[Demographic analysis of a congenital heart disease clinic of the Mexican Institute of Social Security, with special interest in the adult]. / Análisis demográfico de una clínica de cardiopatías congénitas del Instituto Mexicano del Seguro Social, con interés en el adulto.

INTRODUCTION: Congenital heart disease (CHD) has an incidence of 8-10 cases per 1000 live births. In Mexico, there are 18,000-20,000 new cases per year. Most tertiary care centers for CHD attend only pediatric population; the Mexican Institute of Social Security (IMSS) has a clinic that attends pediatric and adult population. OBJECTIVE: To analyze the demographic aspects of the CHD clinic of IMSS. METHODS: From 2011 to 2016 a cross-sectional study of the CC clinic of a third level hospital of the IMSS, including all patients with confirmed structural heart disease of recent diagnosis was carried out. The sex, age, reference entity, antecedent of pregnancy and treatment were registered. The population was divided into age ranges (<2 years, 2.1-6 years, 6.1-10 years, 10.1-17 years and >17.1 years). Descriptive statistics and χ2 test were used in qualitative variables. RESULTS: 3,483 patients with CHD (male:female ratio, 0.8:1.2) were included. Increased pulmonary flow acyanogenic cardiopathies were the most frequent CHD group (47.2%), with atrial septal defect being the most frequent diagnosis overall; 25.6% were adults and 35% of women with a history of pregnancy. Chiapas was Federal entity with greater proportion of patients diagnosed in the adult stage (33.82%); 7% were not candidates for any treatment for complications of the disease. CONCLUSIONS: CHD is a late diagnosis; it is necessary to create a national register to promote new health policies and a rational distribution of resources for these patients.

Análisis demográfico de una clínica de cardiopatías congénitas del Instituto Mexicano del Seguro Social, con interés en el adulto / Demographic analysis of a congenital heart disease clinic of the Mexican Institute of Social Security, with special interest in the adult

Resumen Introducción: Las cardiopatías congénitas (CC) en México se presentan con una cifra estimada entre 18,000-20,000 nuevos casos por año. La mayor parte de los centros que atienden a estos enfermos son exclusivamente pediátricos y el Instituto Mexicano del Seguro Social (IMSS) cuenta con una clínica que atiende a todas las edades. Objetivo: Analizar los aspectos demográficos de una clínica de CC del niño y del adulto del IMSS. Métodos: De 2011 a 2016 se realizó un estudio transversal de la clínica de CC de un hospital de tercer nivel del IMSS, incluyendo todos los pacientes con cardiopatía estructural confirmada de reciente diagnóstico. Se registró el sexo, la edad, la entidad federativa de referencia, el antecedente de embarazo y el tratamiento. Se dividió a la población en rangos de edades (< 2 años, 2.1-6 años, 6.1-10 años, 10.1-17 años y > 17.1 años). Se empleó estadística descriptiva y prueba de y2 en las variables cualitativas. Resultados: Tres mil cuatrocientos ochenta y tres enfermos con CC (relación hombre:mujer,0.8:1.2), las cardiopatías acianógenas de flujo pulmonar aumentado son el grupo más grande (47.2%); 25.6% fueron adultos y 35% de las mujeres con antecedente de al menos una gesta. En general la cardiopatía más frecuente fue la comunicación interauricular. La entidad federativa con mayor frecuencia de adultos de reciente diagnóstico fue Chiapas (33.82%); el 7% no fueron candidatos a ningún tratamiento por complicaciones inherentes a la cardiopatía. Conclusiones: Existe un diagnóstico tardío de la atención de las CC en la etapa adulta. Es necesario crear un registro nacional para promover nuevas políticas de salud y distribución de recursos destinados a estos pacientes.

