The impact of an integrative healthcare system on longevity in a nonagenarian population in Northern Mexico: an observational study.

BACKGROUND: Despite the growth in the older population, there is a noticeable research gap regarding integrative health systems for older people and their impact on longevity in nonagenarians. This study aimed to evaluate the effect of an integrative health system consisting of medical services, recreational facilities, and housing on longevity in a population of nonagenarians in Northern Mexico. METHODS: This was a cross-sectional, retrospective, descriptive-analytical study in which we measured and analyzed medical history such as number of hospitalizations, visits to geriatric consultation, hypertension, history of chronic pain, polypharmacy, dementia, rheumatic disease, diabetes mellitus, insomnia, depression, ischemic cardiomyopathy, among others. We also measured social engagement and number of caregivers. A logistic regression was performed to evaluate the predictors of mortality in this population. RESULTS: We included one hundred and ninety-five nonagenarians with a mean (SD) age of 94 (4.2) years and of which 112 (55.7%) were female. The findings from logistic regression analysis indicated that a higher frequency of hospitalizations was associated with an elevated mortality risk (OR = 1.272, p = 0.049). Conversely, increased visits to geriatric consultation services as primary care were linked to a reduced mortality risk (OR = 0.953, p = 0.002). Additionally, social engagement displayed a protective effect (OR = 0.336, p = 0.05). CONCLUSIONS: This study highlighted the role of systemic health approaches in extending life through insights into nonagenarian patients' involvement in primary care, as measured by consultation frequency, and participation in social activities, mitigating mortality risks. Meanwhile, it emphasized the potential consequences of higher hospitalization rates on increased mortality risk.

Effectiveness of different booster vaccine combinations against SARS-CoV-2 during a six-month follow-up in Mexico and Argentina.

Introduction: Given the limited number of patients in Latin America who have received a booster dose against the COVID-19, it remains crucial to comprehend the effectiveness of different vaccine combinations as boosters in real-world scenarios. This study aimed to assess the real-life efficacy of seven different vaccine schemes against COVID-19, including BNT162b2, ChAdOx1-S, Gam-COVID-Vac, and CoronaVac as primary schemes with either BNT162b2 or ChAdOx1-S as booster vaccines. Methods: In this multicentric longitudinal observational study, participants from Mexico and Argentina were followed for infection and SARS-CoV-2 Spike 1-2 IgG antibodies during their primary vaccination course and for 185 days after the booster dose. Results: A total of 491 patients were included, and the booster dose led to an overall increase in the humoral response for all groups. Patients who received BNT162b2 exhibited the highest antibody levels after the third dose, while those with primary Gam-COVID-Vac maintained a higher level of antibodies after six months. Infection both before vaccination and after the booster dose, and Gam-COVIDVac + BNT162b2 combination correlated with higher antibody titers. Discussion: The sole predictor of infection in the six-month follow-up was a prior COVID-19 infection before the vaccination scheme, which decreased the risk of infection, and all booster vaccine combinations conveyed the same amount of protection.

Effect of the SARS-CoV-2 pandemic on metabolic control in patients with type 2 diabetes: a 5-year cohort follow-up managed by a dynamic multidisciplinary team in Northeastern Mexico.

BACKGROUND: The SARS-CoV-2 pandemic brought a radical shift in the healthcare system and suboptimal care for vulnerable patients, such as those with Type 2 Diabetes Mellitus (T2D). Therefore, we compared metabolic control and macro/microvascular complications of patients with T2D before and throughout the three-year SARS-CoV-2 pandemic. RESEARCH DESIGN AND METHODS: A retrospective observational cohort of subjects with T2D studied from 2018 to 2022 in Northern Mexico was treated by a dynamic multidisciplinary team. Levels of Glycated hemoglobin (HbA1c), fasting serum glucose (FG), LDL-Cholesterol (LDL-C), blood pressure (BP), albuminuria, triglycerides, Body Mass Index (BMI), and FIB-4 score, micro and macrovascular complications were evaluated. RESULTS: A total of 999 patients were studied, 51.7% males with a mean (SD) age of 60.1 (12.7) years. Adequate glycemic control based on HbA1c increased by 15.2% and 42.3% in FSG (p < 0.001) between the beginning 2018 and the end of 2022. LDL-C control decreased by 5.1% between 2018 and 2022 (p < 0.001). Systolic BP control decreased by 2.6% (p < 0.001), whereas diastolic BP control increased by 1.8% (p = 0.01) between 2018 and 2022. Albuminuria control increased by 8.5% (p = 0.002). When comparing the Area Under the Curve (AUC) of metabolic parameters between patients who developed SARS-CoV-2 vs. those who did not, AUC was statistically higher in those who developed SARS-CoV-2 (p < 0.05). Diabetic neuropathy was the most prevalent microvascular complication (n = 35; 3.6%); ischemic heart disease was the most frequent macrovascular complication (n = 11;1.1%). CONCLUSIONS: A multidisciplinary dynamic team that adapts to the pandemic SARS-CoV-2 maintains and increases metabolic control in subjects with type 2 diabetes in Mexico. This represents a low percentage of chronic complications. The AUC of metabolic parameters of subjects with SARS-CoV-2 infection is higher, reflecting more variability in metabolic control.

