Prevalencia, tratamiento y control de la hipertensión arterial en adultos mexicanos: resultados de la Ensanut 2022.

OBJETIVO: Describir la prevalencia de hipertensión arterial (HTA), las características del tratamiento y la proporción de adultos mexicanos que tiene tensión arterial (TA) controlada. Material y métodos. Se midió la TA a 8 647 adultos en la Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022). Se consideró que un participante tenía HTA o TA controlada cuando cumplía los criterios de la American College of Cardiology y la American Heart Association (ACC/AHA) o la Eighth Joint National Committee (JNC-8). RESULTADOS: La prevalencia de HTA en adultos fue 47.8% (según criterio del ACC/AHA). De éstos, 65.5% desconocía su diagnóstico. En adultos con diagnóstico previo de HTA, 33.7% tuvo TA controlada. Según la clasificación JNC-8, 29.4% de los adultos tenía HTA y 43.9% ignoraba su diagnóstico. Conclusión. En la Ensanut 2022 la mitad de los adultos tenía HTA y de ellos, tres de cada cinco no habían sido diagnosticados. El sistema de salud debe mejorar sus mecanismos de detección de HTA porque el subdiagnóstico y el mal control de la TA ocasiona discapacidad, mala calidad de vida y mortalidad prematura.

Espacios cardioprotegidos en México: acciones para prevenir la muerte súbita cardiaca. Una postura de profesionales de la salud.

La muerte súbita cardiaca es un problema de salud pública a nivel mundial. Aunque su incidencia no es conocida, se estima que causa hasta 50% de la mortalidad de origen cardíaco y hasta 20% de la mortalidad total en los adultos. En México, estimaciones previas sugieren que causa en promedio 33 000 muertes al año; sin embargo, los datos no son precisos. La  mitad de los eventos por muerte súbita cardiaca se deben a un paro cardiaco súbito extrahospitalario que, de no ser atendido oportunamente, deriva en una muerte súbita cardiaca. Por tanto, la capacidad de responder pronta y adecuadamente a estos eventos con las maniobras y equipos necesarios mejora la sobrevida de las víctimas. Para atender este problema, en algunos estados del país se han creado espacios cardioprotegidos que permiten realizar maniobras de reanimación cardiopulmonar y desfibrilación cardiaca de acceso público oportunamente. Como objetivo, los profesionales de la salud establecen la importancia de implementar espacios cardioprotegidos y crear políticas públicas al respecto en todo el país.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud.

La creciente epidemia de obesidad ha sido uno de los retos más importantes de salud pública en México durante los últimos años. Con apoyo de la Federación Mundial de Obesidad, en 2021 formamos un grupo de profesionales para identificar y resumir las acciones prioritarias en las que puede enfocarse nuestro país para hacer frente a esta epidemia. Al proceso de desarrollo y discusión de este grupo se sumaron más de 1 000 profesionales de la salud para retomar recomendaciones de documentos y guías de alto nivel previamente publicados. En conmemoración del Día Mundial de la Obesidad, en este 2022 se presenta esta postura como insumo para el desarrollo de acciones en el ámbito profesional y de los diferentes sectores, en la que se incluyen 10 recomendaciones de acción, desde la perspectiva poblacional hasta la atención individualizada, y se enfatiza en la importancia de la participación social, de las intervenciones integrales con visión centrada en la persona y de la sostenibilidad planetaria, además de mejorar la educación y las campañas de difusión, propiciar un ambiente promotor de entornos activos y blindar de conflictos de interés los esfuerzos de prevención y control. La postura hace un llamado para abordar la obesidad de manera seria, con base en la evidencia científica, oportuna e integral, con enfoque de curso de vida, de forma ética y sensible, y sin perpetuar las barreras del estigma de peso en la sociedad.

Approach to cardiology residents clinical aptitude evaluation. Multicenter design.

