ASSOCIATION BETWEEN APOE-ε4 CARRIER STATUS AND QUALITATIVE NEUROIMAGING CHARACTERISTICS IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT.

BACKGROUND: The pathogenesis of mild cognitive impairment (MCI) is multifactorial and includes the presence of genetic variants such as the ε4 allele of the apolipoprotein E gene (APOE-ε4). Association between the APOE-ε4 carrier status and deleterious structural and functional changes on magnetic resonance imaging (MRI) has been previously described in individuals with Alzheimer's disease. However, the central nervous system changes may possibly develop in earlier stages of cognitive impairment, as reflected in MCI. OBJECTIVE: The objective of the study was to determine the association between APOE-ε4 carrier status and qualitative changes on MRI (medial temporal and parietal atrophy), as well as the detection of white matter hyperintensities (WMH) in older adults with MCI, in the memory clinic of a tertiary care hospital in Mexico City. METHODS: A cross-sectional study of 72 adults aged 60 years or above who underwent an exhaustive clinical, neuroimaging, and neuropsychological evaluation. Multivariate logistic regression models were constructed to determine the association between APOE-ε4 carrier status and qualitative/quantitative changes on MRI. RESULTS: Mean age was 75.2 years (± 7.2) and 64% were female. Twenty-one participants were cognitively normal and 51 had MCI. Almost 56% were APOE-ε4 carriers and were associated with medial-temporal atrophy according to the Scheltens scale (odds ratio [OR]: 20.0, 95% confidence intervals [CI]: 3.03-131.7), parietal atrophy according to the Koedam's score (OR: 6.3; 95% CI 1.03-39.53), and WMH according to the Fazekas scale (OR: 11.7, 95% CI: 1.26-108.2), even after adjusting for age, educational level, and cardiovascular risk factors. CONCLUSION: The APOE-ε4 carrier status was associated with medial temporal and parietal atrophy, as well as WMH. Our findings support the hypothesis suggesting the contribution of this genotype to neurodegeneration and cerebral vascular pathology.

Influence of COMT polymorphism in cognitive performance on dementia in community-dwelling elderly Mexican (SADEM study).

There is an inconsistent finding about the relationship of catechol-O-methyltransferase (COMT) with dementia susceptibility, as well as with cognitive impairment. To substantiate this, we examined COMT genotype effects in certain cognitive domains in dementia. To evaluate the effects of COMT Val158Met on cognitive performance, we used The Mini-Mental State Examination (MMSE), the cognitive subscale of the Alzheimer's Disease Assessment Scale-cognitive (ADAS-cog) and the Syndrome Kurz Test (SKT). The results show COMT Val/Met, Val/Val genotype polymorphisms had a significant effect on cognition performance (OR = 1.75 (95 %CI 1.22-2.54) and (OR = 2.76 (95 %CI 1.78-4.26), p < 0.001), and with adjustment for all cognitive test scores together, Val/Val (OR = 4.98 (95 % CI 1.47-16.86) and Val/Met (OR = 3.62 (95 % CI 1.37-9.56) had effect. Our study allows us to understand the role of COMT in cognitive performance in dementia, as well as interaction with other known risk factors for this pathology. This data might help in developing new therapeutic targets for cognitive impairment, main symptom of dementia. Other risk genotypes or haplotypes should be evaluated to determine the association with cognitive decline in dementia.

Relationship of inflammatory profile of elderly patients serum and senescence-associated secretory phenotype with human breast cancer cells proliferation: Role of IL6/IL8 ratio.

