Serum vitamin D levels and mortality in Mexicans: results from the Mexican Healthand Aging study / Niveles séricos de vitamina D y mortalidad en mexicanos: resultados del Estudio Nacional de Envejecimiento en México

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.(AU)

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 susconsecuencias 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 mortalidaden 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 vitaminaD 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 decorte 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 másayuda para las actividades de la vida diaria, informaron un mayor número de enfermedades crónicas y puntuaciones más bajas en cognición. Elriesgo 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 despuésde 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 mexicanosresidentes en la comunidad.(AU)

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.

Joint position statement on management of patient with osteoporosis during COVID-19 contingency from the AMMOM, CONAMEGER, FELAEN, FEMECOG, FEMECOT, and ICAAFYD.

Infection by SARS-Cov-2 (COVID-19) has affected practically all the world. This joint position statement of Latin American Medical Societies provides an updated guide for the prevention, diagnosis, and treatment of osteoporotic patients in the face of possible clinical scenarios posed by the COVID-19 health crisis. BACKGROUND: Infection by SARS-Cov-2 (COVID-19) has affected practically all the world. Characterized by high contagiousness, significative morbidity, and mortality in a segment of those infected, it has overwhelmed health services and forced to redirect resources to the emergency while impacting the attention of acute non-COVID-19 and many chronic conditions. OBJECTIVE: The objective of this study is to provide an updated guide for the prevention, diagnosis, and treatment of osteoporotic patients in the face of possible clinical scenarios posed by the COVID-19 health crisis. METHODS: A task force, of bone specialists with a wide range of disciplines in the field of osteoporosis and fragility fracture, was convened with the representation of several professional associations, namely, the Mexican Association of Bone and Mineral Metabolism (AMMOM), the National College of Geriatric Medicine (CONAMEGER), the Latin American Federation of Endocrinology (FELAEN), the Mexican Federation of Colleges of Obstetrics and Gynecology (FEMECOG), the Mexican Federation of Colleges of Orthopedics and Traumatology (FEMECOT), and the Institute of Applied Sciences for Physical Activity and Sports of the University of Guadalajara (ICAAFYD). Clinical evidence was collated, and an evidence report was rapidly generated and disseminated. After finding the gaps in the available evidence, a consensus opinion of experts was made. The resulting draft was reviewed and modified accordingly, in 4 rounds, by the participants. RESULTS: The task force approved the initial guidance statements, with moderate and high consensus. These were combined, resulting in the final guidance statements on the (1) evaluation of fracture risk; (2) stratification of risk priorities; (3) indications of bone density scans and lab tests; (4) initiation and continuation of pharmacologic therapy; (5) interruptions of therapy; (6) treatment of patients with incident fracture; (7) physical therapy and fall prevention; and (8) nutritional interventions. CONCLUSION: These guidance statements are provided to promote optimal care to patients at risk for osteoporosis and fracture, during the current COVID-19 pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document" and future updates are anticipated.

Hand grip strength and early mortality after hip fracture.

This research describes the risk of death in elderly after hip fracture according to their strength, measured by hand grip. The result is that the weaker the patient, the greater the risk of death after hip fracture, highlighting the need to assess the force in those patients. For the coming years, most of hip fractures will occur in developing countries. It has been described that low muscular strength, measured by grip strength, increases the risk of mortality in those with hip fracture, in both high-and low- income countries. The objective of this study was to determine the mortality among patients with hip fracture and lower hand grip strength (HGS). MATERIAL AND METHODS: We conducted a cohort and longitudinal study at Hip and Pelvic Surgery Department of a tertiary hospital, in Monterrey, Mexico. The study included patients aged over of 69, admitted for hip fracture surgery from February 1st 2013 to July 31st 2014. HGS measurement was performed by a trained physician at arrival to emergency department prior to surgery; clinimetric variables were asked, and a complete medical history was included. RESULTS: A total of 670 patients were included in the study and grouped in different tertiles according to hand grip strength. During follow-up, there were 112 deaths (17.4%), 61 (27.5%) in tertile 1, 37 (17.1%) in tertile 2, and 14 (6.8%) in tertile 3, p < 0.001. The association remained significant after adjusting for confounding variables. Less than 5% of patients discharged from hospital were identified with osteoporosis. CONCLUSION: Lower hand grip strength in patients with a hip fracture is associated with high mortality after hip fracture.

