STEMI and NSTEMI: Real-world Study in Mexico (RENASCA).

INTRODUCTION: Mexico is the country with the highest mortality due to acute myocardial infarction in adults older than 45 years old according to the OECD (28 vs. 7.5% of the average). The first real-world study, RENASCA IMSS, showed a high-risk population at 65%, but 50% without reperfusion strategies. The aim was to describe the clinical presentation, treatment, and outcomes of acute coronary syndromes at the IMSS. METHODS: RENASCA IMSS is a nation-wide, prospective, longitudinal-cohort study. We include consecutive patients with an Acute Coronary Syndrome diagnosis (ACC/AHA/ESC) admitted in 177 representative hospitals of the IMSS (166 of second level and 11 of third level of attention). In an electronic database clinical, paraclinical, times, reperfusion treatment, complications, and other variables were assessed. Confidentiality was maintained in data and informed consent was obtained. Registrer calibration was performed with more than 80% of the variables and 80% of the cases. RESULTS: From March 1, 2014 to December 25, 2017; 21,827 patients were enrolled presenting an average age 63.2 ± 11.7, 75% men (16,259) and 25% women (5,568). The most frequent risk factors were: hypertension (60.5%), smoking (46.8%), diabetes (45.5%), dyslipidemia (35.3%) and metabolic syndrome (39.1%). STEMI diagnosis was established in 73.2% of the patients and NSTEMI in 26.8%. The STEMI group within the Code Infarction showed an improvement in the reperfusion therapy (34.9% before vs. 71.4% after, p ≤0.0001) and reduction of mortality (21.1 vs. 9.4%, p ≤0.0001); while the NSTEMI group showed high risk set by a GRACE score of 131.5 ± 43.7 vs. 135.9 + 41.7, p ≤0.0001. Mortality was more frequent within the STEMI group (14.9 vs. 7.6%, p ≤0.0001). CONCLUSIONS: RENASCA IMSS study represents the largest Acute Coronary Syndromes real-world study in Mexico, demonstrating that the Mexican population has a high risk. Patients with a STEMI diagnosis were more frequently enrolled and were associated with higher mortality and complications; however, there is improvement in the reperfusion therapy and in mortality with the Code Infarction strategy.

[Overweigth, obesity, metabolic syndrome and waist/height index in health staff]. / Sobrepeso, obesidad, síndrome metabólico e índice cintura/talla en el personal de salud.

INTRODUCTION: Health staff self-applied strategies are insufficiently to reduce cardiovascular risk factors. The aim of this article is to investigate the prevalence of overweight, obesity and metabolic syndrome and waist/height index on health staff. METHODS: This is a cross-sectional study from January to April 2014 in 735 workers of the UMAE Specialties La Raza. A diagnosis of overweight and obesity was established according to WHO criteria and metabolic syndrome NCEP ATP-III. In 250 participants lipid profile and blood chemistry were obtained. Descriptive statistics was applied, chi square, Student t test or Kruskal-Wallis to compare groups. RESULTS: We included 496 women and 239 men (physicians, nurses and other workers). 38% were overweight; 22% had obesity. We found fasting hyperglycemia>126 mg/dl in 5.1%, between 100-126 mg/dl in 17.4%, hypertriglyceridemia in 40.4%; HDL cholesterol<40 mg/dl 66% in men and HDL cholesterol<50 mg/dl 51.4% in women. Waist measurement was 93±11 cm in men vs. 88±13 m in women. The waist/height index in the ideal weight group was 0.048±0.04, for overweight 0.55±0.04 and for obesity 0.65±0.064 (p<0.01). Metabolic syndrome prevalence was 30.6%, smoking 21.6% and alcohol consumption 35%. CONCLUSIONS: The prevalence of obesity-overweight was 60% and metabolic syndrome 30%, making it necessary to take immediate actions to modify the lifestyle of health staff.

Introducción: el personal de salud se autoaplica insuficientes estrategias para reducir sus propios factores de riesgo cardiovascular. El objetivo fue investigar la prevalencia de sobrepeso, obesidad y síndrome metabólico en personal de salud.Métodos: diseño transversal de enero a abril de 2014, en 735 trabajadores de la UMAE Especialidades La Raza. El diagnóstico de sobrepeso y obesidad se estableció acorde a criterios de la OMS y síndrome metabólico NCEP ATP-III. En 250 participantes se realizó perfil de lípidos y química sanguínea. Se aplicó estadística descriptiva, chi cuadrada, t de Student o Kruskal-Wallis al comparar los grupos, el valor de significancia fue p < 0.05.Resultados: incluimos 496 mujeres y 239 hombres (entre médicos, enfermeras y otros). Tuvieron sobrepeso 38 %, y obesidad 22 %. Encontramos hiperglucemia de ayuno > 126 mg/dl 5.1 %, entre 100-126 mg/dl 17.4 %, hipertrigliceridemia 40.4 %; colesterol-HDL < 40 mg/dl en 66 % de hombres y colesterol-HDL < 50 mg/dl en 51.4 % de mujeres. La cintura 93 ± 11cm en hombres frente a 88 ± 13 cm en mujeres. El índice cintura/talla en el grupo de peso ideal fue 0.048 ± 0.04, en el de sobrepeso 0.55 ± 0.04 y en el de obesidad 0.65 ± 0.064. Tuvieron síndrome metabólico 30.6 %, tabaquismo 21.6 % y consumo de alcohol 35 %. Solo 2 % presentaron presión arterial > 135/85.Conclusiones: la prevalencia de obesidad y sobrepeso del personal de salud es de 60 % y de síndrome metabólico 30 %, por lo que es necesario tomar acciones inmediatas que modifiquen el estilo de vida del personal de salud.

Síndrome de Münchhausen: laparotomofilia migrans: informe de dos pacientes / Münchhausen's syndrome: laparatomaphilia migrans: report of two patients

Se presentan dos casos de pacientes con múltiples antecedentes patológicos y particularmente quirúrgicos que habían sido atendidos en diferentes hospitales por diferentes grupos médicos y que consultaron supuestamente por persistencia de problemas derivados de cirugías previas. En ambos se demostró la falsificación de información médica con el único objetivo de encontrarse bajo el cuidado médico sin tratar de obtener ninguna ganancia secundaria. A este padecimiento ficticio o facticio se le conoce como síndrome de Münchhausen en su variedad de laparatomofilia migrans. Este síndrome ocasiona múltiples internamientos hospitalarios con estudios y procedimientos innecesarios. En estos casos llamó la atención la multiplicidad de procedimientos quirúrgicos a los que estas pacientes se habían sometido e intentaban someterse a otros más. Consideramos que el médico y en particular el cirujano debe conocer esta entidad con el objeto de detectar oportunamente a esos pacientes.