Aging is considered a systemic, chronic and low-grade inflammatory state, called "inflammaging", which has been contemplated as a risk factor for cancer development and progression in the elderly population. Cellular senescence is a multifactorial phenomenon of growth arrest and distorted function, which has been recognized as a contributor to aging. Senescent cells have an altered secretion pattern called Senescent Associated Secretory Phenotype (SASP), that comprise a complex mix of factors including cytokines, growth factors, chemokines and matrix metalloproteinases among others. The SASP secreted by accumulated senescent cells during old age has been related to local inflammation that leads to cellular transformation and therefore may be supporting the inflammaging process. Here, we evaluated if the pro-inflammatory profile within the serum obtained from elderly patients (EPS) was able to induce cellular proliferation in the breast cancer transformed cell line (MCF-7), in a similar way to the proliferation stimulated by the SASP obtained from WI-38 primary cells prematurely induced to senescence by oxidative stress (SIPS). At the same time, the participation of IL-6/IL-8 ratio was determined. Our results showed that not all the EPS increased MCF-7 proliferation. However, there was an interesting relationship between IL-6 and IL-8 concentrations, when the IL-6 was higher than IL-8. Similar results were found with SASP from SIPS-WI-38 on the MCF-7 proliferation. Although it is known that those cytokines are fundamental factors to induce proliferation; the occurrence of other components in the cellular microenvironment is necessary to carry out this effect.

Clinical and Demographic Predictors of Conversion to Dementia in Mexican Elderly with Mild Cognitive Impairment.

BACKGROUND: Mild cognitive impairment (MCI) is considered a clinical stage between normal cognitive aging and dementia. The clinical course of MCI is heterogeneous, with a significant number of cases progressing to dementia or reverting back to normal. OBJECTIVE: To determine the predictors of conversion from mild cognitive impairment to dementia among Mexican older adults. MATERIALS AND METHODS: A sample of 175 persons underwent clinical and neuropsychological evaluation to establish mild cognitive impairment diagnosis. These patients were followed-up for a mean 3.5 years. RESULTS: Mean age was 81.7 (± 6.9) years, 57% were women, and mean education level was 9.5 (± 6.1) years. Sixty-one percent of mild cognitive impairment participants progressed to dementia. Multivariate Cox regression analysis showed that progression to dementia was associated with age (HR: 4.95; 95% CI: 1.96-12.46; p = 0.001), low education level (HR: 5.81; 95% CI: 1.90-7.78; p < 0.002), history of stroke (HR: 3.92; 95% CI: 1.37-11.16; p < 0.012) and cognitive decline (HR: 1.31; 95% CI: 1.18-1.45; p = 0.000). CONCLUSIONS: Age, poor education, cognitive decline, and a history of stroke were predictors of conversion to dementia. The identification and control of modifiable risk factors could influence conversion to dementia.

Validation of a prognostic score for mortality in elderly patients admitted to Intensive Care Unit.

CONTEXT: The performance of a prognostic score must be evaluated prior to being used. The aim of the present study was to evaluate the predictive ability of hospital mortality of Simplified Acute Physiology Score 3 (SAPS 3) score in elderly patients admitted to Intensive Care Units (ICUs). AIMS: The aim of the present study was to evaluate the SAPS 3 score predictive ability of hospital mortality in elderly patients admitted to ICU. SETTINGS AND DESIGN: This study was conducted as a prospective cohort, in two mixed ICUs. PATIENTS AND METHODS: Two hundred and eleven elderly patients were included. INTERVENTIONS: None. We compared the predictive accuracy of SAPS 3 measured at the first hour at ICU and Acute Physiology and Chronic Health Evaluation II (APACHE II) measured with the worst values in the first 24 h at ICU. The patients were followed until hospital discharge. STATISTICAL ANALYSIS USED: Evaluation of discrimination through area under curve receiver operating characteristic (aROC) and calibration by Hosmer-Lemeshow (HL) test. RESULTS: The median age was 68 years. The hospital mortality rate was 35.54%. The mean value of SAPS 3 was 62.54 ± 12.51 and APACHE II was 17.46 ± 6.77. The mortality predicted by APACHE II was 24.98 ± 19.96 and for standard SAPS 3 equation 41.18 ± 22.34. The discrimination for SAPS 3 model was aROC = 0.68 (0.62-0.75) and to APACHE II aROC = 0.70 (0.63-0.78). Calibration: APACHE II with HL 10.127 P = 0.26, and standard SAPS 3 equation HL 7.204 P = 0.51. CONCLUSIONS: In this study, the prognostic model of SAPS 3 was not found to be accurate in predicting mortality in geriatric patients requiring ICU admission.

