conditions. Patterns of information related to public policies, health services, social determinants, and risk factors were identified from the structural subunits, but with a certain tendency to remain indirectly connected to the nodes of medical conditions. Conclusions: Scientific evidence indicates that gender disparity does matter for the care quality in many diseases, especially those related to the circulatory system. However, there is still a gap between the medical and social factors that give rise to possible disparities by sex.

Assessment of Sodium and Potassium Intake by 24 h Urinary Excretion in a Healthy Mexican Cohort.

BACKGROUND AND AIMS: A high dietary sodium intake and a low potassium intake are associated with adverse cardiovascular health. Data on these nutrients consumption in Mexico is limited. The aim of this study was to assess sodium and potassium intake by 24 h urinary excretion in a clinically healthy Mexican population. We additionally explored their association with blood pressure. METHODS: 711 clinically healthy participants aged 20-50 years old recruited in the Tlalpan 2020 cohort from September 2014-December 2015, were included in this cross-sectional analysis. All participants provided a 24 h urine sample and underwent anthropometric, biochemical, and blood pressure evaluations. Univariate and multivariate linear regression analyses were used to assess the association of urinary sodium, potassium, and Na/K ratio with blood pressure. RESULTS: Mean (95% confidence interval [CI]) urinary sodium and potassium in the overall population was 3150.1 (3054.2-3246.0) mg/d and 1909.5 (1859.3-1959.6) mg/d, respectively. Overall, only 121 (17%) met the WHO recommendation for sodium intake (<2000 mg/d) and 16 (2.3%) met the goal for potassium intake (≥3510 mg/d). Urinary sodium (ß coefficient 1.3, 95% CI: 0.7, 1.8, p <0.001) and potassium (ß coefficient 2.1, 95% CI: 1.0, 3.2, p <0.001) were found to be associated with systolic blood pressure in the univariate analysis but not in the multivariate analysis. CONCLUSIONS: Sodium intake was higher and potassium intake was lower than the WHO recommendations in this healthy Mexican population. Sodium and potassium intakes were not associated with blood pressure at the mean levels of intake observed in this population, after adjusting for key variables.

Tratamiento de conducto arterioso permeable: Comparación de costos del cierre quirúrgico y transcateterismo en una institución pública / Treatment of patent ductus arteriosus: Comparison of costs between surgical and trans-catheter closures in a public institution

El costo del tratamiento transcateterismo del conducto arterioso permeable en comparación con el quirúrgico es un asunto controvertido en nuestro medio. El propósito de este estudio fue estimar y comparar los costos directos relacionados con ambos procedimientos. Método: Se incluyeron 57 pacientes tratados con intervencionismo y 26 con cirugía. Se obtuvo información sobre las características sociodemográficas, el número y tipo de exámenes de laboratorio y de gabinete, el tipo y duración de anestesia, la duración del procedimiento y la estancia hospitalaria y de terapia intensiva. Se construyó una matriz que integró los costos del sistema institucional de costos unitarios vigente. Resultados: Ambos grupos compartían características sociodemográficas. El diámetro del conducto fue mayor en el grupo quirúrgico (p<0.05). Tanto la estancia hospitalaria como el número de complicaciones post intervención fueron menores en los pacientes tratados con intervencionismo (p<0.05). El tratamiento con dispositivo Amplatzer® es más costoso que el tratamiento quirúrgico y ambos más costosos que el oclusor tipo resorte. En el tratamiento quirúrgico el 86.5% de los costos totales lo consumen la estancia hospitalaria, con el Amplatzer® este rubro fue del 36%, sin embargo el dispositivo representa el 40% del costo total. Conclusiones: No obstante el costo del tratamiento con dispositivo Amplatzer® es mayor que el quirúrgico, el cierre con oclusor representa ventajas con relación a menor estancia hospitalaria, consumo de recursos y número de complicaciones, lo que permite la optimización de los recursos hospitalarios.

