Factores que afectan el estado nutricional en personas mayores mexicanas: Enasem, 2018.

OBJETIVO: Analizar los factores que afectan el estado nutricional en personas mayores mexicanas del Estudio Nacional de Salud y Envejecimiento en México 2018 (Enasem 2018). Material y métodos. Análisis transversal secundario de determinantes sociales, factores relativos a la salud y eventos estresantes de la vida con dos problemas nutricionales relevantes en personas mayores: 1) desnutrición y 2) exceso de peso considerando sobrepeso y obesidad, mediante regresión logística múltiple. RESULTADOS: 4 587 participantes. La prevalencia de desnutrición fue 16.1% y está relacionada con edad ≥80 años, sin pareja, sin escolaridad, sobrestimación de índice de masa corporal (IMC), dificultad motriz, dependencia funcional instrumental, hospitalización en año previo y caídas en los últimos dos años, autorreporte de fuerza prensil débil, reporte de desastre que afectó vivienda o accidente que afectó la salud. La prevalencia de exceso de peso fue 43.6%, relacionada con ser mujer, tener 60 a 79 años, percibirse sin sobrepeso u obesidad y subestimarlo contra IMC, tener ≥3 enfermedades, síntomas somáticos e inactividad física. CONCLUSIONES: Los factores que afectan el estado nutricional hacia desnutrición o exceso de peso en las personas mayores requieren considerarse como áreas de intervención importante en el envejecimiento.

Copy number alterations and epithelial­mesenchymal transition genes in diffuse and intestinal gastric cancers in Mexican patients.

Gastric cancer (GC) is a common malignancy with the highest mortality rate among diseases of the digestive system, worldwide. The present study of GC alterations is crucial to the understanding of tumor biology and the establishment of important aspects of cancer prognosis and treatment response. In the present study, DNA from Mexican patients with diffuse GC (DGC), intestinal GC (IGC) or non­atrophic gastritis (NAG; control) was purified and whole­genome analysis was performed with high­density arrays. Shared and unique copy number alterations (CNA) were identified between the different tissues involving key genes and signaling pathways associated with cancer. This led to the molecular distinction and identification of the most relevant molecular functions to be identified. A more detailed bioinformatics analysis of epithelial­mesenchymal transition (EMT) genes revealed that the altered network associated with chromosomal alterations included 11 genes that were shared between DGC, IGC and NAG, as well as 19 DGC­ and 7 IGC­exclusive genes. Furthermore, the main molecular functions included adhesion, angiogenesis, migration, metastasis, morphogenesis, proliferation and survival. The present study provided the first whole­genome high­density array analysis in Mexican patients with GC and revealed shared and exclusive CNA­associated genes in DGC and IGC. In addition, a bioinformatics­predicted network was generated, focusing on CNA­altered genes associated with EMT and the hallmarks of cancer, as well as precancerous alterations that may lead to GC. Molecular signatures of diffuse and intestinal GC, predicted bioinformatically, involve common and distinct CNA­EMT genes related to the hallmarks of cancer that are potential candidates for screening biomarkers of GC, including early stages.

[Interinstitutional Command Mexico: organizational decision-making in the face of COVID-19]. / Comando interinstitucional México: toma de decisiones organizacionales ante COVID-19.

Background: The third wave of COVID-19 in Mexico produced a high demand for hospital care, which is why it was created a multidisciplinary group to optimize decision-making: the Interinstitutional Command for the Health Sector (COISS, according to its initials in Spanish). So far, there is no scientific evidence of the COISS processes or their effect on the behavior of epidemiological indicators and the hospital care needs of the population in the context of COVID-19 in the entities involved. Objectives: To analyze the trend on epidemic risk indicators throughout the COISS group's management in the third wave of COVID-19 in Mexico. Material and methods: Mixed study: 1) non-systematic review of information from technical documents issued by COISS, 2) secondary analysis of open-access institutional databases through the description of healthcare needs of cases notified with COVID-19 symptoms, and an ecological analysis by each Mexican state on the behavior of hospital occupancy, RT-PCR positivity, and COVID-19 mortality in two-time points. Results: The COISS activity in identifying states with epidemic risk generated actions aimed at a reduction in hospital occupancy of beds, positivity by RT-PCR, and mortality from COVID-19. Conclusions: The decisions of the COISS group reduced the indicators of epidemic risk. Continuing the work of the COISS group is an urgent need. Conclusions: The decisions of the COISS group reduced the indicators of epidemic risk. Continuing the work of the COISS group is an urgent need.

