Fibroblast growth factor 21 is associated with increased serum total antioxidant capacity and oxidized lipoproteins in humans with different stages of chronic kidney disease.

Background and aims: Oxidative stress (OS) induces the production of fibroblast growth factor 21 (FGF21). Previous data have revealed that FGF21 protects cells from OS injury and death, making it a potential therapeutic option for many diseases with increased OS. However, the association of this growth factor with OS markers in humans with chronic kidney disease (CKD) remains unknown. This study aims to evaluate the association of serum FGF21 with serum total antioxidant capacity (TAC) and oxidized low-density lipoproteins (OxLDL) in subjects in different stages of kidney disease. Methods: This is a cross-sectional study that included 382 subjects with different stages of CKD, irrespective of type 2 diabetes (T2D) diagnosis. Associations of serum FGF21 with OxLDL, TAC, sex, age, body mass index (BMI), fasting plasma glucose, estimated glomerular filtration rate (eGFR), T2D, and smoking, were evaluated through bivariate and partial correlation analyses. Independent associations of these variables with serum FGF21 were evaluated using multiple linear regression analysis. Results: Serum FGF21 was significantly and positively correlated with age (r = 0.236), TAC (lnTAC) (r = 0.217), and negatively correlated with eGFR (r = -0.429) and male sex (r = -0.102). After controlling by age, sex, BMI, T2D, smoking, and eGFR; both TAC and OxLDL were positively correlated with FGF21 (r = 0.117 and 0.158 respectively, p < 0.05). Using multiple linear regression analysis, eGFR, male sex, T2D, OxLDL, and TAC were independently associated with serum FGF21 (STDß = -0.475, 0.162, -0.153, 0.142 and 0.136 respectively; p < 0.05 for all) adjusted for age, BMI, smoking, and fasting plasma glucose. Conclusion: A positive association between serum FGF21 and OS has been found independently of renal function in humans. Results from the present study provide novel information for deeper understanding of the role of FGF21 in OS in humans with CKD and T2D; mechanistic studies to explain the association of serum FGF21 with oxidative stress in CKD are needed.

Seroprevalence of HPV serotypes 6, 11, 16 and 18 in unvaccinated children from Mexico City.

Data regarding humoral immunity against HPV infection are scarce. Most analyses focus on the identification of viruses on mucous membranes and primarily refer to women of reproductive age. The aim of this work was to estimate the seroprevalence of antibodies against HPV serotypes 6, 11, 16 and 18 among unvaccinated boys living in Mexico City. A cross-sectional study of 257 male students from 48 public primary schools in Mexico City, whose ages fluctuated between 9 and 14 years, was carried out. Immunological status was assessed by applying the competitive Luminex Immunoassay of HPV (cLIA). Among the study population, we initially found that 38.52% (n = 99) of the children tested positive against one or more of the HPV 6, 11, 16 and/or 18 serotypes. The most commonly found serotype was isolated HPV 18 or in combination with other serotypes (22% and 31%, respectively), followed by HPV 6 with frequencies of 4.7% and 11%, respectively; however, lower frequencies were estimated for HPV 16 (2%; 6%) and isolated HPV 11, 4%. If a second set of cut-off points for seropositivity is applied, the overall prevalence for any serotype is reduced to 15.2%. As it appears that a significant sector of the study population has had basal contact with an HPV serotype, we recommend considering the possibility of vaccination against HPV at earlier ages.

[The diagnosis of chronic kidney disease as a tracer of the technical capacity in care facilities of 20 Mexican states]. / Diagnóstico de la enfermedad renal crónica como trazador de la capacidad técnica en la atención médica en 20 estados de México.

OBJECTIVE: To assess knowledge and technical capacity of primary care physicians in the management of patients with diabetes mellitus and high blood pressure as well as patients at risk of developing chronic kidney disease, and to use the latter condition as a tracer of the quality of primary care of the Mexican health system. MATERIAL AND METHODS: A cross-sectional study included 149 primary health physicians in primary care units from state health care services in 20 states. An instrument with two clinical cases was applied. RESULTS: The average score of the physicians evaluated was 53.7 out of 100. Those physicians working in larger size units and graduated before the year 2000 tend to receive lower scores. CONCLUSIONS: The use of chronic kidney disease as a tracer of the technical capacity of the Mexican health care system is useful to understand the problems of primary care in the country's public settings.