The variant rs8048002 T>C in intron 3 of the MHC2TA gene is associated with risk of developing acute coronary syndrome.

Recently, an intronic single nucleotide polymorphism (rs8048002) in the MHC class II transactivator gene (MHC2TA) was shown to be associated with increased susceptibility to several inflammatory diseases. The aim of the present study was to test for an association between this MHC2TA gene polymorphism and susceptibility to the risk of developing acute coronary syndromes (ACS) in a group of Mexicans patients. The single nucleotide polymorphism (rs8048002) of the MHC2TA gene was analyzed by 5' exonuclease TaqMan genotyping assays in a group of 452 patients with ACS and 456 healthy controls. The C allele and TC genotype were associated with risk of developing ACS (OR=4.55, pC=6×10(-4) and OR=4.41, pC=1.5×10(-3), respectively). Multiple logistic analysis was used for estimate risk between ACS patients and controls adjusted by cardiovascular risk factors (gender, age, hypertension, dyslipidemia, smoking, diabetes, body mass index and alcohol consumption). In this analysis, the TC+CC genotypes were significantly associated with increased risk of ACS as compared to TT genotype (OR=4.56, pC=0.004). In summary, our data suggest that the MHC2TA rs8048002 C>T gene polymorphism plays an important role in the risk of developing ACS.

Prevalence of HMTV in breast carcinomas and unaffected tissue from Mexican women.

BACKGROUND: Breast cancer is a complex multifactorial genetic disease. Among other factors, race and, to an even greater extent, viruses are known to influence the development of this heterogeneous disease. It has been reported that MMTV-like (HMTV) gene sequences with a 90 to 98% homology to mouse mammary tumor virus are found in several populations with a prevalence range of 0 to 74%. In the Mexican population, 4.2% of patients with breast cancer exhibit the presence of HMTV (MMTV-like) sequences. The aim of this study was to evaluate the presence and current prevalence of retroviral HMTV (MMTV-like) sequences in breast cancer in Mexican women. METHODS: We used nested PCR and real-time PCR with a TaqMan probe. As a positive control, we used the C3H MMTV strain inserted into pBR322 plasmid. To confirm that we had identified the HMTV sequences, we sequenced the amplicons and compared these sequences with those of MMTV and HMTV (GenBank AF033807 and AF346816). RESULTS: A total of 12.4% of breast tumors were HMTV-positive, and 15.7% of the unaffected tissue samples from 458 patients were HMTV-positive. A total of 8.3% of the patients had both HMTV-positive tumor and adjacent tissues. The HMTV-positive samples presented 98% similarity to the reported HMTV sequence. CONCLUSIONS: These results confirm that the HMTV sequence is present in breast tumors and non-affected tissues in the Mexican population. HMTV should be considered a prominent causative agent of breast cancer.

Prevalence of anemia and its impact on the state of frailty in elderly people living in the community: SADEM study.

