Serum vitamin D levels and mortality in Mexicans: results from the Mexican Health and Aging Study.

Introduction: Background: the population in Latin America is aging and elders face several obstacles for good health, including an elevated frequency of vitamin D deficiency. Thus, identification of patients at high risk to develop its negative consequences should be a priority. Objective: the objective of this analysis was to determine if levels of vitamin D lower than 15 ng/ml are associated with high mortality in Mexican elderly population, from the database of the Mexican Health and Aging Study (MHAS). Methods: prospective, population study in Mexico, that included Subjects of 50 years and older who were evaluated for Serum vitamin D levels during the year 2012 (third wave of the study). Serum 25(OH)D levels were categorized into four groups, based on cutoff points used in previous studies on vitamin D and frailty: < 15, 15-< 20, 20-< 30 and ≥ 30 ng/ml. Mortality was evaluated during 2015 (fourth wave of the study). Hazard ratio was calculated (for mortality) through Cox Regression Model, adjusted for covariates. Results: we included 1626 participants, and those with lower levels of vitamin D were older, more often women, required more aid for activities of daily living, reported higher number of chronic diseases, and lower scores on cognition. The relative risk of death was 5.421 (95 % CI 2.465-11.92, p < 0.001) for the participants with vitamin D levels < 15, which after adjusting for covariates, remained statistically significant. Conclusions: levels of vitamin D lower of 15, are associated with an increase in the rate of mortality in community-dwelling senior Mexicans.

Introducción: Introducción: la población en América Latina está envejeciendo y los adultos mayores enfrentan varios obstáculos para gozar de buena salud, incluida una frecuencia elevada de deficiencia de vitamina D. Por lo tanto, la identificación de pacientes con alto riesgo de desarrollar sus consecuencias negativas debe ser una prioridad. Objetivo: el objetivo de este análisis fue determinar si los niveles de vitamina D inferiores a 15 ng/ml están asociados con una alta mortalidad en la población adulta mayor mexicana, a partir de la base de datos del Estudio de Salud y Envejecimiento en México. Métodos: estudio poblacional prospectivo en México, que incluyó Sujetos de 50 años y mayores que fueron evaluados para los niveles de vitamina D en suero durante el año 2012 (tercera ola del estudio). Los niveles séricos de 25(OH)D se clasificaron en cuatro grupos, según los puntos de corte utilizados en estudios previos sobre vitamina D y fragilidad: < 15, 15-< 20, 20-< 30 y ≥ 30 ng/ml. La mortalidad se evaluó durante 2015 (cuarta ola del estudio). Se calculó la razón de riesgo (para la mortalidad) a través del modelo de regresión de Cox, ajustado por covariables. Resultados: incluimos 1626 participantes, y aquellos con niveles más bajos de vitamina D eran mayores, más a menudo mujeres, requerían más ayuda para las actividades de la vida diaria, informaron un mayor número de enfermedades crónicas y puntuaciones más bajas en cognición. El riesgo relativo de muerte fue de 5,421 (IC 95 % 2,465-11,92, p < 0,001) para los participantes con niveles de vitamina D < 15, que después de ajustar por covariables, se mantuvo estadísticamente significativo. Conclusiones: niveles de vitamina D inferiores a 15, se asocian con un aumento en la tasa de mortalidad en adultos mayores mexicanos residentes en la comunidad.

Acellular fraction from malignant effusions has cytotoxicity in breast cancer cells.

Malignant ascites (MA) and malignant pleural effusion (MPE) are frequently developed in patients with metastatic cancer; however, the biological properties of these fluids have not been clarified. The present study explored the biological role of a low molecular fraction derived from malignant effusions on the activation of peripheral blood mononuclear cells and on the proliferation of breast cancer cells and fibroblast 55x cells. A <10-kDa fraction from effusions of 41 oncological patients and 34 individuals without cancer was purified, and its potential role in inhibiting nitric oxide (NO) production on lipopolysaccharide (LPS)-stimulated peripheral blood mononuclear cells was explored, as well as its cytotoxicity on MCF-7 breast cancer cells and fibroblast 55x cells. A significant decrease in NO production was observed in the <10-kDa fraction from malignant effusions. In addition, the acellular fraction from MA decreased the viability of breast cancer cells without affecting human fibroblasts. These data support the presence of low molecular weight molecules in malignant samples with a specific role in inhibiting the defense mechanisms of peripheral blood mononuclear cells and decreasing the viability of breast cancer cells in vitro.

Validation of the FRAIL scale in Mexican elderly: results from the Mexican Health and Aging Study.