Association of vaccine status, reinfections, and risk factors with Long COVID syndrome.

The COVID-19 pandemic had a profound global impact, characterized by a high fatality rate and the emergence of enduring consequences known as Long COVID. Our study sought to determine the prevalence of Long COVID syndrome within a population of Northeastern Mexico, correlating it with patients' comorbidities, number of COVID-19 reinfection, and vaccination status. Employing an observational cross-sectional approach, we administered a comprehensive questionnaire covering medical history, demographics, vaccination status, COVID-related symptoms, and treatment. Our participant cohort included 807 patients, with an average age of 41.5 (SD 13.6) years, and women accounting 59.3% of the cohort. The follow-up was 488 (IQR 456) days. One hundred sixty-eight subjects (20.9%) met Long COVID criteria. Long COVID-19 was more prevalent when subjects had reinfections (p = 0.02) and less frequent when they had a complete vaccination scheme (p = 0.05). Through logistic regression, we found that male gender (OR 0.5, p ≤ 0.001), blood types of AB- (OR 0.48, p = 0.003) and O- (OR 0.27, p ≤ 0.001) in comparison with A+ and two doses of vaccines (OR 0.5, p = 006) to be protective factors against Long COVID; while higher BMI (OR 1.04, p = 0.005) was a risk factor. We saw that the prevalence of Long COVID was different within vaccinated patients and specific blood types, while being female and a higher BMI were associated with an increased risk of having long-COVID.

Temperature Differences Between Controlled Primary Hypothyroidism and Healthy Patients: An Exploratory Study.

Introduction: Hypothyroidism is conventionally treated with replacement therapy through levothyroxine (LT4). Despite the improvement in symptoms, cold intolerance persists in some patients. The present study aims to determine whether there is a difference in temperature perception and skin temperature between patients with primary controlled hypothyroidism (PCH) and a group of healthy controls matched for body mass index and age. Secondarily we aimed to determine difference in quality of life. Methodology: Skin temperature measurements were performed in both groups, both in the central and peripheral regions of the body. In addition, subjects were asked about their perception of temperature in a temperature-controlled room; anthropometric measurements were taken, their quality of life was assessed using the ThyPRO-39, and a thyroid hormone profile was performed. Results: Eleven patients in the PCH group and 30 patients in the control group were studied. It was found that the group with PCH presented a significantly lower palmar temperature than the control group [mean (SD) of 32.05 (1.79) vs 33.10 (1.30) oC, P = .046]. A mediation model showed a direct effect. Temperature perception was equal between groups. The median (interquartile range) of ThyPRO was 8 (5.2) points in the control group vs 21.8 (13.5) in the group of controlled hypothyroidism, P < .001. Discussion: These results suggest that, despite LT4 treatment, patients continue to present abnormalities in thermogenesis-related thermogenesis, and this may be due to a lack of hormonal adaptation to environmental changes and physiological demands, leading to lower body temperatures and increased sensitivity to cold.

Analyzing the Interplay between COVID-19 Viral Load, Inflammatory Markers, and Lymphocyte Subpopulations on the Development of Long COVID.