A robust biomarker of differential correlations improves the diagnosis of cytologically indeterminate thyroid cancers.

The fine-needle aspiration of thyroid nodules and subsequent cytological analysis is unable to determine the diagnosis in 15 to 30% of thyroid cancer cases; patients with indeterminate cytological results undergo diagnostic surgery which is potentially unnecessary. Current gene expression biomarkers based on well-determined cytology are complex and their accuracy is inconsistent across public datasets. In the present study, we identified a robust biomarker using the differences in gene expression values specifically from cytologically indeterminate thyroid tumors and a powerful multivariate search tool coupled with a nearest centroid classifier. The biomarker is based on differences in the expression of the following genes: CCND1, CLDN16, CPE, LRP1B, MAGI3, MAPK6, MATN2, MPPED2, PFKFB2, PTPRE, PYGL, SEMA3D, SERGEF, SLC4A4 and TIMP1. This 15-gene biomarker exhibited superior accuracy independently of the cytology in six datasets, including The Cancer Genome Atlas (TCGA) thyroid dataset. In addition, this biomarker exhibited differences in the correlation coefficients between benign and malignant samples that indicate its discriminatory power, and these 15 genes have been previously related to cancer in the literature. Thus, this 15-gene biomarker provides advantages in clinical practice for the effective diagnosis of thyroid cancer.

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.

Alelo C del polimorfismo rs2209972 del gen de la enzima degradadora de insulina y enfermedad de Alzheimer en diabéticos tipo 2. Estudio de casos y controles / 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 (AU)

Fundamento y objetivo: En las últimas décadas se ha producido una transformación en las pirámides poblacionales, con un aumento en la expectativa de vida, lo que conlleva un mayor número de enfermedades crónico-degenerativas, como son la diabetes mellitus y la demencia, que han mostrado tener una asociación estrecha, pero cuya etiología aún está por discernir. El objetivo de este estudio fue determinar la asociación entre el alelo C de la enzima degradadora de insulina y la enfermedad de Alzheimer en pacientes con diabetes tipo 2. Material y métodos: Estudio de casos y controles, en el cual se incluyeron pacientes de la clínica de Geriatría del Hospital General del Noreste de México. Los casos fueron aquellos con una puntuación en el Mini-Mental State Examination (MMSE) menor de 24 y criterios para demencia de acuerdo con el DSM-IV. Los controles fueron pacientes con MMSE superior a 24. Resultados: Se analizaron datos de 97 pacientes. No hubo diferencias respecto a las características basales clínicas y de laboratorio entre los casos y los controles (p > 0,05). Se documentó una prevalencia de 98% del alelo C de la enzima degradadora de insulina. Encontramos una asociación entre homocigosidad para el genotipo CC de la enzima degradadora de insulina y enfermedad de Alzheimer, con una OR de 2,5 (IC 95% 1,6–3,3) en el examen bivariado, y en el examen multivariado se encontró asociación con una OR de 3,3 (IC 95% 1,3–8,2). Conclusiones: La evidencia muestra una asociación entre deterioro cognitivo y presencia del alelo C del polimorfismo rs2209972 del gen de la enzima degradadora de insulina (AU)

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.

Galectin labeling of cells from paraffinized tissues may serve as a diagnostic tool in the detection and classification of thyroid carcinomas.