Abstract Introduction: Congenital heart disease (CHD) has an incidence of 8-10 cases per 1000 live births. In Mexico, there are 18,000-20,000 new cases per year. Most tertiary care centers for CHD attend only pediatric population; the Mexican Institute of Social Security (IMSS) has a clinic that attends pediatric and adult population. Objective: To analyze the demographic aspects of the CHD clinic of IMSS. Methods: From 2011 to 2016 a cross-sectional study of the CC clinic of a third level hospital of the IMSS, including all patients with confirmed structural heart disease of recent diagnosis was carried out. The sex, age, reference entity, antecedent of pregnancy and treatment were registered. The population was divided into age ranges (< 2 years, 2.1-6 years, 6.1-10 years, 10.1-17 years and > 17.1 years). Descriptive statistics and y2 test were used in qualitative variables. Results: 3,483 patients with CHD (male:female ratio, 0.8:1.2) were included. Increased pulmonary flow acyanogenic cardiopathies were the most frequent CHD group (47.2%), with atrial septal defect being the most frequent diagnosis overall; 25.6% were adults and 35% of women with a history of pregnancy. Chiapas was Federal entity with greater proportion of patients diagnosed in the adult stage (33.82%); 7% were not candidates for any treatment for complications of the disease. Conclusions: CHD is a late diagnosis; it is necessary to create a national register to promote new health policies and a rational distribution of resources for these patients.

Correlación entre la resonancia magnética y la ecocardiografía transtorácica en la evaluación de la insuficiencia pulmonar en pacientes pediátricos con cardiopatía congénita / Correlation between magnetic resonance and transthoracic echocardiogram for the assessment of pulmonary insufficiency in pediatric patients with congenital heart disease

Objetivo: Establecer la correlación y la concordancia del grado de severidad de insuficiencia pulmonar entre la ecocardiografía y la resonancia magnética en la población pediátrica de un hospital de tercer nivel de atención. Métodos: Se estudiaron 20 pacientes con diagnóstico de cardiopatía congénita con insuficiencia pulmonar, a quienes se les realizaron ecocardiograma transtorácico y resonancia magnética. Se calculó: relación de la vena contracta y el chorro de insuficiencia pulmonar, tiempo de hemipresión, presencia de flujo diastólico reverso en tronco pulmonar e índice de insuficiencia pulmonar; en cuanto a la resonancia magnética: la fracción y el volumen regurgitante. Se realizó análisis de correlación mediante coeficiente de correlación de Spearman y prueba de Tau B. Resultados:La tetralogía de Fallot corregida representó el 60% de la muestra. La correlación fue significativa en la fracción y el volumen regurgitante de la resonancia magnética, así como en las variables ecocardiográficas índice de insuficiencia pulmonar en modo M, vena contracta y porcentaje de vena contracta/arteria pulmonar. La correlación entre los grados de insuficiencia pulmonar por resonancia magnética y ecocardiografía fue 0,85 (p < 0,001). Conclusiones: La vena contracta y el porcentaje VC/AP son variables que tienen alta correlación con la fracción y el volumen regurgitante de la resonancia magnética nuclear para evaluar la insuficiencia pulmonar en pacientes en posoperatorio de cardiopatía congénita.

Motivation: To establish the correlation and concordance of the degree of severity of pulmonary insufficiency between echocardiography and magnetic resonance in pediatric population of a third level hospital. Methods: 20 patients diagnosed with congenital heart disease and with pulmonary insufficiency were studied, they underwent a transthoracic echocardiogram and a magnetic resonance. The relationship of the vena contracta, the pulmonary regurgitation jet, the pressure half-time time, the presence of reversed end-diastolic flow and the pulmonary insufficiency index were calculated. With regards to the magnetic resonance, both fraction and regurgitant volume were measured. An analysis of the correlation was conducted.by means of the Spearman correlation and the Tau B. Results: Corrected Fallot's tetralogy represented 60% of the sample. The correlation was significant in the fraction and the regurgitant volume of the magnetic resonance, as well as in the echocardiographic variables of M-mode pulmonary insufficiency, vena contracta and vena contracta/pulmonary artery percentage. The correlation between the degrees of pulmonary insufficiency by magnetic resonance and echocardiogram was 0.85 (p < 0.001). Conclusions: Vena contracta and the VC/PA percentage are variables that present high correlation with the fraction and the regurgitant volume of nuclear magnetic resonance to assess pulmonary insufficiency in patients after a congenital cardiac disease surgery.