BACKGROUND: The aging population in Latin America is characterized by not optimal conditions for good health, experiencing high burden of comorbidity, which contribute to increase the frequency of frailty; thus, identification should be a priority, to classify patients at high risk to develop its negative consequences. AIM: The objective of this analysis was to validate the FRAIL instrument to measure frailty in Mexican elderly population, from the database of the Mexican Health and Aging Study (MHAS). MATERIALS AND METHODS: Prospective, population study in Mexico, that included subjects of 60 years and older who were evaluated for the variables of frailty during the year 2001 (first wave of the study). Frailty was measured with the five-item FRAIL scale (fatigue, resistance, ambulation, illnesses, and weight loss). The robust, pre-frail or intermediate, and the frail group were considered when they had zero, one, and at least two components, respectively. Mortality, hospitalizations, falls, and functional dependency were evaluated during 2003 (second wave of the study). Relative risk was calculated for each complications, as well as hazard ratio (for mortality) through Cox regression model and odds ratio with logistic regression (for the rest of the outcomes), adjusted for covariates. RESULTS: The state of frailty was independently associated with mortality, hospitalizations, functional dependency, and falls. The pre-frailty state was only independently associated with hospitalizations, functional dependency, and falls. CONCLUSIONS: Frailty measured through the FRAIL scale, is associated with an increase in the rate of mortality, hospitalizations, dependency in activities of daily life, and falls.

C allele of the rs2209972 single nucleotide polymorphism of the insulin degrading enzyme gene and Alzheimer's disease in type 2 diabetes, a case control study.

BACKGROUND AND OBJECTIVE: In the last few decades we have witnessed an interesting transformation of the population pyramids throughout the world. As the population's life expectancy increases, there are more chronic diseases such as diabetes mellitus and dementias, and both of them have shown an association. GENERAL OBJETIVE: To determine the association between Alzheimer's disease in diabetic patients and the insulin degrading enzyme in outpatients of a second level Hospital in Monterrey, Mexico. MATERIALS AND METHODS: This was a case control study in which we included outpatients from the Geriatrics Clinic of a Hospital in Northeastern Mexico. Cases were patients with a Mini Mental Score Exam (MMSE) below 24 and DSM-IV criteria for Dementia. Controls were patients who had MMSE scores greater than 24. RESULTS: Data from 97 patients were analyzed. Regarding physical examination and the results of laboratory tests, there were no differences between the two groups (p>0.05). A 98% prevalence of the insulin degrading enzyme was documented in the sample studied. We found an association between a homozygous status for the CC genotype and Dementia with an estimated Odds Ratio (OR) of 2.5 (CI 95% 1.6-3.3) on the bivariate test, while, on the multivariate analysis, the OR was estimated 3.3 (CI 95% 1.3-8.2). CONCLUSIONS: Evidence shows that cognitive impairment is more frequent among those exposed to the C allele of the rs2209972 SNP of the insulin degrading enzyme gene.

Association between polymorphism c.1-765G>C of the COX2 gene and cognitive impairment in individuals 65 years or more with diabetes from a Geriatric Service in Monterrey, Mexico.

BACKGROUND AND OBJECTIVE: Cognitive impairment and dementia are common geriatric syndromes in diabetic patients. Inflammation plays a crucial role in the pathophysiology of Alzheimer's disease and cognitive impairment. Cyclooxygenases (COX) 1 and 2 participate in inflammation. The polymorphism c.1-765G>C of the COX2 gene might be protective against cognitive decline in Mexicans with diabetes mellitus through its reduced promotor activity. To determine the association between polymorphism c.1-765G>C of the COX2 gene and cognitive impairment in elderly adults with diabetes. PATIENTS AND METHODS: Case-control study. We included diabetic patients from the Geriatric Clinic of General Hospital No. 17 who were over 65 years and accepted to participate. Cases were patients with a score of 24 or less on the Mini Mental Status Examination (MMSE) and with DSM IV criteria for dementia. Controls were those with MMSE scores of 25 or greater. Results We included 97 patients (50 cases and 47 controls). There were no differences regarding clinical and laboratory characteristics between cases and controls. The frequency of the C allele and the CG genotype was higher in controls than in cases and this difference remained significant in a multivariate analysis with an odds ratio of 0.012 (95% CI 0.001-0.091) and 0.009 (95% CI 0.001-0.076) in the bivariate and multivariate analysis, respectively, using the GG genotype frequency as a reference. CONCLUSION: Cognitive impairment in Mexican patients with diabetes is associated with less exposure to the CG genotype of the c.1-765G>C polymorphism of COX2.

[Clinical characteristics of the thyroid follicular carcinoma]. / Características clínicas del carcinoma folicular de tiroides.