Anemia represents a global health problem that negatively impacts quality of life in elderly population; however, its impact on the geriatric syndrome of frailty is unclear. We examined the prevalence of anemia among elderly and sought a relationship between hemoglobin and the phenotype of frailty. Baseline hemoglobin quintiles and anemia were assessed in relation to frailty status in a prospective study with 1,933 older community-dwelling adults enrolled in the Study on Aging and Dementia in Mexico (SADEM). Logistic regression was used to model the relationship between frailty and Hb, adjusting for risk factors of frailty, sociodemographic data, cognitive decline, chronic diseases, and some risky habits. Prevalence of frailty was 8.3 %. Frailty risk was highest at the lowest hemoglobin quintile (<14.3 g/dL for men; <13.3 g/dL for women), and 160 (8.3 %) were anemic (<13 g/dL for men; <12 g/dL for women). The relationship between frailty and Hb levels, adjusted for age and sex, observed in the first and fifth quintiles, compared with the fourth quintile, were 1.53 (95 % confidence interval (CI), 1.46-1.60) and 1.05 (95 % CI, 1.01-1.15). After multivariate adjustment, the odds ratios (ORs) were 1.23 (95 % CI, 1.17-1.13) and 1.06 (95 % CI, 1.01-1.11). The association was not diminished by risk factors for frailty (body mass index (BMI), comorbidity, cognitive decline, smoking, alcohol consumption, etc.). In community-dwelling older adults, low hemoglobin concentrations and anemia were independently associated with increased frailty risk. This suggests that mild anemia and low Hb levels are independent, modifiable risk factors for frailty.

Protective role of DDAH2 (rs805304) gene polymorphism in patients with myocardial infarction.

The purpose of the present study was to establish the role of DDAH gene polymorphisms in the risk of developing myocardial infarction (MI) in a clinical cohort of Mexican patients. One polymorphism (rs1498373) in the DDAH1 and three in the DDAH2 (rs805304, rs3131383, and rs805305) genes were performed by TaqMan genotyping assays in 473 patients with MI and 447 healthy unrelated controls. Similar distribution of DDAH1 and DDAH2 polymorphisms was observed in MI patients and healthy controls. Under a recessive model adjusted for age, gender, and obesity, the rs805304 C allele was associated with decreased risk of MI (OR = 0.70, 95% CI = 0.51-0.96, P = 0.030). The effect of the polymorphisms on various cardiovascular risk factors was analyzed. Under a recessive model adjusted for age and gender, the DDAH2 rs805304 C allele was associated with decreased risk of obesity (OR = 0.35, 95% CI = 0.22-0.57, P = 0.001). The three DDAH2 polymorphisms were in strong linkage disequilibrium. Our results suggest that the rs805304 C allele was associated with decreased risk of MI and decreased risk of obesity.

Value of EQ-5D in Mexican city older population with and without dementia (SADEM study).

BACKGROUND: The EuroQoL-5D (EQ-5D) is a brief, multi-attribute, preference-based health status measurement. The objective of this study was to assess the validity and reliability of EQ-5D in older adults with and without dementia in Mexico City. METHODS: The Study on Aging and Dementia in Mexico (SADEM) was a survey of 3101, Mexican adults (60 + years old). An in-home face-to-face interview was administered. EQ-5D using ranking to rate states on a 100-point visual analogue scale; Daily Living Activities (ADL), Instrumental Activities of Daily Living (IADL), Mini Mental State Examination (MMSE), Short Form of the quality of life survey (SF-36), and Charlson comorbility index were used for comparison. The validity and reliability of EQ-5D were tested. We identified states of health for direct valuation; state 11111 ("no problems") had to be included because it was essential to the reseating (onto a 0-1 scale) of the visual analogue scale data. We included all plausible combinations of levels across each of the five EQ-5D dimensions and evaluated any significant interaction effects and factorial designs, based on balanced complete blocks. RESULTS: The EQ-5D was applied to 3101 older people, of whom 109 (3.4%) had dementia. The general reliability of EQ-5D for cases was 0.80 and for controls 0.76, for each dimension. We had a total of 103 combinations for controls and 45 for cases. The percentage for the state of health "no problems" (11111) for controls was 30.4%, and had the highest percentage of cases (8.8%). CONCLUSION: The resulting valuations form the basis for clinical use and facilitate the interpretation and evaluation of health care.

Microglia as a Possible Alternative Therapeutic for Dementia.