INTRODUCTION: To the best of our knowledge, the research herein presented is the first multicenter study in Mexico to analyze the development of clinical aptitude in medical units that train cardiologists. OBJECTIVE: To determine the degree of development of clinical aptitude in cardiology residents at three High Specialty Medical Units. METHODS: Multicenter, cross-sectional design. All students of the 2019-2020 academic year were included in the study. An instrument was constructed that evaluated clinical aptitude based on eight indicators and 170 items; conceptual/content validity and reliability were assessed by five cardiologists with teaching and educational research experience. RESULTS: By indicator and year of residence, significant statistical differences were observed in the CMN20Nov academic site. At HCSXXI and INCICh, statistically significant differences were observed in one of eight indicators. Differences between R1 residents (n = 41) of all three academic sites were estimated by indicator, with statistical significance being recorded in three of eight indicators. Between R2 (n = 35) and between R3 residents (n = 43), the result was similar. CONCLUSIONS: The degree of clinical aptitude development can be considered intermediate in all three academic sites, probably because the instrument explored problematized clinical situations that required for the residents to critically reflect on their clinical experience.

INTRODUCCIÓN: Hasta donde se tiene conocimiento, la investigación que se presenta constituye el primer trabajo multicéntrico en México que estudia el desarrollo de la aptitud clínica en unidades formadoras de cardiólogos. OBJETIVO: Determinar el grado de desarrollo de la aptitud clínica en residentes de cardiología en tres unidades médicas de alta especialidad. MÉTODOS: Diseño transversal multicéntrico. Se analizaron todos los estudiantes del ciclo académico 2019-2020. Se construyó un instrumento que evaluó la aptitud clínica a partir de ocho indicadores y 170 ítems; la validez conceptual/de contenido y la confiabilidad fueron valoradas por cinco cardiólogos con experiencia docente y en investigación educativa. RESULTADOS: Por indicador y año de residencia se observaron diferencias estadísticas significativas en la sede CMN20Nov; en HCSXXI e INCICh se observaron diferencias estadísticamente significativas en uno de ocho indicadores. Se estimaron diferencias entre residentes R1 (n = 41) de las tres sedes por indicador, con significación estadística en tres de ocho indicadores. El resultado fue semejante al comparar R2 (n = 35) y R3 (n = 43). CONCLUSIONES: El grado de desarrollo de la aptitud clínica se puede considerar medio en las tres sedes académicas, probablemente debido a que el instrumento exploró situaciones clínicas problematizadas que exigieron del residente la reflexión crítica de su experiencia clínica.

May Measurement Month 2019: an analysis of blood pressure screening results from Mexico.

May Measurement Month 2019 (MMM19) in Mexico was an opportunistic survey, aimed to improve blood pressure (BP) awareness at the individual and population levels. This survey followed the methodology of MMM19, previously published. The total number of participants screened was 39 700, 56.7% female, 36.6% were of mixed ethnicity, mean age [standard deviation (SD)] was 46.9 (17.4) years, and mean body mass index was 27.2 (SD: 4.4) kg/m2. Seven per cent of the participants reported having diabetes, 2.4% reported having a myocardial infarction in the past, 1.1% stroke, 2.0% were pregnant at the time of the survey, 3.7% of women had suffered from hypertension in a previous pregnancy, 11.4% declared that they were smokers, and 47.0% drank alcohol at least once a week. After multiple imputations, of all 39 700 participants, 10 140 (25.5%) had hypertension; of all participants with hypertension, 43.8% were aware of their diagnosis, 41.7% were on antihypertensive medication, and 27.8% had controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). Of those on antihypertensive medication, 27.8% had controlled BP. In Mexico, MMM is the largest hypertension survey ever done, it provides complementary data to the existing information on arterial hypertension in the country and helps to increase the visibility of hypertension: a priority health problem.

May Measurement Month 2018: an analysis of blood pressure screening results from Mexico.

In 2015, arterial hypertension was responsible for 18.1% of the total deaths in Mexico and its mortality rate has increased to 29.9% in the last 6 years. It is currently the main risk factor for preventable premature deaths of adults in the country. Good quality epidemiological information is the first step to improve health services. May Measurement Month 2018 (MMM18) in Mexico is an opportunistic survey, which follows the previously published methodology. MMM18 included screening 10 139 participants, 2187 (21.6%) of whom were classified as having hypertension. Of these, 42.0% were aware of the condition before measurement, and 38.0% were on medication, of which 66.5% were controlled. Hence, of all hypertensive patients, 25.3% were controlled (<140/90 mmHg). MMM18 in Mexico provides complementary data to the existing information on arterial hypertension in the country and helps to increase the visibility of hypertension: a priority health problem.

[Prevalence, diagnosis and control of hypertension in Mexican adults with vulnerable condition. Results of the Ensanut 100k]. / Prevalencia, diagnóstico y control de hipertensión arterial en adultos mexicanos en condición de vulnerabilidad. Resultados de la Ensanut 100k.