The global impact of the SARS-CoV-2 infection has been substantial, affecting millions of people. Long COVID, characterized by persistent or recurrent symptoms after acute infection, has been reported in over 40% of patients. Risk factors include age and female gender, and various mechanisms, including chronic inflammation and viral persistence, have been implicated in long COVID's pathogenesis. However, there are scarce studies in which multiple inflammatory markers and viral load are analyzed simultaneously in acute infection to determine how they predict for long COVID at long-term follow-up. This study explores the association between long COVID and inflammatory markers, viral load, and lymphocyte subpopulation during acute infection in hospitalized patients to better understand the risk factors of this disease. This longitudinal retrospective study was conducted in patients hospitalized with COVID-19 in northern Mexico. Inflammatory parameters, viral load, and lymphocyte subpopulation during the acute infection phase were analyzed, and long COVID symptoms were followed up depending on severity and persistence (weekly or monthly) and assessed 1.5 years after the acute infection. This study analyzed 79 patients, among them, 41.8% presented long COVID symptoms, with fatigue being the most common (45.5%). Patients with long COVID had higher lymphocyte levels during hospitalization, and NK cell subpopulation levels were also associated with long COVID. ICU admission during acute COVID-19 was also linked to the development of long COVID symptoms.

Efficacy of Six Different SARS-CoV-2 Vaccines during a Six-Month Follow-Up and Five COVID-19 Waves in Brazil and Mexico.

Comparisons among the different vaccines against SARS-CoV-2 are important to understand which type of vaccine provides more protection. This study aimed to evaluate the real-life efficacy through symptomatic infection and the humoral response of six different vaccines against SARS-CoV-2-BNT162b2, mRNA-1273, ChAdOx1-S, CoronaVac, Ad26.COV2, and Ad5-nCoV. This multicentric observational longitudinal study involved hospitals from Mexico and Brazil in which volunteers who received complete vaccination schemes were followed for 210 days after the last dose. SARS-CoV-2 Spike 1-2 IgG levels were taken before receiving the first vaccine, 21 days after each dose, and the last sample at six months (+/-1 month) after the last dose. A total of 1132 individuals exposed to five COVID-19 waves were included. All vaccines induced humoral responses, and mRNA vaccines had the highest antibody levels during follow-up. At six months, there was a decline in the SARS-CoV-2 Spike 1-2 IgG antibody titers of 69.5% and 36.4% in subjects with negative and positive history of infection respectively. Infection before vaccination and after complete vaccination scheme correlated with higher antibody titers. The predictors of infection were vaccination with CoronaVac compared to BNT162b2 and ChAdOx1-S. In the presence of comorbidities such as diabetes, rheumatoid arthritis, or dyslipidemia, CoronaVac lowered the risk of infection.

Evaluation of Transplacental Antibody Transfer in Pregnant Women Immunized with Different SARS-CoV-2 Homologous or Heterologous Schemes.

There is scarce information related to transplacental antibody transfer against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with different homologous and heterologous vaccination schemes. This study aimed to correlate the magnitude of transplacental transfer anti-SARS-CoV-2 antibodies in different homologous and heterologous schemes. An observational cross-sectional study was developed to identify pregnant women vaccinated against SARS-CoV-2. They were questioned about their immunization status; blood samples from the mother, umbilical cord during labor, and the newborn 72 h after birth were taken to measure anti-S1 and anti-S2 specific IgG antibodies for SARS-CoV-2. We recruited 104 women with a median age of 29 (SD 1.17). We found antibodies in all newborns with vaccinated mothers. Homologous BNT162b2 mRNA regimen had the highest mean (SD) antibody titers (AU/mL) in maternal (994.93 (3.08), p = 0.039), umbilical cord (1316.43 (2.79), p = 0.016), and newborn (1192.02 (3.55), p = 0.020) blood. The generalized linear model showed a positive effect over antibodies with at least one dose in maternal (ß = -1.1, p = 0.002) and newborn (ß= -0.717, p = 0.044) blood, and with two doses (ß = -0.684, p = 0.026) in umbilical cord blood. In conclusion, antibodies were detected in all vaccinated women and their newborns. Transfer of antibodies was found from the first dose, and the levels increased with the number of vaccine doses. Vaccination should be encouraged in pregnant women with any available scheme.

Viral load and its relationship with the inflammatory response and clinical outcomes in hospitalization of patients with COVID-19.