Dementia is a syndrome in which there is deterioration in memory, behavior, and the ability to perform everyday activities. Alzheimer's disease and vascular dementia are the most common forms of dementia. There is evidence supporting the hypothesis that inflammatory and immune mechanisms are involved in dementia. Microglia, the resident macrophage tissues in the central nervous system, play a significant role in neuroinflammation and play an important role in amyloid-ß clearance in the brain, and impaired microglial clearance of amyloid-ß has also been shown to be involved in the pathogenesis of Alzheimer's disease. However, there is also abundant evidence that microglia have harmful actions in dementia. Once activated, they can mediate uptake at neuronal synapses. They can also exacerbate tau pathology and secrete deleterious inflammatory factors that can directly or indirectly damage neurons. Thus, depending on the stage of the disease, microglia can act both protectively and detrimentally. Therefore, it is still necessary to continue with studies to better understand the role of microglia in the pathology of dementia. Currently available drugs can only improve cognitive symptoms, have no impact on progression and are not curative, so identifying and studying new therapeutic approaches is important. Considering the role played by microglia in this pathology, it has been pointed out as a possible therapeutic approach. This manuscript aims to address the relationship between microglia and dementia and how this relationship could be used for therapeutic purposes.

Brain health index as a predictor of possible vascular dementia in the Mexican health and aging study 2012-2015.

To determine the burden of disease among subjects at risk of developing stroke or dementia, brain health indexes (BHI) tend to rely on anatomical features. Recent definitions emphasize the need of a broader perspective that encompasses cardiovascular risk factors (CVRFS) and lifestyle components which can be considered partial contributors to optimal brain health. In this study, we aimed to establish the association and risk detected by a Brain Health Index and the risk of possible vascular dementia (PVD) using data from the Mexican Health and Aging Study (MHAS) 2012-2015. The MHAS is a longitudinal study of adults aged ≥ 50 years. We analyzed the data obtained between 2012 and 2015. CVRFS included in the index were diabetes mellitus, hypertension, myocardial infarction, depression, obesity, physical inactivity, and smoking history. A PVD diagnosis was established when scores in the Cross-Cultural Cognitive Examination were below reference norms and limitations in ≥1 instrumental activities of daily living and a history of stroke were present. A multinomial regression model was developed to determine the association between BHI scores and PVD. In 2015, 75 PVD cases were identified. Mean age was 67.1 ±13.2 years, 35.8% were female, and the mean educational level was 5.8 ±5.5 years. In cases with a higher score in the BHI, the model revealed a hazards ratio of 1.63 (95% CI: 1.63-1.64, p< 0.001) for PVD. In this longitudinal study, with the use of a feasible multifactorial BHI in the Mexican population, a greater score was associated with a 1.63-fold risk of developing PVD during the 3-year follow-up, while the risk for stroke was 1.75. This index could potentially be used to predict the risk of PVD in adults with modifiable CVRFS.

Factors associated with help-seeking behaviors in Mexican older individuals with depressive symptoms: a cross-sectional study.

OBJECTIVE: Depression in the older individuals is associated with multiple adverse outcomes, such as high health service utilization rates, low pharmacological compliance, and synergistic interactions with other comorbidities. Moreover, the help-seeking process, which usually starts with the feeling "that something is wrong" and ends with appropriate medical care, is influenced by several factors. The aim of this study was to explore factors associated with the pathway of help seeking among older adults with depressive symptoms. METHODS: A cross-sectional study of 60-year or older community dwelling individuals belonging to the largest health and social security system in Mexico was carried out. A standardized interview explored the process of seeking health care in four dimensions: depressive symptoms, help seeking, help acquisition, and specialized mental health. RESULTS: A total of 2322 individuals were studied; from these, 67.14% (n = 1559) were women, and the mean age was 73.18 years (SD = 7.02); 57.9% had symptoms of depression; 337 (25.1%) participants sought help, and 271 (80.4%) received help; and 103 (38%) received specialized mental health care. In the stepwise model for not seeking help (χ(2) = 81.66, p < 0.0001), significant variables were female gender (odds ratio (OR) = 0.7, 95% confidence interval (CI) 0.511-0.958, p = 0.026), health-care use (OR 3.26, CI 95% 1.64-6.488, p = 0.001). Number of years in school, difficulty in activities, Short Anxiety Screening Test score, and indication that depression is not a disease belief were also significant. CONCLUSIONS: Appropriate mental health care is rather complex and is influenced by several factors. The main factors associated with help seeking were gender, education level, recent health service use, and the belief that depression is not a disease. Detection of subjects with these characteristics could improve care of the older individuals with depressive symptoms.