BACKGROUND: the prevalence of thyroid follicular carcinoma (TFC) is 39 % in patients with an undetermined histological diagnosis. The aim was to know the prevalence of TFC in a hospital with high population concentration. METHODS: surgical reports with a final diagnosis of TFC were reviewed. The size of the tumor, age, gender, pre- and post-surgical diagnosis and comorbidities were retrieved. RESULTS: a total of 35 reports with a diagnosis of TFC were found: 30 (85 %) were females with a mean age 44 ± 16.9 years. The mean age was 57 ± 6.6 in males. The diagnoses before surgery were follicular carcinoma 14 (40 %), thyroid cancer 6 (17.1 %), thyroid adenoma 4 (11.4 %), goiter 3 (8.5 %), thyroid nodule 3 (8.5 %), one papillary carcinoma (2.8 %), one thyroid neoplasm (2.8 %), one poorly differentiated adenocarcinoma (2.8 %), one well differentiated follicular adenocarcinoma (2.8 %), and one medullary thyroid cancer (2.8 %). The comorbidities found were Hashimoto disease 2 (5.6 %) and papillary contralateral carcinoma 2 patients (5.6 %). CONCLUSIONS: follicular carcinomas of the thyroid of our population differ in clinical presentation compared with previous reports.

Introducción: se ha identificado carcinoma folicular en 39 % de los pacientes con nódulos tiroideos cuya citología prequirúrgica ha indicado resultados indeterminados. El propósito de esta investigación fue conocer la prevalencia de esta entidad en un hospital de concentración. Métodos: se buscaron los reportes quirúrgicos con diagnóstico de carcinoma folicular. Se registró tamaño del tumor, sexo y edad del paciente, diagnósticos pre y posquirúrgico y patologías asociadas. Resultados: se diagnosticó carcinoma folicular en 35 pacientes: 30 mujeres (85 %) y cinco hombres (15 %). La edad en los hombres fue de 57 ± 6.6 y de 44 ± 16.9 en las mujeres. Los diagnósticos preoperatorios fueron carcinoma folicular en 14 (40 %), cáncer tiroideo en seis (17.1 %), adenoma folicular en cuatro (11.4 %), bocio en tres (8.5 %), nódulo tiroideo en tres (8.5 %); carcinoma papilar, tumor de tiroides, carcinoma poco diferenciado de tiroides, adenocarcinoma folicular bien diferenciado, cáncer medular en un paciente (2.8 %) cada uno. Las patologías asociadas fueron tiroiditis de Hashimoto y carcinoma papilar contralateral, con dos pacientes cada uno (5.6 %). Conclusiones: la edad de los pacientes y la presentación clínica del carcinoma folicular difirieron de las informadas en otras investigaciones.

[Prevalence of type 2 diabetes mellitus in elderly patients and associated factors in a general hospital of the north of Mexico]. / Prevalencia de diabetes mellitus de tipo 2 y factores asociados en la población geriátrica de un hospital general del norte de México.

UNLABELLED: There are few reports on the impact of diabetes in the geriatric population. OBJECTIVE: To determine the prevalence of diabetes in the geriatric population in a hospital in Northeast Mexico. DESIGN: A cross-sectional study and a probabilistic sampling were made. The files of outpatients of the geriatrics department in a General Hospital in Monterrey, Mexico,were examined. The information obtained from these files was related to the patient's personal pathological and non-pathological background, besides a full geriatric evaluation. RESULTS: A total of 171 files were examined, out of which 97 (56.7%) belonged to females and 74 (43.3%) to males. The mean age was 78 ± 6.9 years. Diabetes was found in 76 patients (44%), major depression was found in 85 patients (50%), with the latter being more common in diabetic patients (p = 0.002). It was also found that diabetic patients take more drugs during their disease. Adjusting for age, gender, and academic level, cognitive impairment was found in 110 patients (64.3%). CONCLUSIONS: Diabetes mellitus is more frequent in the geriatric population and it uses more resources.

The rate of primary hypothyroidism in diabetic patients is greater than in the non-diabetic population. An observational study.

BACKGROUND AND OBJECTIVE: The aim of our study was to identify the rate of diabetic patients treated for hypothyroidism and compare them with a group without type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS: We reviewed the computerized clinical records of 5161 patients. We identified diabetic patients treated with l-thyroxine. We compared the prevalence of PH with those patients under treatment with levothyroxine without T2DM. We excluded patients with a thyroid neoplasia, thyroid surgery, panhypopituitarism, or surgical complications of multinodular goiter or a thyroid nodule. Subclinical hypothyroidism was not considered. RESULTS: We included 1848 adult patients with T2DM in the study group, 58% women and 42% men. For the control group, we included 3313 non-diabetic patients, 55% women and 45% men. The mean age in the study group was 52±7 years, and 47±4 years in the control group (p<.001). The rate of hypothyroidism in the study group was 5.7%, and in the control group 1.8% (odds ratio of 3.45; 95% confidence interval 2.51-4.79) (p<.001). CONCLUSION: A strong association between T2DM and hypothyroidism was found. We recommend a thyroid profile in all patients with T2DM, similar to the recommendation in type 1 diabetes mellitus.