OBJECTIVE: To describe the prevalence of hypertension (HBP) in adults with vulnerability, the percentage of them with previous diagnosis and the proportion that had adequate control. MATERIALS AND METHODS: Blood pressure was measured in 7 838 adults who participated in the Ensanut 100k. Those who self-reported the diagnosis of HBP or had systolic blood pressure (SBP) ≥130mmHg or diastolic blood pressure (DBP) ≥80mmHg were classified as hypertensive. Controlled blood pressure was considered when SBP was <130mmHg and TAD <80mmHg. RESULTS: The prevalence of hypertension in adults with a vulnerability condition was 49.2%, of which 54.7% did not know had hypertension. Of the hypertensive patients who received pharmacological treatment (69.0%), 66.8% of them had blood pressure under control. CONCLUSIONS: Almost half of Mexican adults in vulnerable condition have HBP and of these more than half do not know that they have this disease. One third of hypertensive adults have inadequate control.

OBJETIVO: Describir la prevalencia de hipertensión arterial (HTA) en adultos en condición de vulnerabilidad, el porcentaje de ellos con diagnóstico previo y la proporción con control adecuado. MATERIAL Y MÉTODOS: Se midió la tensión arterial a 7 838 adultos participantes en la Ensanut 100k. Se clasificó como hipertensos a quienes autorreportaron el diagnóstico de HTA o presentaban tensión arterial sistólica (TAS) ≥130mmHg o tensión arterial diastólica (TAD) ≥80mmHg. Se consideró tensión arterial controlada cuando la TAS fue <130mmHg y la TAD <80mmHg. RESULTADOS: La prevalencia de HTA en adultos en condición de vulnerabilidad fue de 49.2%, de los cuales 54.7% desconocía tener HTA. De los hipertensos que recibían tratamiento farmacológico (69.0%), el 66.8% tuvo tensión arterial controlada. CONCLUSIONES: Casi la mitad de los adultos mexicanos en condición de vulnerabilidad tiene HTA y de ellos, más de la mitad desconoce que tiene esta enfermedad. Asimismo, un tercio de los adultos hipertensos tiene un inadecuado control de su enfermedad.

Development of the Mexican Heart Team: The Long and Winding Road.

Heart failure (HF) is the leading cause of death worldwide. Efforts to decrease HF mortality rates include a multidisciplinary approach management. Although evidence suggests that this has been an optimal strategy for treating HF, the model remains not widely implanted. The current article explores the rationale behind the formation of a Heart Team in a developing country and its development despite the lack of an allocated budget.

Complete revascularization with PCI in STEMI patients with multivessel disease, when is the appropriate time? / Revascularización completa mediante ICP en pacientes con STEMI y enfermedad coronaria multivaso, ¿cuál es el momento adecuado?

Objective: The purpose was to compare the outcomes of patients with ST-elevation myocardial infarction and multivessel coronary artery disease undergoing one-time multivessel revascularization (OTMVR) versus in-hospital staged complete revascularization with percutaneous coronary intervention. Methods: This was a single-center, retrospective, observational, and cohort study, including data from January 2013 to April 2019. A total of 634 patients were included in the study. Comparisons were made between patients who underwent in-hospital staged complete revascularization versus OTMVR. The primary endpoint was all-cause in-hospital mortality, secondary endpoints included cardiovascular complications, all-cause new hospitalization, and mortality evaluated at 30 days and 1 year. In addition, we constructed a logistic regression model for determining the risk factors that predicted mortality. Results: Of the 634 patients, 328 were treated with staged revascularization and 306 with OTMVR. About 76.7% were men, with a mean age of 63.3 years. Less complex coronary lesions and a higher proportion of the left anterior descending artery as the culprit vessel were found in the OTMVR group. Compared with staged revascularization, the primary and secondary endpoints occurred less frequently with OTMVR strategy. Conclusions: OTMVR did not generate more complications and demonstrate better clinical outcomes than in-hospital staged revascularization.

Objetivo: El propósito fue comparar resultados de pacientes con infarto agudo de miocardio con elevación del segmento ST y enfermedad coronaria multivaso sometidos a revascularización completa de un solo momento frente a revascularización completa por etapas mediante intervención coronaria percutánea. Métodos: Estudio cohorte observacional, retrospectivo, unicéntrico, con datos de enero de 2013 a abril de 2019, incluyendo 634 pacientes. Se compararon resultados entre pacientes sometidos a revascularización completa por etapas frente a revascularización completa en un solo momento. El objetivo primario fue valorar mortalidad intrahospitalaria por cualquier causa y como objetivos secundarios se evaluaron a 30 días y 1 año las complicaciones cardiovasculares, hospitalizaciones y mortalidad. Se construyó un modelo de regresión logística para determinar los factores de riesgo que predijeron mortalidad. Resultados: De 634 pacientes, 328 fueron tratados con revascularización por etapas y 306 con revascularización en una intervención. El 76.7% fueron hombres, con una media de edad de 63.3 años. En el grupo de revascularización de un solo tiempo se encontraron lesiones coronarias menos complejas y una mayor proporción de la arteria descendente anterior como vaso culpable. Comparado con el grupo de revascularización por etapas, los objetivos primarios y secundarios ocurrieron con menos frecuencia en el grupo de revascularización en un solo tiempo. Conclusiones: Comparada con la revascularización intrahospitalaria por etapas, la revascularización en una intervención lleva a mejores desenlaces clínicos sin generar más complicaciones.

Reaching blood pressure guideline targets with the CNIC polypill in patients with a previous cardiovascular event in Mexico: a post hoc analysis of the SORS study.

Aim: To determine the effectiveness of Centro Nacional de Investigaciones Cardiovasculares (CNIC)-polypill (acetylsalicylic acid 100 mg, ramipril 5/10 mg, simvastatin 40 mg) in achieving blood pressure (BP) goals. Patients & methods: A multicenter, observational, one cohort, prospective study. BP targets were analyzed in patients with cardiovascular disease after 12-months treatment with the CNIC polypill. Results: A total of 572 patients (59.4 ± 13.9 years, 57.3% men) were analyzed. At baseline, BP was 147.1 ± 18.1/88.3 ± 10.6 mmHg, 97.1% of patients were taken renin-angiotensin system inhibitors, 5.4% calcium antagonists, 1.9% diuretics and 13.1% ß-blockers. The proportion of patients who achieved BP targets increased from 20.1 to 55.4% (p < 0.001). Conclusion: In routine practice, switching from usual care to the CNIC-polypill in patients with cardiovascular disease could facilitate achieving BP goals.

The CNIC-polypill improves atherogenic dyslipidemia markers in patients at high risk or with cardiovascular disease: Results from a real-world setting in Mexico.

BACKGROUND: In many patients, the risk of cardiovascular (CV) events persists despite statin treatment and attaining target LDL-c levels. This residual risk is in part attributed to atherogenic dyslipidemia (AD). We studied the clinical effectiveness of the CNIC-polypill in improving the lipid profile, and lipid ratios and indices indicative of AD that are more accurate in predicting lipid-related CV risk. METHODS: Post-hoc analysis of a multicenter, observational, non-comparative, prospective registry in 533 patients in Mexico. We evaluated blood lipids at baseline (usual care) and after 12 months of treatment with the CNIC-polypill (Sincronium®), including total cholesterol (TC), triglycerides (TG), cholesterol low-density lipoproteins (LDL-c), cholesterol high-density lipoproteins (HDL-c), and cholesterol non-high-density lipoproteins (non-HDL-c). We also calculated and compared AD-related lipid ratios and indices, including remnant cholesterol (RC), Castelli's risk index-I (CRI-I), atherogenic index (AI), atherogenic coefficient (AC), a surrogate of insulin resistance (IRS), atherogenic index of plasma (AIP), and lipoprotein combined index (LCI). RESULTS: At 1 year of treatment, there was a significant reduction in the levels of TC (-22.6%), TG (-29.2%), LDL-c (-13.8%), and non-HDL-c (-29.2%) (all p < 0.001). The likelihood that patients attained their corresponding target LDL-c and TG levels was almost three-fold and seven-fold higher, respectively (p < 0.001). The values of the AD-related ratios RC, CRI-I, AI, AC, AIP, and LCI were all significantly lower (p < 0.001) after one year of treatment. CONCLUSIONS: In patients with or at high risk of CVD, one-year treatment with the CNIC-polypill significantly lowered lipid ratios indicative of AD compared to baseline.

Implications of myocardial injury in Mexican hospitalized patients with coronavirus disease 2019 (COVID-19).