[Health status and wellness among older adult beneficiaries of the ISSSTE and IMSS in Southwest Mexico City]. / Estado de salud y bienestar en adultos mayores derechohabientes usuarios del ISSSTE e IMSS del suroeste de la Ciudad de México.

OBJECTIVE: To explore the conditions of health and wellness in older adults beneficiaries to ISSSTE and IMSS of the Southwest Mexico City. MATERIAL AND METHODS: Cross-sectional study samples of users to health services in primary care ISSSTE (n = 161) and IMSS (n = 176) in Southwest Mexico City. Were determined chronic health conditions, cognitive function, depressive symptoms, use of health services, nutritional status, functioning and disability and quality of life related to health. RESULTS: It is observed that there is a difference between samples ISSSTE vs. IMSS in comorbidity conditions (ISSSTE 53.4% vs. IMSS 57.9%), nutritional status (malnutrition risk ISSSTE 25.8% us. IMSS 36.4%; overweight ISSSTE 23.3% vs. IMSS 11.6%) (p < 0.05). There were no differences between samples IMSS us. ISSSTE in cognitive function, depression, use of health services, abdominal obesity, functioning and disability, and quality of life related to health. CONCLUSIONS: The conditions of health and wellness in older adults beneficiaries to ISSSTE and IMSS users are similar, with meaning in comorbidity conditions, nutritional status.

[Involvement of matrix metalloproteinases in acute coronary syndrome (ACS)]. / Participación de las metaloproteinasas de matriz en el síndrome isquémico coronario agudo (SICA).

Matrix metalloproteinases (MMP) are enzymes that degrade extracellular matrix (ECM) proteins and regulate both their accumulation and composition. The MMP are involved in the atherosclerotic process since they contribute to the formation of the plaque and its subsequent rupture. This last step triggers the myocardial ischemia that will be clinically reflected as an acute coronary syndrome (ACS). Thus, MMP activity is a key to whether ACS develops or not. With an elevated transcription rate of the genes that codify these proteinases comes a higher enzymatic activity. This explains that if a polymorphism in the mentioned genes modifies transcription, there could be a predisposition to developing ACS. Several studies reveal that certain genetic variations in MMP-1, -2, -3, -7, -8, -9, -12, and -14 have an important role either as risk factors or as protective factors for the expression of ACS.

Multifactor Dimensionality Reduction Analysis to Evaluate the Association of Dopamine Beta-Hydroxylase (DΒH) Polymorphisms with Susceptibility to Dementia (SADEM Study).

Dementia is a multifactorial disease in which environmental, lifestyle, and genetic factors intervene. Population studies have been used in looking for the susceptibility genes for this disease. Since the activity of dopamine b hydroxylase (DßH) is reduced in the hippocampus and neocortex in the brain, changes in the physiological status of dopamine have been reported in Alzheimer's disease (AD) induced by this enzyme. Therefore, DBH polymorphisms have been associated with susceptibility to some neurological diseases such as AD, but few studies have investigated the relationship between these polymorphisms with other types of dementia, especially in Mexican populations. The aim of this study was to evaluate the association between single-nucleotide polymorphism (SNP) in the dopamine b-hydroxylase (DBH gene (rs1611115) and their interactions with environmental factors and the dementia risk. We examined the genotype of the gene DBH (rs1611115) polymorphism in patients with dementia and healthy. The interaction and the impact of DBH (rs1611115) polymorphism on dementia were examined through multifactor dimensionality reduction (MDR) analysis, and the results were verified by the Chi-square test. Hardy-Weinberg equilibrium (HWE) was also checked by the Chi-square test. The relative risk was expressed by odds ratio (OR) and 95%. A total of 221 dementia patients and 534 controls met the inclusion criteria of MDR analyses. The results of the MDR analysis showed that the development of dementia was positively correlated with interaction between the TT genotype of the DBH1 locus rs1611115 TT and diabetes, hypertension, and alcohol consumption (OR = 6.5: 95% CI = 4.5-9.5), originating further cognitive damage. These findings provide insight into the positive correlation between the metabolism and cardiovascular disorders and the presence of the T allele by means of a recessive model of DBH rs1611115 polymorphism with the suspensibility of dementia.

