الملخص
Resumen Antecedentes: La cirrosis hepática es una causa importante de morbilidad y mortalidad en el mundo. En México, constituye una las primeras seis causas de muerte. Objetivo: Analizar los datos epidemiológicos derivados del estudio de Global Burden of Disease y su relación con los factores de riesgo asociados al desarrollo de hepatopatías crónicas en México. Material y métodos: Se realizó el análisis de datos provenientes del Instituto para la Medición y Evaluación de la Salud y del Instituto Nacional de Estadística y Geografía. Resultados: La cirrosis hepática tiene una prevalencia alta en México, con una carga de enfermedad importante traducida en años perdidos de vida saludable, por muerte prematura y por discapacidad. La mortalidad por cirrosis ocupó el sexto lugar (3.6 %) en 2021 y fue la octava causa de años de vida saludable perdidos (2.8 %). De 1990 a 2021, la tasa de mortalidad se incrementó de 26.7 a 34.2 por 100 000 habitantes. Conclusiones: La carga de enfermedad por cirrosis hepática se continúa derivando del consumo de alcohol y de la hepatitis C; la prevalencia de la cirrosis causada por enfermedad hepática esteatósica se ha incrementado en la última década. Existen cambios epidemiológicos en la frecuencia y carga de la hepatopatía crónica que muestra variaciones territoriales en México.
Abstract Background: Liver cirrhosis is a major cause of morbidity and mortality worldwide. In Mexico, it is one of the six leading causes of death. Objective: To analyze epidemiological data derived from the Global Burden of Disease study and their relationship with risk factors associated with the development of chronic liver diseases in Mexico. Material and methods: An analysis of data from the Institute for Health Metrics and Evaluation and the National Institute of Geography and Statistics was carried out. Results: Liver cirrhosis has a high prevalence in Mexico, with significant burden of disease translating into lost years of healthy life, premature death and disability. Mortality due to cirrhosis ranked sixth (3.6%) in 2021 and was the eighth cause of years of healthy life lost (2.8%). From 1990 to 2021, the mortality rate increased from 26.7 to 34.2 per 100,000 population. Conclusions: The burden of disease due to liver cirrhosis continues to be caused by alcohol consumption and hepatitis C; cirrhosis caused by steatotic liver disease has increased in terms of prevalence over the past decade. There are epidemiological changes in the frequency and burden of chronic liver disease that show territorial variations in Mexico.
الملخص
ABSTRACT Background: Risk factors for coronavirus disease (COVID-19) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) asymptomatic carriage (AC) in healthcare workers (HCWs) have been scarcely characterized. Objective: The objective of the study was to study factors associated with COVID-19 and AC in HCWs of a COVID-19 academic medical center. Methods: This is a case-control study. Cases were either symptomatic or asymptomatic HCWs with a positive SARS-CoV-2 polymerase chain reaction (PCR) test result between March 16 and May 21 of 2020. Adjusted odds ratios (aOR) were calculated by means of multivariable logistic regression. In addition, each subject was followed for 14 days to inform outcomes. Results: One hundred thirty of 249 (52.2%) symptomatic HCWs had COVID-19; 10 were hospitalized but none died. Of 987 asymptomatic HCWs, 37 (3.7%) were AC; 6 of the remaining 950 asymptomatic HCWs with a negative PCR test result were found to be presymptomatic COVID-19 cases the following 14 days. Nurses were more frequently present in the COVID-19 group (51.5% vs. 37.0%), but multivariable analysis rendered non-significant results. After adjustment for age, comorbidities, and working place, factors found to be associated with AC were: working in wards as a nurse (aOR = 9.19, 95% confidence interval [CI] = 1.05-80.22, p = 0.045), kitchen personnel (aOR = 4.09, 95% CI = 1.55-10.83, p = 0.005), and being a physician (aOR = 0.12, 95% CI = 0.03-0.54, p = 0.006). Conclusions: HCW category was the predominant factor associated with AC of SARS-CoV-2 in this study.
الملخص
Resumen Objetivo: Describir la submuestra de adultos para el análisis de biomarcadores de enfermedades crónicas, así como los tamaños de muestra (n) y la representatividad de las mismas en la Encuesta Nacional de Salud y Nutrición 2016. Material y métodos: Se calculó una submuestra con representatividad nacional para la obtención de sangre, suero y orina en adultos. Se comparó la prevalencia de variables de interés para las submuestras. Resultados: Las n obtenidas de suero y orina fueron de 4 000 y 3 782 adultos con al menos un valor en algún marcador bioquímico sérico y marcadores de orina, respectivamente. Esta n varió con el agrupamiento de marcadores y selección por horas de ayuno. No se observaron diferencias en la distribución de las variables de interés entre las muestras de hogar, sangre y orina. Conclusión: Los datos ponderados de las submuestras de marcadores en orina, suero y sangre son comparables con la muestra total de adultos de la encuesta. Los datos de las submuestras permitirán monitorear la distribución de enfermedades crónicas en México, incluidas las alteraciones en función hepática, renal, y consumo de sodio.
Abstract Objective: To describe the adult subsample for the analysis of biomarkers of chronic diseases, as well as the sample sizes (n) and representativity of the Encuesta Nacional de Salud y Nutrición (Ensanut) 2016. Materials and methods: An adult subsample with national representativity was calculated to obtain blood, serum and urine samples. The prevalence of variables of interest was compared for each subsample. Results: The n for at least one serum biomarker and urine samples were 4 000 and 3 782, respectively. The n varied depending on the grouping of biomarkers and fasting time selection. No differences were observed in the distribution of variables between the whole sample, urine and blood biomarkers samples. Conclusion: The weighted subsamples of urine, serum and blood biomarkers are comparable to the weighted sample of adults in the survey. The data of the subsample will allow to monitor the distribution of chronic diseases in Mexico, including altered function of liver and kidney, and sodium intake.
الموضوعات
Adult , Humans , Biomarkers , Chronic Disease/epidemiology , Nutrition Surveys , Mexico/epidemiologyالملخص
ABSTRACT Background: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. Objective: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). Methods: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. Results: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. Conclusions: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.
الموضوعات
Humans , Male , Female , Adult , Middle Aged , Aged , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Pandemics , Betacoronavirus , Severity of Illness Index , Biomarkers/blood , Abdominal Pain/epidemiology , Body Mass Index , Comorbidity , Treatment Outcome , Critical Care , Dyspnea/etiology , Tertiary Care Centers/statistics & numerical data , Ambulatory Care , Gastrointestinal Diseases/epidemiology , SARS-CoV-2 , COVID-19 , Inpatients/statistics & numerical data , Mexico , Obesity/epidemiologyالملخص
Resumen: En el escenario de la salud mexicana, la epidemia por virus de la hepatitis C se encuentra presente junto con sus comorbilidades y mortalidad prematura. Actuar de manera inmediata permitirá una contención de la misma en el corto plazo dada la existencia de herramientas de prevención, diagnóstico y terapias farmacológicas altamente eficaces. La Coalición para el estudio de la hepatitis C en México ha desarrollado una postura donde aprovecha esas medidas de contención y presenta el desarrollo de un programa nacional para la detección, tratamiento oportuno y seguimiento de pacientes con hepatitis C.
Abstract: In the Mexican health scenario, the hepatitis C virus epidemic is present, along with its comorbidities and premature mortality. Acting immediately will allow its containment in short term with the proper implementation of the current available tools for prevention, diagnosis and highly effective pharmacological therapies. The Coalition for the study of hepatitis C in Mexico has developed a position paper that takes advantage of these containment measures and presents the development of a National program for the detection, timely treatment and follow-up of patients with hepatitis C.