Background: The values of viral load in COVID-19 disease have gained relevance, seeking to understand its prognostic value and its behavior in the course of the disease, although there have been no conclusive results. In this study we sought to analyze serum viral load as a predictor of clinical outcome of the disease, as well as its association with inflammatory markers. Methods: An observational and retrospective study in a private hospital in North Mexico, patients with SARS-COV-2 infection confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) were followed through clinical outcome, viral load measurement, quantification of inflammatory markers and lymphocyte subpopulations. For the analysis, multiple regression models were performed. Results: We studied 105 patients [47 (SD 1.46) years old, 68.6% men]. After analysis with multiple regression models, there was an association between viral load at admission and vaccination schedule (ß-value=-0.279, p= 0.007), age (ß-value= 0.010, p = 0.050), mechanical ventilation (ß-value= 0.872, p = 0.007), lactate dehydrogenase (ß-value= 1.712, p= 0.004), D-dimer values at admission (ß-value= 0.847, p= 0.013) and subpopulation of B lymphocytes at admission (ß-value= -0.527, p= 0.042). There was no association with days of hospitalization, use of nasal prongs or high flux mask. Peak viral load (10 days after symptoms onset) was associated with peak IL-6 (ß-value= 0.470, p= 0.011). Peak viral load matched with peak procalcitonin and minimal lymphocyte values. C-reactive protein peak was before the peak of viral load. The minimum value viral load was documented on day 12 after symptom onset; it matched with the minimum values of IL-6 and ferritin, and the peak of D-dimer. Conclusions: SARS-COV-2 admission viral load is associated with vaccination status, mechanical ventilation, and different inflammatory markers.

Satisfacción en simulación clínica en estudiantes de medicina / Medical students' satisfaction with clinical simulation

Introducción: El avance tecnológico ha generado cambios en los procesos de enseñanza-aprendizaje. Con la simulación clínica existen resultados controversiales. La satisfacción del estudiante se relaciona con el nivel de aprendizaje adquirido. Objetivo: Identificar el nivel de satisfacción con el uso de simulación clínica durante la formación académica de estudiantes de medicina. Métodos: Estudio descriptivo, transversal y observacional, realizado entre agosto-noviembre de 2019 en el Laboratorio de Simulación Clínica de la Universidad de Monterrey. Se incluyeron estudiantes de medicina, y se excluyendo los repetidores y con inasistencias. Se eliminaron las encuestas incompletas en variables principales. La muestra censal fue n = 509. Se utilizó la encuesta de Calidad y Satisfacción en Simulación Clínica (Alfa de Cronbach .861), tipo Likert de 1-5, con 3 componentes: aprendizaje significativo, estructura de la simulación y relación interpersonal. Se realizaron estadísticas descriptivas. Resultados: Predominaron el sexo masculino 54,8 por ciento (279) y la edad promedio 21,8 años (DE 4.1). La mediana del puntaje de la escala resultó 73 (15-75). El nivel de satisfacción más alto se obtuvo en el séptimo semestre con 74 (15-75) y en Cirugía general con 75 (75-59). Los reactivos con mayor porcentaje de respuesta "Muy de acuerdo" fueron: "La capacitación del profesorado es adecuada" 90,8 por ciento (462) y La simulación es un método docente útil para el aprendizaje 89,4 por ciento (455); y con menor puntuación La duración del caso es adecuada 61,1 por ciento (311) y En simulación, es útil el ver las propias actuaciones grabadas 61,3 por ciento (312). Conclusión: Existe un alto nivel de satisfacción con el uso de simulación clínica durante la formación de estudiantes de medicina(AU)

Introduction: Technological development has produced changes in the teaching-learning processes. Clinical simulation also shows controversial results. Student satisfaction is related to acquired level of learning. Objective: To identify the level of satisfaction of medical students with the use of clinical simulation during their academic training. Methods: Descriptive, cross-sectional and observational study carried out, between August and November, 2019, at the Clinical Simulation Laboratory of University of Monterrey. Medical students were included, except for students repeating their studies and those who were used to being absent. Surveys incomplete on main variables were eliminated. The census sample was n=509. The Quality and Satisfaction Survey of Clinical Simulation (Cronbach's Alpha .861) was used, Likert type 1-5, with three components: significant learning, simulation structure and interpersonal relationship. Descriptive statistics were made. Results: The male sex predominated 54.8 percent (279), while the average age was 21.8 years (SD 4.1). The median of the scale score was 73 (15-75). The highest level of satisfaction was obtained in the seventh semester, accounting for 74 (15-75) and in General Surgery, accounting for 75 (75-59). The items with the highest percentage of Strongly agree were Teacher training is adequate (90.8 percent: 462) and Simulation is a useful teaching method for learning (89.4 percent: 455). The lower score corresponded to The case duration is adequate (61.1 percent 311) and In simulation, it is useful to watch recorded performances themselves (61.3 percent 312). Conclusion: There is a high level of satisfaction with the use of clinical simulation during the training of medical students(AU)