Desarrollo y validación de la Escala de Mortalidad Neonatal-9 México para predecir la mortalidad en neonatos críticamente enfermos / Development and validation of the Neonatal Mortality Score-9 Mexico to predict mortality in critically ill neonates

Introducción. Las escalas pronósticas son de utilidad para el médico que ejerce en las unidades de cuidados intensivos neonatales. Existen escalas neonatales validadas, en su mayoría para neonatos de bajo peso al nacer. El objetivo fue crear y validar una escala predictora de mortalidad en neonatos que incluyera nuevas variables pronósticas. Población y métodos. Se realizó el estudio en un hospital materno-infantil de la ciudad de México, del Instituto Mexicano del Seguro Social. En la primera fase, se diseñó un estudio de casos y controles anidado en una cohorte (neonatos ingresados con criterios de gravedad durante el primer día de vida), en el que se identificó y construyó una escala con parámetros graduales de puntuación acumulativa de nueve variables independientes para predecir muerte: peso, acidemia metabólica, lactato, paO2/FiO2, p(A-a) O2, A/a, plaquetas y glucosa sérica. La validación se realizó en una cohorte prospectiva, de las mismas características, tomando como variable de desenlace la mortalidad hasta el séptimo día. Resultados. La cohorte incipiente estuvo conformada por 424 neonatos. Se seleccionaron 22 casos y 132 controles, y se identificaron 9 variables, que conformaron la escala nombrada escala de mortalidad neonatal-9 México. La cohorte de validación estuvo integrada por 227 neonatos. Se registraron 44 (19%) defunciones, con un área bajo la curva de 0,92. Con una puntuación de entre 16 y 18, se reportó un hazard ratio de 85 (11-102), una especificidad de 99%, un valor predictivo positivo de 71% y un valor predictivo negativo de 90%. Conclusiones. La escala propuesta es un instrumento fiable para predecir la gravedad en neonatos.

Introduction. Prognostic scales or scores are useful for physicians who work in neonatal intensive care units. There are several validated neonatal scores but they are mostly applicable to low birth weight infants. The aim of this study was to develop and validate a mortality prognostic score in newborn infants, that would include new prognostic outcome measures. Population and Methods. The study was conducted in a mother and child hospital in the city of Mexico, part of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security). In the first phase of the study, a nested case-control study was designed (newborn infants admitted on the basis of severity criteria during the first day of life), in which a scale was identified and developed with gradual parameters of cumulative score consisting of nine independent outcome measures to predict death, as follows: weight, metabolic acidemia, lactate, PaO2/FiO2, p(A-a) O2, A/a, platelets and serum glucose.Validation was performed in a matched prospective cohort, using 7-day mortality as an endpoint. Results. The initial cohort consisted of 424 newborn infants. Twenty-two cases and 132 controls were selected; and 9 outcome measures were identified, making up the scale named neonatal mortality score-9 Mexico. The validation cohort consisted of 227 newborn infants. Forty-four (19%) deaths were recorded, with an area under the curve (AUC) of 0.92. With a score between 16 and 18, an 85 (11-102) hazard ratio, 99% specificity, 71% positive predictive value and 90% negative predictive value were reported. Conclusions .The proposed scale is a reliable tool to predict severity in newborn infants.

Development and validation of the Neonatal Mortality Score-9 Mexico to predict mortality in critically ill neonates.

INTRODUCTION: Prognostic scales or scores are useful for physicians who work in neonatal intensive care units. There are several validated neonatal scores but they are mostly applicable to low birth weight infants. The aim of this study was to develop and validate a mortality prognostic score in newborn infants, that would include new prognostic outcome measures. POPULATION AND METHODS: The study was conducted in a mother and child hospital in the city of Mexico, part of the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security). In the first phase of the study, a nested case-control study was designed (newborn infants admitted on the basis of severity criteria during the first day of life), in which a scale was identified and developed with gradual parameters of cumulative score consisting of nine independent outcome measures to predict death, as follows: weight, metabolic acidemia, lactate, PaO2/FiO2, p(A-a) O2, A/a, platelets and serum glucose.Validation was performed in a matched prospective cohort, using 7-day mortality as an endpoint. RESULTS: The initial cohort consisted of 424 newborn infants. Twenty-two cases and 132 controls were selected; and 9 outcome measures were identified, making up the scale named neonatal mortality score-9 Mexico. The validation cohort consisted of 227 newborn infants. Forty-four (19%) deaths were recorded, with an area under the curve (AUC) of 0.92. With a score between 16 and 18, an 85 (11-102) hazard ratio, 99% specificity, 71% positive predictive value and 90% negative predictive value were reported. Conclusions .The proposed scale is a reliable tool to predict severity in newborn infants.