[An indirect estimation of current and future inequalities in the frequency of end stage renal disease in Mexico]. / Una estimación indirecta de las desigualdades actuales y futuras en la frecuencia de la enfermedad renal crónica terminal en México.

OBJECTIVE: To describe current and future health inequalities in End Stage Renal Disease in Mexico (ESRD) in Mexican states with varying degrees of marginality. MATERIAL AND METHODS: Using results, obtained by us in 2009, of an indirect estimation of incidence, prevalence, and mortality rates, and of the average case duration, we grouped these data according to the social deprivation level of the Mexican states. We measured health inequalities using the Health Concentration Index. RESULTS: We found rising inequalities, between 2005 and 2025, in ESRD incidence, prevalence and mortality rates, as well as in the average duration of cases. CONCLUSION: We project an important increase in the prevalence of ESRD for 2025 which will be greater in the Mexican states with more marginality. This will increase health inequities already present and represent important challenges for health care financing, especially if no action is taken to control the causes and progression of ESRD.

Diagnóstico de la enfermedad renal crónica como trazador de la capacidad técnica en la atención médica en 20 estados de México / The diagnosis of Chronic Kidney Disease as a tracer of the technical capacity in care facilities of 20 Mexican states

OBJETIVO. Evaluar el conocimiento y la capacidad técnica de los médicos de primer nivel de atención en el manejo de los pacientes con diabetes mellitus e hipertensión arterial y de pacientes en riesgo de desarrollar enfermedad renal crónica (ERC) y utilizar la enfermedad terminal de esta última como trazador de la calidad de la atención primaria en el sistema de salud mexicano. MATERIAL Y MÉTODOS. Se realizó un estudio transversal en los servicios de salud de las secretarías de salud en 20 estados de junio a diciembre de 2008. Se construyó un cuestionario con dos casos clínicos. RESULTADOS. El promedio de calificación de los 149 médicos evaluados fue de 53.7 Los médicos que trabajan en las unidades de mayor tamaño tienden a tener mayor antigüedad y obtuvieron las calificaciones más bajas. CONCLUSIÓN. La utilización del diagnóstico de la ERC como un trazador permite detectar la capacidad de los médicos en el primer nivel de atención y el potencial del uso de esta metodología para evaluar procesos críticos en el sistema de salud.

OBJECTIVE. To assess knowledge and technical capacity of primary care physicians in the management of patients with diabetes mellitus and high blood pressure as well as patients at risk of developing chronic kidney disease, and to use the latter condition as a tracer of the quality of primary care of the Mexican health system. MATERIAL AND METHODS. A cross-sectional study included 149 primary health physicians in primary care units from state health care services in 20 states. An instrument with two clinical cases was applied. RESULTS. The average score of the physicians evaluated was 53.7 out of 100. Those physicians working in larger size units and graduated before the year 2000 tend to receive lower scores. CONCLUSIONS. The use of chronic kidney disease as a tracer of the technical capacity of the Mexican health care system is useful to understand the problems of primary care in the country´s public settings.

Una estimación indirecta de las desigualdades actuales y futuras en la frecuencia de la enfermedad renal crónica terminal en México / An indirect estimation of current and future inequalities in the frequency of end stage renal disease in Mexico

OBJETIVO. Describir las desigualdades actuales y futuras de la enfermedad renal crónica terminal (ERCT) en México, que se presentan entre grupos de entidades federativas con diferentes grados de marginación. MATERIAL Y MÉTODOS. Partiendo de una estimación indirecta de la incidencia, prevalencia, mortalidad y duración promedio que realizamos en 2009, presentamos datos agrupados de acuerdo con el grado de marginación estatal. Medimos la desigualdad con el Índice de Concentración de Salud. RESULTADOS. Encontramos desigualdades crecientes entre 2005 y 2025 en las tasas de incidencia, prevalencia y mortalidad, así como en la duración promedio de los casos. CONCLUSIÓN. Para 2025 esperamos importantes incrementos en la prevalencia de la ERCT que afectarán en mayor medida a los estados más marginados, lo que aumentará la inequidad presente en este problema de salud y representará importantes retos para el financiamiento de los servicios de salud, si no se incide sobre las causas y la progresión hacia la ERCT.