This study seeks to determine whether the relative levels of attachment to galectins 1 and 3 of cells from thyroid tissues embedded in paraffin blocks can differentiate thyroid tumors from normal tissues. A total of 48 thyroid paraffin sample blocks from 4 groups of patients were analyzed: 12 samples served as controls, 12 samples were from patients with thyroid adenoma, 12 samples were from patients with thyroid follicular carcinoma, and 12 samples were from patients with thyroid papillary carcinoma. The relative attachment of cells to galectins 1 and 3 antigens was determined using the InnoCyte™ ECM Cell Adhesion kit at different cell sample concentrations. All of the samples from thyroid tissue preparations showed attachment to galectins 1 and 3. The samples from tissues with a diagnosis of adenoma, follicular and papillary carcinoma showed an increased adherence to galectins 1 and 3 relative to the controls. Significant differences were found between the means of the adherent cells from the adenomas compared with the follicular and papillary carcinoma samples. When the outcomes from the galectins 1 and 3 cell surface binding were compared, no statistical differences were found. The cells from adenoma and carcinoma samples show more adhesion to galectins 1 and 3 than cells from the control samples. The samples prepared from follicular and papillary carcinomas show more cells adherent to galectins 1 and 3 than those from the adenomas.

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

Fundamento y objetivo: Determinar la asociación entre fragilidad y mortalidad, dependencia funcional, caídas y hospitalizaciones en el Estudio Nacional de Salud y Envejecimiento en México (ENASEM).Sujetos y métodos: Estudio prospectivo poblacional en México en el que se seleccionaron sujetos de 60 años o más, que fueron evaluados en las variables de fragilidad durante la primera vuelta del estudio en el año 2001 y que incluyó: dificultad para levantarse de una silla después de haber estado sentado(a) durante largo tiempo, pérdida de peso de 5 kilogramos o más en los últimos dos años y falta de energía. Los sujetos fueron catalogados como robustos, prefrágiles y frágiles cuando tenían cero, una o dos de las características anteriores, respectivamente. La mortalidad, hospitalizaciones, caídas y dependencia funcional fueron evaluadas en la segunda vuelta del estudio en el año 2003. Se calculó el riesgo relativo para cada una de las complicaciones, así como análisis multivariado con regresión de Cox para el caso de mortalidad y regresión logística para el resto.Resultados: Los estados de prefragilidad y fragilidad se asociaron independientemente con mortalidad, con índices de riesgo ajustados de 1,61 (intervalo de confianza del 95% [IC 95%] 1,01-2,55) y 1,94 (IC 95% 1,20-3,13), respectivamente. Sólo el estado de fragilidad se asoció independientemente con hospitalización y dependencia funcional, con una razón de momios ajustada de 1,53 (IC 95% 1,13-2,07) y 3,07 (IC 95% 1,76-5,34), respectivamente. No hubo asociación entre los estados de prefragilidad y fragilidad con caídas. Conclusión: El estado de fragilidad se asocia independientemente con mortalidad, hospitalizaciones y disfuncionalidad en actividades básicas de la vida diaria en los siguientes dos años en población mexicana (AU)

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 (AU)

La proporción de hipotiroidismo primario en pacientes diabéticos es mayor que la de pacientes no diabéticos. Estudio observacional / The rate of primary hypothyroidism in diabetic patients is greater than in the non-diabetic population. An observational study

Fundamento y objetivo: Nuestro objetivo fue determinar la proporción de pacientes con diabetes mellitus tipo 2(DM2) con hipotiroidismo primario (HP) y compararlos con un grupo sin diabetes. Pacientes y métodos: Se revisó una base electrónica que incluyó 5.161 pacientes. Se identificaron los pacientes con DM2 tratados con levotiroxina. Se comparó con la prevalencia de HP en aquellos pacientes sin DM2. Se excluyeron enfermos con neoplasia o cirugía de tiroides, panhipopituitarismo o complicaciones quirúrgicas de bocio multinodular o nódulo tiroideo.Resultados: Se incluyeron 1.848 pacientes adultos con DM2 en el grupo de estudio, 58% mujeres y 42% hombres. Para el grupo control se revisaron 3.313 individuos, 55% mujeres y 45% hombres. La edad media del grupo de estudio fue de 52±7 años, y 47±4 años en el grupo control (p<0,001). La tasa de hipotiroidismo en el grupo de estudio fue de 5,7% (n=105) y en el grupo control 1,8% (n=60) (odds ratio 3,45; intervalo de confianza del 95% 2,51-4,79) (p<0,001).Conclusión: Existe una asociación significativa entre HP y DM2. Recomendamos el perfil tiroideo en todos los pacientes con DM2, similar a lo sugerido en la diabetes mellitus tipo 1 (AU)