Introducción: la tercera ola por COVID-19 en México provocó una alta demanda de atención hospitalaria, por lo cual se conformó un grupo multidisciplinario para optimizar la toma de decisiones sanitarias: Comando Interinstitucional del Sector Salud (COISS). Hasta el momento, no hay evidencia científica de los procesos del COISS ni de su efecto sobre el comportamiento de indicadores epidemiológicos y las necesidades de atención hospitalaria de la población bajo el contexto de COVID-19 en entidades federativas involucradas. Objetivos: analizar la tendencia de indicadores de riesgo epidémico durante la gestión del grupo COISS en la tercera ola por COVID-19 en México. Material y métodos: estudio mixto: 1) revisión no sistemática de documentos técnicos del COISS, 2) análisis secundario de bases de datos de libre acceso, mediante la descripción de necesidades de atención hospitalaria de los casos notificados con síntomas de la COVID-19 y un análisis ecológico por entidades federativas sobre el comportamiento de la ocupación hospitalaria, positividad y mortalidad por COVID-19 en dos cortes temporales. Resultados: la actividad del COISS en la identificación de entidades federativas de riesgo epidémico generó acciones encaminadas a una reducción en la ocupación hospitalaria de camas generales, positividad por RT-PCR y mortalidad por COVID-19. Conclusiones: las decisiones del grupo COISS disminuyeron los indicadores de riesgo epidémico. Continuar el trabajo del grupo COISS es una necesidad apremiante.

Looking for Crumbs in the Obesity Forest: Anti-obesity Interventions and Obesity-Associated Cardiometabolic Traits in the Mexican Population. History and Systematic Review With Meta-Analyses.

Mexicans and Mexican Americans share culture, genetic background, and predisposition for chronic complications associated with obesity and diabetes making imperative efficacious treatments and prevention. Obesity has been treated for centuries focused-on weight loss while other treatments on associated conditions like gout, diabetes (T2D), and hypertriglyceridemia. To date, there is no systematic review that synthesizes the origin of obesity clinics in Mexico and the efforts to investigate treatments for obesity tested by randomized clinical trials (RCT). We conducted systematic searches in Pubmed, Scopus, and Web of Science to retrieve anti-obesity RCT through 2019 and without an inferior temporal limit. The systematic review included RCT of anti-obesity treatments in the Mexican adult population, covering alternative medicine, pharmacological, nutritional, behavioral, and surgical interventions reporting metabolism-associated traits such as BMI, weight, waist circumference, triglycerides, glucose, among others. Only the studies with at least 3 months of treatment were included in the meta-analyses in order to reduce placebo effects. We found 634 entries, after removal of duplicates and screening the studies based on eligibility criteria, we analyzed 43 national, and 2 multinational-collaborative studies. Most of the national studies had small sample sizes, and the implemented strategies do not have replications in the population. The nutrition/behavioral interventions were difficult to blind, and most studies have medium-to-high risk of bias. Nutritional/behavioral interventions and medications showed effects on BMI, waist circumference, and blood pressure. Simple measures like pure water instead of sweet beverages decrease triglycerides and systolic blood pressure. Dark chocolate showed the highest effect for BMI and high blood pressure, and treatment with insulin increased weight in those with T2D. The study of obesity in Mexico has been on-going for more than four decades, the interest on RCT just increased until this millennium, but with small sample sizes and lack of replication. The interventions affect different cardiometabolic associated traits, which should be analyzed in detail in the population living near the Mexico-U.S. border; therefore, bi-national collaboration is desirable to disentangle the cultural effects on this population's treatment response. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020221436, identifier: CRD42020221436.

"Help! I Need Somebody": Music as a Global Resource for Obtaining Wellbeing Goals in Times of Crisis.

Music can reduce stress and anxiety, enhance positive mood, and facilitate social bonding. However, little is known about the role of music and related personal or cultural (individualistic vs. collectivistic) variables in maintaining wellbeing during times of stress and social isolation as imposed by the COVID-19 crisis. In an online questionnaire, administered in 11 countries (Argentina, