Trends in the mortality of diabetes in Mexico from 1998 to 2022: a joinpoint regression and age-period-cohort effect analysis.

OBJECTIVE: The purpose was to analyze age-standardized trends in diabetes mortality rates (DMR) from 1998 to 2022, stratified by sex and Mexican state, and the effects attributable to age, period, and cohort by sex. STUDY DESIGN: Joinpoint regression and age-period-cohort effect analysis. METHODS: Based on the tenth revision of the International Classification of Diseases, E11, E12, E13, and E14 codes of the death certificate, a daily record of mortality was extracted from the death certificate attributable to diabetes as the main cause. From 1998 to 2022, sexes and ages (≥20 years) were used to calculate the crude mortality rates and standardized at the national and Mexican state levels. Additionally, the age-period-cohort model was used to examine age, period, and cohort effects. RESULTS: From 1998 to 2005, the age-adjusted DMR increased by 3.6% (95% confidence interval [CI]: 2.7, 4.5) for the total population, as shown by the joinpoint regression analysis at a national level; from 2017 to 2020, it increased by 7.4% (95% CI: 0.6, 14.8). The DMR with the highest increase during the study period came mainly from states in the country's southeastern region, 2.3% to 3.7% per year. The net age and period effects showed that mortality increased with advancing age and with going time, respectively; and the net cohort effect revealed that mortality increased in more recent birth cohorts, mainly in men Rate Ratio (RR) = 2.37 (95% CI: 2.29, 2.46) vs RR = 1.13 (95% CI: 1.09, 1.17). CONCLUSION: The DMR increased among older age groups. The period effect showed that mortality increased over time. Furthermore, the cohort effect showed that mortality increased in more recent birth cohorts, especially among men.

Knowledge and recommendations regarding breast cancer early screening in an upper middle income country: Primary and secondary health care professionals.

OBJECTIVE: To compare the current breast cancer prevention and control Mexican standard with recommendations that health care professionals provide to women for breast self-exams, clinical breast exams and mammography, as well as health care professional knowledge of the risk factors for and main clinical signs of the disease. METHODS: In 2012, using a cross-sectional design, trained interviewers surveyed health care providers in a sample of 798 medical units, of which 756 corresponded to the first and second levels of medical care. One health care professional from each unit was interviewed for the study. The sampling method was systematic and representative of the national and regional levels. Relative frequencies and 95% confidence intervals (CI) were obtained using the weighting factor assigned to each medical unit. RESULTS: Regarding the indicator about recommendations provided to the population regarding early screening for and risk factors and clinical signs of breast cancer, the average number of health care professional responses in accordance with the Mexican standard was 10.7 (95% CI 10.0-11.4) out of a maximum of 28 points, which corresponds to an average rate of 38.2% of responses (95% CI 35.6-40.8). The percentage of correct answers increased in all areas of breast exam knowledge as training hours in the previous year increased. CONCLUSIONS: Health care professionals are unaware of the current standards on breast cancer; therefore, these recommendations are not routinely translated into health care practice, which is a barrier to increasing the coverage of screening programs in health care services.

Distribution of triglyceride-rich lipoproteins and their remnants and their contribution to cardiovascular risk in the Mexican population.

BACKGROUND AND AIMS: In recent years, scientific interest in triglyceride-rich lipoproteins (TRL) and remnant cholesterol has increased, focusing on the evidence that these lipoproteins are a causal factor for developing atherosclerotic cardiovascular disease (ASCVD). Furthermore, a high remnant concentration (>38 mg/dL) has been associated with several non-cardiovascular risks. We aimed in this study to describe the percentile distribution of remnant cholesterol. Additionally, we evaluated the association between remnant cholesterol plasma concentration and epidemiologically relevant cardio-metabolic outcomes such as hypertension, type 2 diabetes (T2D), and ASCVD. METHODS: We analyzed data from 9,591 adults from the National Survey of Health and Nutrition (ENSANUT) 2018 with fasting blood samples and complete medical history questionnaires. We built multivariate models to evaluate the association between chronic diseases and blood remnant concentration. To compare our 2018-sub-sample against a population reference, we used the NHANES (2005-2014) publicly available datasets by ethnicity. RESULTS: Remnants were independently associated with cardiovascular risk, diabetes, hypertension, obesity, and metabolic syndrome. For all outcomes, the blood remnant concentration was a stronger predictor than LDL. At all deciles, the blood remnant concentration was higher in ENSANUT-2018. CONCLUSIONS: A remnant blood concentration above 38 mg/dL was highly prevalent among Mexicans. Remnants were significantly associated with a higher risk of diabetes, hypertension, obesity, and cardiovascular risk. This association occurred independently of other lipid markers.

First Report of Haplotype I-b of Phytophthora infestans in Central Mexico.

Central Mexico is considered a center of genetic diversity for Phytophthora infestans on the basis of a range of genotypic and phenotypic characteristics (3). Surprisingly, while mitochondrial DNA (mtDNA) haplotypes I-a, II-a, and II-b have been reported from central Mexico, haplotype I-b has not been found in central Mexico (1). Therefore, a more extensive search for haplotypes was conducted in areas where sexual reproduction occurs. During the summer of 2003, leaflets of cvs. Rosita and Tollocan with a single lesion of late blight were collected in the area of Villarreal, located in Terrenate County in Tlaxcala, Mexico (170 km northeast of Mexico City). Fourteen P. infestans isolates were characterized for mtDNA haplotype, isozyme genotype (glucose 6- phosphate isomerase [Gpi] and peptidase [Pep]), and mating type. Isolation, mating type, and isozyme genotype were characterized following reported protocols (1,4). MtDNA haplotype was determined by amplifying and digesting the P2 and P4 regions and comparing amplicons to those of reference strains of known haplotype (1,2). Twelve isolates were mtDNA haplotype I-a and two were I-b. While the mtDNA I-b has been associated with the US-1 lineage (mating type: A1, Gpi: 86/100, Pep: 92/100), the genotypes for the Mexican isolates were A2, 86/100 Gpi, 100/100 Pep from cv. Rosita and A2, 86/100 Gpi, 92/100 Pep from cv. Tollocan. To our knowledge, this is the first report of the I-b mtDNA haplotype of P. infestans from central Mexico and it is now clear that all four haplotypes exist in Mexico. This finding therefore, stresses the importance of including a representative regional sampling of Mexican and Andean isolates in studies inferring the origin of this species. References: (1) W. G. Flier et al. Phytopathology 93:382, 2003. (2) G. W. Griffith and D. S. Shaw. Appl. Environ. Microbiol. 64:4007, 1998. (3) N. J. Grünwald and W. G. Flier. Ann. Rev. Phytopathol. 43:171, 2005. (4) N. J. Grünwald et al. Phytopathology 91:882, 2001.

Early changes in nitric oxide synthase activity in atrial intramural arteries following experimental spinal cord injury in rats.

Previously, we have shown that immediately after an experimental spinal cord injury (SCI) in anaesthetized rats, there is a large fall in mean arterial pressure (MAP) and heart rate (HR), followed by an abrupt increase in MAP. To evaluate the participation of nitric oxide (NO), we evaluated the activity of nitric oxide synthase (NOS) using Nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase histochemistry in sections of atria at several post-injury time-intervals. Staining increased at 3 min, reached a maximum at 9 min and diminished 30 min after injury. Pretreatment with atropine prevented changes in MAP, HR and NADPH-d staining suggesting that such modifications result from an increased vagal stimulation. In conclusion, the NOS activity is transiently elevated in the atrial intramural arteries of rats subjected to an SCI.

Mechanisms involved in the cardiovascular alterations immediately after spinal cord injury.

The early cardiovascular effects resulting from an acute spinal cord injury (SCI) produced by a contusion procedure at T5-T6 were evaluated in anaesthetized rats. The mean arterial pressure (MAP) and heart rate (HR) were measured during one hour after the injury. A marked decrease in MAP and HR was observed immediately after injury, followed by an abrupt increase in MAP. These changes were observed between 3 and 9 min and the basal values were recovered after 20 min. Fall in the MAP and HR and increase in MAP induced by SCI were abolished by atropine. The interruption of the parasympathetic outflow by vagotomy also significantly diminished the fall and increase in MAP and the fall in HR. Likewise, pre-treatment with nitric oxide synthase inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME) completely abolished the effects produced by SCI. These data suggest that after SCI the decrement in MAP and HR was probably due to acetylcholine release from parasympathetic fibers and NO from endothelial source probably by a cholinergic stimulation. Additionally, the MAP increase observed was probably due to a reflex compensatory vasoconstriction.

[Evaluation of a program for the early detection of cancer of the uterine cervix in Mexico City. A populational-based epidemiologic study of cases and controls]. / Evaluación del programa de detección oportuna del cáncer del cuello uterino en la Ciudad de México. Un estudio epidemiológico de casos y controles con base poblacional.

Cervical cancer is still an important public health problem in Mexico; in spite of the development of various programs aimed at lowering mortality due to this disease, impact has not yet been achieved. In this study we present an evaluation of the Early Detection Program for Cervical Cancer in Mexico City. The authors carried out a case-control study with a populational base, in which a sample of cases obtained in eight hospitals and a sample of controls representative of the general population were included. We report a protective effect attributed to the program. The women with complete cytology showed 2.4 times less risk of cervical cancer. Nevertheless the effect of the program at a populational level is still limited because it covers only 20 per cent of the cases in the population. The results indicate the need for developing operative research programs in order to increase the demand for and the quality and efficiency of preventive services.

[Reproductive risk factors and uterine cervix cancer in Mexico City]. / Factores de riesgo reproductivo y cáncer cérvico-uterino en la Ciudad de México.

An epidemiological case control study nested in the Early Cancer Detection program of the Health Ministry in Mexico City was carried out to evaluate the principal reproductive risk factors associated with uterine cervix cancer. Information from 12,741 gynecological cytologies reported to the National Cancer Registry, during the period between January 2 to March 31, 1987 was studied. In this population group the most important reproductive risk factors associated with uterine cervix cancer were: multiple births (seven or more births, OR = 3.24, IC 95% = 2.20-4.76), initiation of active sex life before 14 years (OR = 1.53, 95% IC = 1.13-2.08) and late menarche (in the group with menarche after 17 year of ages OR = 3.22, 95% IC = 1.06-9.77). In relation to the Early Cancer Detection program, an important number of women made use of the program when they showed symptoms. The prevalence among women who had at least one symptom was 43.09 per cent. Women with a tumor at the cervical level at the time of the cytology were 7.76 times more likely to have of uterine cervix cancer (95% IC = 4.84-13.15). Symptoms such as dysfunctional bleeding (OR 2.79, IC 95% = 1.90-4.12), metrorrhagia (OR 2.66, 95% IC 1.83-3.86) and bloody leukorrhea (OR 2.64, 95% IC 2.05-3.38) can be relevant findings in women at high risk. The attributable fraction of higher exposure in the presence of gynecological signs and symptoms is the cervical tumor, with 87.46 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)

Persistence of the embryonic lateral marginal vein: report of two cases.

PURPOSE: Congenital venous malformations of the lower limbs represent a particular challenge for the vascular surgeon. Persistence of fetal veins is a rare malformation, and the most common is the persistence of the lateral marginal vein usually observed in patients with Klippel-Trenaunnay Syndrome. The persistence of this embryonic vein as an isolated venous malformation without the other characteristics of the Klippel-Trenaunnay Syndrome has not yet been reported. This paper describes two cases. METHODS: Two patients, a 17-year-old male patient and a 16-year-old female, have had since their birth a large venous trunk in the lateral aspect of the right leg and thigh. The limbs underwent duplex scanning and phlebography. The surgical removal of the lateral marginal vein was performed. RESULTS: Surgical treatment resulted in very good functional and aesthetic results. Follow-up at 26 months showed no evidence of varicose vein recurrence. CONCLUSIONS: To achieve good results, surgical intervention may be indicated in cases of orthopedic deformity, hemorrhage, symptomatic, and unaesthetic lesions.

Triacetonamina. II. Acciones cardiovasculares in vivo / Triacetonamine. II. In vivo cardiovascular actions

Se estudiaron in vivo los efectos en el sistema cardiovascular del clorhidrato de triaetonamina (TAN). Se registraron las presiones arterial y venosa, el flujo arterial, el electrocardiograma y la pletismografía en el perro, y se calculó la resistencia total. En conejos se registró el electrocardiograma y la presión arterial. La TAN produjo en todos los casos una hipotensión arterial de intensidad, dependiente de la dosis para una primera administración. Dosis repetidas produjeron taquifilaxia, sobre todo en el perro. Se observó sistemáticamente bradicardia moderada sin alteraciones notables en el patrón electrocardiográfico. Con la administración de dosis más elevadas (4 a 9 mg/kg) se encontró ligero aplanamiento de la onda P y disminución del voltaje del complejo QRS, que desaparecieron a los 10-20 minutos de la administración de dicha sustancia(AU)