ABO gene polymorphisms are associated with acute coronary syndrome and with plasma concentration of HDL-cholesterol and triglycerides.

The role of ABO gene polymorphisms in acute coronary syndrome (ACS) and lipid metabolism is increasingly recognized. We investigated whether ABO gene polymorphisms are significantly associated with ACS and the plasma lipid profile. Six ABO gene polymorphisms (rs651007 T/C, rs579459 T/C, rs495928 T/C, rs8176746 T/G, rs8176740 A/T, and rs512770 T/C) were determined by 5'exonuclease TaqMan assays in 611 patients with ACS and 676 healthy controls. The results demonstrated that the rs8176746 T allele was associated with a lower risk of ACS under the co-dominant, dominant, recessive, over-dominant, and additive models (P = 0.0004, P = 0.0002, P = 0.039,  P = 0.0009, and P = 0.0001, respectively). Furthermore, under co-dominant, dominant, and additive models, the rs8176740 A allele was associated with a lower risk of ACS (P = 0.041, P = 0.022, and P = 0.039, respectively). On the other hand, the rs579459 C allele was associated with a lower risk of ACS under the dominant, over-dominant, and additive models (P = 0.025, P = 0.035, and P = 0.037, respectively). In a subanalysis performed with the control group, rs8176746 T and rs8176740 A alleles were associated with low systolic blood pressure and with both high high-density lipoprotein-cholesterol (HDL-C) and low triglyceride plasma concentrations, respectively. In conclusion, ABO gene polymorphisms were associated with a lower risk of ACS, and lower systolic blood pressure and plasma lipid levels, suggesting a causal relationship between ABO blood groups and the incidence of ACS.

Prevalence of mild cognitive impairment and its subtypes in the Mexican population.

BACKGROUND/AIM: To estimate the prevalence of mild cognitive impairment (MCI) and its subtypes, taking into account education and health status. METHODS: This is the first report of our Study on Aging and Dementia in Mexico. This study included 2,944 elderly individuals 60 years old or more with in-home assessment for cognitive impairment. The prevalence of MCI was based on Petersen criteria. MCI was classified as amnestic of single domain (a-MCI-s) or multiple domain (a-MCI-md) or nonamnestic of single domain (na-MCI-s) or multiple domain (na-MCI-md). In addition to a battery of neuropsychological measures, a self-report depression measure and a medical history including history of stroke, heart disease and other health conditions were recorded. RESULTS: The global estimated prevalence of MCI in the Mexican population was 6.45%. Of these subjects, 2.41% met criteria for a-MCI-s, 2.56% for a-MCI-md, 1.18% for na-MCI-s and 0.30% for na-MCl-md. Women showed a higher prevalence of MCI than men (63.7 vs. 36.3%, respectively). The analysis showed that heart disease [odds ratio (OR) 1.5], stroke (OR 1.2) and depression (OR 2.1) were associated with an increased risk of MCI. CONCLUSIONS: The prevalence of MCI in Mexico is similar to that in other countries. The results suggest that stroke, heart disease and depression may have an important role in the etiology of MCI.

Drug-drug interactions at hospital admission in geriatric patients in a single facility: a retrospective study.