The costs of transcatheter closure of patent ductus arteriosus in relation to the surgical closure still a controvertial issue in our hospitals. The aim of the study was compared the costs of both treatments. Methods: We included 57 patients treated with transcatheter occlusion and 26 underwent surgery. Information about laboratory tests, average in hospital days of stay, anesthesia type and duration, operating and hemodinamic room costs, was gather. A database containing the costs from the institution unitary costs system in force was designed. Results: sociodemographyc characteristics were similar in both groups. Ductus size was larger in patients treated with surgery (p<0.05). In hospital stay, as well as, the number of complications after the procedure were less in the patients treated with transcatheter occlusion (p<0.05). The closure with Amplatzer® device was more expensive than the surgical one, and both were more expensive than coil. With surgical treatment, 86.5% of the costs are due to in hospital stay, with the Amplatzer® this issues represented a 36%, however, the cost of the devices by itself represents a 40% of the total treatment cost. Conclusions: Even though total charges of Amplatzer® devices are more expensive than surgery, transcatheter occlusion represents advantages in relation to less in hospital stay, resources used and number of complications, which allows hospital resources optimization.

[Treatment of patent ductus arteriosus. Comparison of costs between surgical and trans-catheter closures in a public institution]. / Tratamiento de conducto arterioso permeable. Comparación de costos del cierre quirúrgico y transcateterismo en una institución pública.

UNLABELLED: The costs of transcatheter closure of patent ductus arteriosus in relation to the surgical closure still a controvertial issue in our hospitals. The aim of the study was compared the costs of both treatments. METHODS: We included 57 patients treated with transcatheter occlusion and 26 underwent surgery. Information about laboratory tests, average in hospital days of stay, anesthesia type and duration, operating and hemodinamic room costs, was gather. A database containing the costs from the institution unitary costs system in force was designed. RESULTS: sociodemographyc characteristics were similar in both groups. Ductus size was larger in patients treated with surgery (p<0.05). In hospital stay, as well as, the number of complications after the procedure were less in the patients treated with transcatheter occlusion (p<0.05). The closure with Amplatzer device was more expensive than the surgical one, and both were more expensive than coil. With surgical treatment, 86.5% of the costs are due to in hospital stay, with the Amplatzer this issues represented a 36%, however, the cost of the devices by itself represents a 40% of the total treatment cost. CONCLUSIONS: Even though total charges of Amplatzer devices are more expensive than surgery, transcatheter occlusion represents advantages in relation to less in hospital stay, resources used and number of complications, which allows hospital resources optimization.

[Diagnostic evaluation of cardiovascular autonomic function in patients with diabetes mellitus]. / Valoración diagnóstica de la función autónoma cardiovascular en el paciente con diabetes mellitus.

Cardiovascular autonomic neuropathy is a common complication of diabetes mellitus. There are several diagnostic methods currently used. New techniques are described. The purpose of this review paper is to describe and analyze the clinical relevance of all this methods and propose an algorithm for the diagnosis of the cardiovascular autonomic neuropathy at daily medical practice.

[How much does the medical treatment of chronic Chagas cardiopathy cost? Direct costs in a cardiology hospital]. / Cuánto cuesta la atención de la cardiopatía chagásica crónica? Costos directos en un hospital de cardiología.

OBJECTIVE: To estimate health care costs of patients with chronic Chagasic cardiomyopathy (CCC) in a cardiovascular referral center (Instituto Nacional de Cardiología I. Chávez). MATERIAL AND METHODS: In a retrospective study, 13 clinical charts of CCC patients treated in the hospital during 1998 were reviewed. Diagnostic and therapeutic procedures and patients admission were identify as well as health care costs, which were drawn from the hospital costs system. RESULTS: 62% of the cases were admitted to the hospital through the out-patient facilities. All the patients had a health care subsidy of 15 to 55% allocated to the institutional budget. Health care costs were calculated for minimal, average, and maximum scenarios, according to the patient's clinical stage and the price of medical equipment used (low, medium, and high). Most of the health care costs are due to the use of high cost diagnostic equipment (33 a 58%) and hospital stay (including the emergency room) (19 a 28%). CONCLUSION: This is the first approximation to the economic study of Chagas disease in Mexico, providing foundations for further studies on health economics and quality care of CCC, and suggests that prevention should be enhanced.