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 (AU)

[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.

[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.

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.

Rosiglitazone as an option for patients with acromegaly: a case series.

INTRODUCTION: In the patient with acromegaly, pituitary surgery is the therapeutic standard. Despite undergoing surgery, a significant number of patients with acromegaly continue to have uncontrolled growth hormone secretion. These patients require other treatments such as external irradiation and/or drug therapy. CASE PRESENTATION: We present the clinical and laboratory responses to six months of treatment with rosiglitazone in four cases. In all four cases, the patients had persistent growth hormone overproduction despite previous surgical treatment and other conventional therapy. Case 1 is a 57-year-old Caucasian woman, case 2 is a 51-year-old Hispanic man, case 3 is a 32-year-old Hispanic woman, and case 4 is a 36-year-old Hispanic man. In three of these patients, basal and nadir growth hormone and insulin-like growth factor 1 levels were significantly decreased (P < 0.05 and P < 0.01, respectively). CONCLUSION: Rosiglitazone could be a treatment option in select patients with acromegaly.

[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.

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

OBJETIVOS: Determinar la asociación entre un bajo desempeño cognoscitivo registrado en 2001 en el Estudio Nacional sobre Salud y Envejecimiento en México (ENASEM), y la mortalidad notificada en 2003 en la segunda vuelta del mismo estudio. MÉTODOS: Se seleccionaron sujetos de 50 o más años de edad que hubiesen completado las secciones de la encuesta de 2001 sobre ejercicios cognoscitivos, estado de salud, y funcionalidad y ayuda para el desempeño de actividades cotidianas. El desempeño cognoscitivo fue evaluado en 2001 utilizando una versión reducida del Examen Cognoscitivo Transcultural (escala de 0 a 80 puntos). En 2003 se realizó el seguimiento de los entrevistados y se registró su supervivencia o mortalidad. RESULTADOS: Los grupos de entrevistados con puntaje menor a 40 notificaron una supervivencia acumulada de 96,1 por ciento y una media de 26,49 meses de supervivencia (IC 95 por ciento 26,41- 26,57), mientras que los de 40 o más puntos informaron una supervivencia acumulada de 98,7 por ciento y una media de supervivencia de 28,76 meses (IC 95 por ciento 28,68-28,85) (Log Rank χ2 = 59,230 P < 0,001). Un puntaje menor a 40 en la evaluación cognoscitiva se asoció con un riesgo relativo de muerte de 1,863 (IC 95 por ciento 1,30-2,65) en el análisis multivariado. También se asociaron con tasas más altas de mortalidad una mayor edad, autoinforme de diabetes, cáncer, haber fumado alguna vez, recibir ayuda en al menos una actividad instrumentada de la vida diaria y tener un mayor puntaje en la escala de depresión. CONCLUSIONES: Un puntaje menor a 40 en la versión abreviada del Examen Cognoscitivo Transcultural se asoció independientemente con un incremento en las tasas de mortalidad dentro de los dos años siguientes.

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 percent, with a mean of 26.49 months of survival (CI 95 percent 26.41-26.57), while those scoring 40 points or over had a cumulative survival rate of 98.7 percent, with a mean of 28.76 months (CI 95 percent 28.68-28.85) (Log Rank χ2 = 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 percent 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.