BACKGROUND: Respiratory illnesses is the most common manifestation of Coronavirus disease 2019 (COVID-19); however, myocardial injury has recently emerged as a frequent complication. METHODS: An observational, longitudinal, prospective, and multicenter study of hospitalized Mexican patients was made. We assessed the prevalence of myocardial injury and its relationship with complications and mortality. RESULTS: 254 COVID-19 patients were included. Their average age was 53.8 years old, 167 (65.7%) were male and 87 (34.3%) female. According to troponin levels, two populations were generated, those with and without myocardial injury. There was no difference in gender or age between both groups. However, there was a greater proportion of obesity and hypertension in myocardial injury group. Multivariate logistic regression analysis revealed that obesity (OR 2.029, 95% CI 1.039-3.961; p = 0.038), arterial oxygen saturation <90% (OR 2.250, 95% CI 1.216-3.560; p = 0.025), and systolic blood pressure <90 mmHg (OR 2.636, 95% CI 1.530-4.343; p = 0.042), were directly related to higher levels of troponins. Multivariate cox proportional hazards analysis showed that primary endpoint (mortality) was determined by overweight/obesity (OR 1.290, 95% CI 0.115-0.730; p = 0.009), ferritin levels (OR 1.001, 95% CI 1.000-1.001; p < 0.001), myocardial injury (OR 3.764, 95% CI 1.307-10.838; p = 0.014), septic shock (OR 4.104, 95% CI 1.142-14.132; p = 0.024), acute respiratory distress syndrome (OR 3.001, 95% CI 1.008-10.165; p = 0.040), and treatment with Hydroxychloroquine/Azithromycin (OR 0.357, 95% IC 0.133-0.955; p = 0.040). Secondary endpoint (Mechanical ventilation risk) was associated to the same factors. CONCLUSIONS: Myocardial injury represents an increased risk of complications and death in Mexican hospitalized patients with COVID-19.

Clinical Effectiveness of the Cardiovascular Polypill in a Real-Life Setting in Patients with Cardiovascular Risk: The SORS Study.

BACKGROUND: The cardiovascular disease pandemic has promoted the cardiovascular polypill as one of the most scalable public health strategies to improve cardiovascular risk by increasing accessibility and adherence to treatments. Data from randomized clinical trials has shown that the polypill strategy significantly improves adherence as well as risk factor control (cholesterol and blood pressure), however, to date, no information from phase IV registries has been available. METHODS: We conducted a multicentre, observational and prospective registry of a polypill-based treatment strategy. A total of 1193 patients in Mexico were included. Patient demographics, clinical history, blood pressure, analysis of blood lipids and the Framingham risk score were measured at baseline and after 12 months of treatment with the CNIC-Ferrer polypill. RESULTS: At one year with the polypill, systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels changed from mean 146.9 mmHg to 128 mmHg (p <0.001), and from 89.1 mmHg to 80.4 mmHg (p <0.001) respectively. LDLc levels were significantly reduced 132.5-107.6 mg/dL (p <0.001). The 10 year Framingham cardiovascular disease risk was also reduced in the high-risk group (33.7 + 22.0 vs. 21.2 + 14.8; p <0.001) and in the intermediate risk group (23.7 + 14.8 vs. 12.7 + 11.4; p <0.001). CONCLUSIONS: To our knowledge, the results of the current study constitute the first real life data on the impact of a polypill therapy on cardiovascular risk factor control. The results show major improvements on the primary outcome, above and beyond those presented previously in the setting of randomized clinical trials.

Complete revascularization with PCI in STEMI patients with multivessel disease, when is the appropriate time? / Revascularización completa mediante ICP en pacientes con STEMI y enfermedad coronaria multivaso, ¿cuál es el momento adecuado?

Abstract Objective: The purpose was to compare the outcomes of patients with ST-elevation myocardial infarction and multivessel coronary artery disease undergoing one-time multivessel revascularization (OTMVR) versus in-hospital staged complete revascularization with percutaneous coronary intervention. Methods: This was a single-center, retrospective, observational, and cohort study, including data from January 2013 to April 2019. A total of 634 patients were included in the study. Comparisons were made between patients who underwent in-hospital staged complete revascularization versus OTMVR. The primary endpoint was all-cause in-hospital mortality, secondary endpoints included cardiovascular complications, all-cause new hospitalization, and mortality evaluated at 30 days and 1 year. In addition, we constructed a logistic regression model for determining the risk factors that predicted mortality. Results: Of the 634 patients, 328 were treated with staged revascularization and 306 with OTMVR. About 76.7% were men, with a mean age of 63.3 years. Less complex coronary lesions and a higher proportion of the left anterior descending artery as the culprit vessel were found in the OTMVR group. Compared with staged revascularization, the primary and secondary endpoints occurred less frequently with OTMVR strategy. Conclusions: OTMVR did not generate more complications and demonstrate better clinical outcomes than in-hospital staged revascularization.