Cuánto cuesta la atención de la cardiopatía chagásica crónica? Costos directos en un hospital de cardiología / How much does the medical treatment of chronic Chagas cardiopathy cost? Direct costs in a cardiology hospital

OBJECTIVE: To estimate health care costs of patients with chronic Chagasic cardiomyopathy (CCC) in a cardiovascular referral center (Instituto Nacional de CardiologÝa I. Chßvez). MATERIAL AND METHODS: In a retrospective study, 13 clinical charts of CCC patients treated in the hospital during 1998 were reviewed. Diagnostic and therapeutic procedures and patients admission were identify as well as health care costs, which were drawn from the hospital costs system. RESULTS: 62 of the cases were admitted to the hospital through the out-patient facilities. All the patients had a health care subsidy of 15 to 55 allocated to the institutional budget. Health care costs were calculated for minimal, average, and maximum scenarios, according to the patient's clinical stage and the price of medical equipment used (low, medium, and high). Most of the health care costs are due to the use of high cost diagnostic equipment (33 a 58) and hospital stay (including the emergency room) (19 a 28). CONCLUSION: This is the first approximation to the economic study of Chagas disease in Mexico, providing foundations for further studies on health economics and quality care of CCC, and suggests that prevention should be enhanced.

Financiamiento de la atención a la salud de la población de la tercera edad / Health care financing for the elderly

Determinar el financiamento directo de la atención a la salud de los adultos mayores en México y hacer una estimación de los gastos que este servicio implica. Material y métodos. Se estimaron las necesidadesde atención a la salud de los ancianos con base en estadísticas censales y en la Encuesta Nacional de Salud II. Enseguida se estimaron las tendencias en el uso de servicios entre los adulto mayores, de acuerdo con la información emitida por distintas instituciones del sector salud. Finalmente, después de haber analizado la aplicación de distintos modelos de atención a la salud en los ancianos en otros países y de haber proyectado las futuras demandas al respecto en México, se estimó el gasto mediante dos métodos: a) con base en una fórmula que incluye egresos, costo día/cama y días de estancia, y b) calculando el gasto de hospitalización y consulta a partir del número de egresos. Resultados. La necesidad actual de atención del adulto mayor supera la capacidad del sistema de salud para proveer los servicios adecuados. De acuerdo con el segundo método de estimación, en 1994 se gastó 4.9 por ciento del presupuesto del sector público en la atención hospitalaria para la población de más de 60 años. Conclusiones. En México, los adultos mayores se han convertido en una prioridad por la naturaleza de sus necesidades y demandas; su atención es una de las fuentes de costos más importantes en los servicios hospitalarios. Es necesario, por tanto, desarrollar una agenda de investigación que permita programar, planear y presupuestar el gasto en asistencia médica para el anciano

Objetive. To determine the direct financial requirements for providing health care to the elderly in Mexico along with an estimation of the current expenditures from services provided to this same population. Material and methods. Health care needs for the elderly were estimated from the censuses and the database of the National Health Survey II. In addition, service use trends for the aged were obtained from health sector statistical yearbooks. Finally, the amounts of expenditures were estimated by two methods: a) using a formula that considers hospital discharges, daily bed costs and length of stay; and b) inferring hospital expenditures and ambulatory visits from the numbers of hospital discharges. Results. Currently health care needs of the aged outnumber the amount of resources and the capacity of the health care sector to meet these needs. Our estimates for the year 1994 show that 4.9% of the total budget available to public health care institutions was dedicated to hospital services provided to the elderly. Conclusions. In Mexico, the aged population health needs are already a priority, due to the particular nature of their needs and demand. Taking care of this population demands an important fraction of the resources spent in hospital services. To correctly plan and allocate resources for providing health care to this population developing a research agenda is an important requirement.