[Frailty and its association with mortality, hospitalization and functional dependence in Mexicans aged 60-years or older]. / Fragilidad y su asociación con mortalidad, hospitalizaciones y dependencia funcional en mexicanos de 60 años o más.

BACKGROUND AND OBJECTIVE: To determine the association between frailty and mortality, dysfunctionality, falls and hospitalizations in the Mexican Health and Aging Study. SUBJECTS AND METHODS: Prospective, population study in Mexico, that included subjects of 60 years and older who were evaluated for the variables of frailty during the year 2001 (first wave of the study) which included: difficulty to rise from a chair after being seated during long time, weight loss of 5 kilograms or more in the last two years, and absence of energy. Frail subjects were considered when they had at least two conditions. The robust group was considered when they had zero conditions. Pre-frail or intermediate were those with one condition. Mortality, hospitalizations, falls, and functional dependency were evaluated during 2003 (second wave of the study). Relative risk was calculated for each complication, as well as hazard ratio and odds ratio through Cox Regression Model (for mortality) and logistic regression (for the rest of the complications) respectively, adjusted for covariates. RESULTS: The states of frailty and pre-frailty were independently associated with mortality, hazard ratio of 1.61 (CI 95% 1.01-2.55) and 1.94 (CI 95% 1.20-3.13), respectively. Only the state of frailty was independently associated with hospitalization and functional dependence, odds ratio of 1.53 (CI 95% 1.13-2.07) and 3.07 (CI 95% 1.76-5.34). There was no association between pre-frailty or frailty with falls. CONCLUSION: Frailty is associated with an increase in the rate of mortality, hospitalizations and dependence in basic activities of daily life.

[Cognitive performance and mortality in people over 50 in Mexico]. / Desempeño cognoscitivo y mortalidad en personas mayores de 50 años en México.

OBJECTIVE: Determine the correlation between the low cognitive performance recorded in 2001 in the National Study on Health and Aging in Mexico (ENASEM) and the mortality reported in 2003 during the second phase of that same study. METHODS: The subjects selected were people aged 50 or over who had completed the sections in the 2001 survey pertaining to cognitive exercises, health status, and functionality and assistance with daily activities. Cognitive performance was assessed in 2001 using an abridged version of the Cross-Cultural Cognitive Examination (scale: 0 to 80 points). In 2003, there was a follow-up to the interviewees, in which their survival or death was recorded. RESULTS: The groups of interviewees scoring less than 40 had a cumulative survival rate of 96.1%, with a mean of 26.49 months of survival (CI 95% 26.41-26.57), while those scoring 40 points or over had a cumulative survival rate of 98.7%, with a mean of 28.76 months (CI 95% 28.68-28.85) (Log Rank chi(2) = 59,230 P < 0,001). A score of less than 40 in the cognitive assessment was associated with a relative risk of death of 1.863 (CI: 95% 1.30-2.65) in the multivariate analysis. Also associated with higher mortality was older age, self-reported diabetes, cancer, having smoked at some time, receiving assistance in at least one instrumental activity of daily living, and scoring higher on the depression scale. CONCLUSIONS: A score of less than 40 in the abridged version of the Cross-Cultural Cognitive Examination was independently correlated with an increase in mortality within the next two years.

[Prevalence of hypokalemia in patients with methylprednisolone pulse therapy]. / Prevalencia de hipokalemia en pacientes tratados con pulsos de metilprednisolona.

OBJECTIVE: To determine the prevalence of hypokalemia in patients with methylprednisolone pulse therapy. DESIGN: We carried out a descriptive, cross-sectional study. MATERIAL AND METHODS: We enrolled 110 outpatients who received pulse doses of 1 g of intravenous methylprednisolone for three consecutive days. Demographic variables, serum electrolytes and an electrocardiogram were documented. RESULTS: The study group consisted of 31 men (28.2%) and 79 women (71.8%). Average age was 40 +/- 13.6 years. Mild hypokalemia was present in 19 patients (17.27% [95% CI 9.75-24.79]); moderate potassium levels were found in just one patient 0.9% [IC 95 0.023-4.96]); no cases of severe hypokalemia occurred. Total prevalence was 18.18% (95% CI 10.5-25.8). There were no significant electrocardiographic changes. DISCUSSION AND CONCLUSION: Mild and moderate hypokalemia was 18.18% without clinical or electrocardiographic consequences. Since there were no cases of severe hypokalemia, close monitoring of potassium levels should be restricted to those patients with other risk factors.