Resumen Objetivo: El propósito fue comparar resultados de pacientes con infarto agudo de miocardio con elevación del segmento ST y enfermedad coronaria multivaso sometidos a revascularización completa de un solo momento frente a revascularización completa por etapas mediante intervención coronaria percutánea. Métodos: Estudio cohorte observacional, retrospectivo, unicéntrico, con datos de enero de 2013 a abril de 2019, incluyendo 634 pacientes. Se compararon resultados entre pacientes sometidos a revascularización completa por etapas frente a revascularización completa en un solo momento. El objetivo primario fue valorar mortalidad intrahospitalaria por cualquier causa y como objetivos secundarios se evaluaron a 30 días y 1 año las complicaciones cardiovasculares, hospitalizaciones y mortalidad. Se construyó un modelo de regresión logística para determinar los factores de riesgo que predijeron mortalidad. Resultados: De 634 pacientes, 328 fueron tratados con revascularización por etapas y 306 con revascularización en una intervención. El 76.7% fueron hombres, con una media de edad de 63.3 años. En el grupo de revascularización de un solo tiempo se encontraron lesiones coronarias menos complejas y una mayor proporción de la arteria descendente anterior como vaso culpable. Comparado con el grupo de revascularización por etapas, los objetivos primarios y secundarios ocurrieron con menos frecuencia en el grupo de revascularización en un solo tiempo. Conclusiones: Comparada con la revascularización intrahospitalaria por etapas, la revascularización en una intervención lleva a mejores desenlaces clínicos sin generar más complicaciones.

Aproximación hacia la evaluación de la aptitud clínica en residentes de cardiología. Diseño multicéntrico / Approach to cardiology residents clinical aptitude evaluation. Multicenter design

Resumen Introducción: Hasta donde se tiene conocimiento, la investigación que se presenta constituye el primer trabajo multicéntrico en México que estudia el desarrollo de la aptitud clínica en unidades formadoras de cardiólogos. Objetivo: Determinar el grado de desarrollo de la aptitud clínica en residentes de cardiología en tres unidades médicas de alta especialidad. Métodos: Diseño transversal multicéntrico. Se analizaron todos los estudiantes del ciclo académico 2019-2020. Se construyó un instrumento que evaluó la aptitud clínica a partir de ocho indicadores y 170 ítems; la validez conceptual/de contenido y la confiabilidad fueron valoradas por cinco cardiólogos con experiencia docente y en investigación educativa. Resultados: Por indicador y año de residencia se observaron diferencias estadísticas significativas en la sede CMN20Nov; en HCSXXI e INCICh se observaron diferencias estadísticamente significativas en uno de ocho indicadores. Se estimaron diferencias entre residentes R1 (n = 41) de las tres sedes por indicador, con significación estadística en tres de ocho indicadores. El resultado fue semejante al comparar R2 (n = 35) y R3 (n = 43). Conclusiones: El grado de desarrollo de la aptitud clínica se puede considerar medio en las tres sedes académicas, probablemente debido a que el instrumento exploró situaciones clínicas problematizadas que exigieron del residente la reflexión crítica de su experiencia clínica.

Abstract Introduction: To the best of our knowledge, the research herein presented is the first multicenter study in Mexico to analyze the development of clinical aptitude in medical units that train cardiologists. Objective: To determine the degree of development of clinical aptitude in cardiology residents at three High Specialty Medical Units. Methods: Multicenter, cross-sectional design. All students of the 2019-2020 academic year were included in the study. An instrument was constructed that evaluated clinical aptitude based on eight indicators and 170 items; conceptual/content validity and reliability were assessed by five cardiologists with teaching and educational research experience. Results: By indicator and year of residence, significant statistical differences were observed in the CMN20Nov academic site. At HCSXXI and INCICh, statistically significant differences were observed in one of eight indicators. Differences between R1 residents (n = 41) of all three academic sites were estimated by indicator, with statistical significance being recorded in three of eight indicators. Between R2 (n = 35) and between R3 residents (n = 43), the result was similar. Conclusions: The degree of clinical aptitude development can be considered intermediate in all three academic sites, probably because the instrument explored problematized clinical situations that required the residents to critically reflect on their clinical experience.

Volviéndonos mejores: necesidad de acción inmediata ante el reto de la obesidad. Una postura de profesionales de la salud / Becoming better: the need for immediate action to address obesity. A position statement from health professionals

resumen está disponible en el texto completo

Abstract: In recent decades, the growing obesity epidemic in Mexico has become one of the most important public health challenges faced by the country. With support from the World Obesity Federation, we formed a working group in 2021 to identify and summarize priority actions that Mexico can take to face this epidemic. More than 1 000 health professionals joined the development and discussion process. Recommendations from previously published, high-level documents and guidelines were taken into account. In commemoration of World Obesity Day 2022, this statement is presented as input for health care professionals to develop actions to address obesity. The statement includes 10 recommendations that include population-level and individual-level actions. It emphasizes the importance of social participation, comprehensive interventions with a person- centered perspective, planetary sustainability, on improving education and communication campaigns, as well as fostering a built environment that promotes active living, and shielding prevention and control efforts from conflicts of interest. The statement calls for obesity to be treated seriously, based on scientific evidence, in a timely and comprehensive manner, employing a life-course and ethical approach that does not perpetuate weight stigma in society.

[Purulent pericarditis. Case report]. / Pericarditis purulenta: presentación de un caso y diagnósticos diferenciales.

Purulent pericarditis is an infrequent disease which affects the pericardium and has a high mortality rate. The diagnosis is suspected in a febrile patient with right cardiac failure and a primary infectious source. However, not all patients present in this form therefore the diagnosis and treatment can be difficult and a real challenge. This report is of a patient with this disease and other etiologic possibilities are discussed.

[Ambulatory pacemaker surgery]. / Implantación de marcapasos definitivos en programa de cirugía ambulatoria.

The chronic cardiac stimulation is know since 1958, pacemaker implant was considered a difficult procedure that was performed through cardiovascular surgery and the patient required several in hospital days. On the grounds of new surgical techniques and development of new materials for pacemakers, as well as the rise of Ambulatory Surgery and its application in pacemaker implants, the hospital stay and consequently, costs have decreased significantly. In 1986, Zegelman reported 583 patients subjected to ambulatory pacemaker surgery without mortality. The purpose of this report it to evaluate the efficacy and safety of ambulatory pacemaker surgery. One hundred seventy seven patients from an ambulatory program and 95 from a traditional program were included. Hospitalization time was 15.7 +/- 15.1 hours in the first group and 238 +/- 188 hours for the second, prevalence of complications was 2.2% in the 272 patients. Complications for both groups were similar and were solved, without mortality. We conclude that the ambulatory pacemaker surgery is effective and safe for patients and is cheaper for hospitals. The success of this program depends on the number of implants in each hospital and the operator's experience.

Prevalencia, diagnóstico y control de hipertensión arterial en adultos mexicanos en condición de vulnerabilidad. Resultados de la Ensanut 100k / Prevalence, diagnosis and control of hypertension in Mexican adults with vulnerable condition. Results of the Ensanut 100k

Resumen: Objetivo: Describir la prevalencia de hipertensión arterial (HTA) en adultos en condición de vulnerabilidad, el porcentaje de ellos con diagnóstico previo y la proporción con control adecuado. Material y métodos: Se midió la tensión arterial a 7 838 adultos participantes en la Ensanut 100k. Se clasificó como hipertensos a quienes autorreportaron el diagnóstico de HTA o presentaban tensión arterial sistólica (TAS) ≥130mmHg o tensión arterial diastólica (TAD) ≥80mmHg. Se consideró tensión arterial controlada cuando la TAS fue <130mmHg y la TAD <80mmHg. Resultados: La prevalencia de HTA en adultos en condición de vulnerabilidad fue de 49.2%, de los cuales 54.7% desconocía tener HTA. De los hipertensos que recibían tratamiento farmacológico (69.0%), el 66.8% tuvo tensión arterial controlada. Conclusiones: Casi la mitad de los adultos mexicanos en condición de vulnerabilidad tiene HTA y de ellos, más de la mitad desconoce que tiene esta enfermedad. Asimismo, un tercio de los adultos hipertensos tiene un inadecuado control de su enfermedad.

Abstract: Objective: To describe the prevalence of hypertension (HBP) in adults with vulnerability, the percentage of them with previous diagnosis and the proportion that had adequate control. Materials and methods: Blood pressure was measured in 7 838 adults who participated in the Ensanut 100k. Those who self-reported the diagnosis of HBP or had systolic blood pressure (SBP) ≥130mmHg or diastolic blood pressure (DBP) ≥80mmHg were classified as hypertensive. Controlled blood pressure was considered when SBP was <130mmHg and TAD <80mmHg. Results: The prevalence of hypertension in adults with a vulnerability condition was 49.2%, of which 54.7% did not know had hypertension. Of the hypertensive patients who received pharmacological treatment (69.0%), 66.8% of them had blood pressure under control. Conclusions: Almost half of Mexican adults in vulnerable condition have HBP and of these more than half do not know that they have this disease. One third of hypertensive adults have inadequate control.

The attempt to demolish the science and practice of preventive cardiovascular medicine. Part I. Addendum to the positioning around the diagnosis and treatment of dyslipidemias of ANCAM and the joint group of associated medical societies / El intento de demoler la ciencia y la práctica de la medicina cardiovascular preventiva. Parte I. Addendum al posicionamiento en torno al diagnóstico y tratamiento de las dislipidemias de la ANCAM y del grupo conjunto de sociedades médicas asociadas

Abstract: This manuscript is an addendum to the positioning around the diagnosis and treatment of dyslipidemias of ANCAM and the joint group of associated medical societies, already published. It is the first part of a wider reflection aimed on refute several of the theses and arguments of a group of clinicians and researchers who question the validity of the "cholesterol hypothesis", the usefulness and safety of statins and the most modern inhibitors of proprotein convertase of subtilisin/kexin type 9 (iPCSK9,) and the role of saturated fatty acids consumed in the usual diet in the atherosclerotic risk. This iconoclastic point of view is dangerous insofar as it undermines the scaffolding that supports the primary and secondary prevention of atherosclerosis. In this section of the manuscript, only the cholesterol hypothesis is discussed. The data of comparative zoology are reviewed, and several experimental animal models are analyzed, both supporting the link between cholesterol and the appearance and evolution of atherosclerotic lesions. The methodology and the results of the Study of the 7 Countries are defended and are exposed the numerous epidemiological, pathological, clinical and interventional evidences, which in our opinion give a solid sustenance to the cholesterol hypothesis. Based on this knowledge it is criticized the LDL cholesterol values currently considered adequate. Furthermore, the so-called residual risk is considered, as well as the conflicting evidence about the usefulness of statins in elderly patients.

Resumen: Este manuscrito es un apéndice del posicionamiento en torno al diagnóstico y tratamiento de las dislipidemias de la ANCAM y el grupo de las sociedades médicas asociadas, previamente publicado. Es la primera parte de un trabajo más amplio enfocado a refutar varias de las tesis y argumentos de un grupo de clínicos e investigadores que ponen en duda la validez de la "hipótesis del colesterol", la utilidad y seguridad de las estatinas y los más modernos inhibidores de la proproteína convertasa de la subtilisina/kexina tipo 9 (iPCSK9) y el papel de los ácidos grasos saturados consumidos en la dieta habitual en el riesgo ateroscleroso. Este punto de vista iconoclástico es peligroso porque socava el andamiaje que soporta la prevención primaria y secundaria de la aterosclerosis. En esta primera sección del manuscrito, se discute sólo la hipótesis del colesterol. Se revisan los datos de zoología comparada y se analizan varios modelos animales de experimentación, que apoyan la liga entre el colesterol y la aparición y evolución de las lesiones aterosclerosa. Se defienden la metodología y los resultados del estudio de los 7 países y se exponen las numerosas evidencias epidemiológicas, patológicas, clínicas e intervencionistas, que a nuestro juicio dan un sustento sólido a la hipótesis del colesterol. Se critican también, en base a ese conocimiento, los valores de colesterol LDL actualmente considerados adecuados, a la vez que se discute el llamado riesgo residual y las evidencias conflictivas acerca de la utilidad de las estatinas en pacientes ancianos.