BACKGROUND: Individuals older than 60 years of age have multiple simultaneous diseases, for which the average number of medications is greater than five, leading up to 3% possibility of having an adverse reaction event. OBJECTIVE: To detect potential drug-drug interactions (PDDIs) and report the average hospital stay for severity potential PPIs, in adults 60 years of age and older in an Internal Medicine Service. METHODS: This was a retrospective analysis with a review of the clinical records of patients 60 years of age and older. The length of stay, number and type of prescribed daily medications, PDDIs, and number of admission diagnoses for each patient, were reviewed. RESULTS: This study included 342 patients with an average and standard deviation of 6 ± 3.0 medications per day. The PDDI levels were 27 (7.9%) severe, 94 (27.5%) moderate, and 61 (17.8%) had both types of interactions. Severe interactions, presented a hospital stay of 10 days, and moderate interaction a 13-day stay. CONCLUSION: The most common interactions and their average length of stay may be utilized for quality evaluation of the medication process of such a major patient population as that of the older adult in the hospital setting.

[Pemphigus vulgaris with exclusive affectation in the esophagus: a case report]. / Pénfigo vulgar con afectación exclusiva en el esófago: reporte de un caso.

Background: Pemphigus vulgaris comprises a group of heterogeneous blistering autoimmune diseases of the skin and mucosa. Esophageal involvement within pemphigus vulgaris is rare with an uncertain prevalence that requires a detailed diagnostic and a therapeutic approach. Clinical case: 37-year-old female, with a history of treatment with Cox-2 inhibitors due to herniated disc. She is sent to the Gastroenterology Service for weight loss of approximately 5 kilos in a month, with the presence of dysphagia, odynophagia and retrosternal pain with poor tolerance to the oral route. Endoscopy was performed, which reported esophagitis dissecans superficialis (EDS), erythematous gastropathy of the antrum and normal duodenum. Findings were correlated with the diagnosis of pemphigus vulgaris with exclusive involvement of the esophagus. The evaluation did not identify lesions on the skin, oral cavity or other mucous membranes. A new endoscopy was performed as a control and it was found immunofluorescence of the esophageal biopsy reactive to IgG 2. Initial management was given with glucocorticoids, anti-inflammatories and immunosuppressants. Conclusions: The importance of the study of pemphigus lies not only in the high associated morbidity and mortality, but also in its intrinsic rarity and the complexity of its detection, given that patients usually take several months to have an accurate diagnosis and even more time to achieve therapeutic goals. It is a priority the dissemination of the study of pemphigus among health professionals involved in its detection.

Introducción: el pénfigo vulgar comprende un grupo de enfermedades heterogéneas autoinmunes ampollosas de la piel y las mucosas. La afectación esofágica en el pénfigo vulgar es rara, con una prevalencia incierta que requiere un abordaje diagnóstico y terapéutico detallado. Caso clínico: mujer de 37 años, con antecedentes de tratamiento con inhibidores de la Cox-2 debido a hernia discal. Se envió a Gastroenterología por pérdida de peso de aprox. 5 kg en un mes. La paciente tuvo presencia de disfagia, odinofagia y dolor retroesternal con pobre tolerancia a la vía oral. Se hizo endoscopía que reportó esofagitis disecante superficial y gastropatía eritematosa de antro; el duodeno estaba en estado normal. Los hallazgos se correlacionaron con el diagnóstico de pénfigo vulgar con afectación exclusiva a esófago. En la valoración no se identificaron lesiones en piel, cavidad oral u otras mucosas. Se hizo nueva endoscopía como control y se encontró inmunofluorescencia de biopsia esofágica reactiva a IgG 2. Se dio manejo inicial con glucocorticoides, antiinflamatorios e inmunosupresores. Conclusiones: la importancia del estudio del pénfigo radica no solo en la alta morbimortalidad asociada, sino en lo raro y complejo de su detección, pues los pacientes suelen tardar varios meses en tener un diagnóstico certero y aún más en conseguir las metas terapéuticas. Es prioritaria la difusión del estudio del pénfigo entre los profesionales de la salud involucrados en su detección.