OBJECTIVE. To describe current and future health inequalities in End Stage Renal Disease in Mexico (ESRD) in Mexican states with varying degrees of marginality. MATERIAL AND METHODS. Using results, obtained by us in 2009, of an indirect estimation of incidence, prevalence, and mortality rates, and of the average case duration, we grouped these data according to the social deprivation level of the Mexican states. We measured health inequalities using the Health Concentration Index. RESULTS. We found rising inequalities, between 2005 and 2025, in ESRD incidence, prevalence and mortality rates, as well as in the average duration of cases. CONCLUSION. We project an important increase in the prevalence of ESRD for 2025 which will be greater in the Mexican states with more marginality. This will increase health inequities already present and represent important challenges for health care financing, especially if no action is taken to control the causes and progression of ESRD.

Cost-effectiveness analysis for joint pain treatment in patients with osteoarthritis treated at the Instituto Mexicano del Seguro Social (IMSS): Comparison of nonsteroidal anti-inflammatory drugs (NSAIDs) vs. cyclooxygenase-2 selective inhibitors.

BACKGROUND: Osteoarthritis (OA) is one of the main causes of disability worldwide, especially in persons >55 years of age. Currently, controversy remains about the best therapeutic alternative for this disease when evaluated from a cost-effectiveness viewpoint. For Social Security Institutions in developing countries, it is very important to assess what drugs may decrease the subsequent use of medical care resources, considering their adverse events that are known to have a significant increase in medical care costs of patients with OA. Three treatment alternatives were compared: celecoxib (200 mg twice daily), non-selective NSAIDs (naproxen, 500 mg twice daily; diclofenac, 100 mg twice daily; and piroxicam, 20 mg/day) and acetaminophen, 1000 mg twice daily. The aim of this study was to identify the most cost-effective first-choice pharmacological treatment for the control of joint pain secondary to OA in patients treated at the Instituto Mexicano del Seguro Social (IMSS). METHODS: A cost-effectiveness assessment was carried out. A systematic review of the literature was performed to obtain transition probabilities. In order to evaluate analysis robustness, one-way and probabilistic sensitivity analyses were conducted. Estimations were done for a 6-month period. RESULTS: Treatment demonstrating the best cost-effectiveness results [lowest cost-effectiveness ratio $17.5 pesos/patient ($1.75 USD)] was celecoxib. According to the one-way sensitivity analysis, celecoxib would need to markedly decrease its effectiveness in order for it to not be the optimal treatment option. In the probabilistic analysis, both in the construction of the acceptability curves and in the estimation of net economic benefits, the most cost-effective option was celecoxib. CONCLUSION: From a Mexican institutional perspective and probably in other Social Security Institutions in similar developing countries, the most cost-effective option for treatment of knee and/or hip OA would be celecoxib.

The activation of MEK-ERK1/2 by glutamate receptor-stimulation is involved in the regulation of RPE proliferation and morphologic transformation.

Retinal pigment epithelial (RPE) cells are the main cell type involved in the pathogenesis of proliferative vitreoretinopathy (PVR). As a result from retinal detachment or surgical procedures, RPE comes in contact with glutamate from serum, glial release and the injured retina. The purpose of this study was to explore a possible role for glutamate in the development of PVR, mediated by the receptor-stimulated activation of the ERK1/2 MAPK pathway, the alteration of cell proliferation and the transdifferentiation of RPE cells, using rat RPE cells in culture as a model system. We demonstrated the expression in these cells of Group I metabotropic-and ionotropic AMPA/KA and NMDA glutamate receptors (GluRs), predominantly of the NMDA subtype, which are targeted to the membrane, and exhibit pharmacological and biochemical characteristics equivalent to those previously established in brain tissue. Proliferation was measured by MTS-reduction colorimetric assay, and actin cytoskeleton dynamics was visualized by immunoflurescence using alpha-sma specific antibodies. Activation of metabotropic, AMPA and NMDA receptors by glutamate induced the time-and dose-dependent phosphorylation of ERK1/2, assessed by Western blot analysis, in parallel to a significant increase in cell proliferation and a decrease in alpha-sma expression and its recruitment into stress fibers. These effects were all prevented by the inhibition of MEK. Hence, results suggest that glutamate could be involved in the generation of PVR, through a GluR-mediated increase in proliferation and phenotypic transformation, cause-effect related to the activation of ERK1/2.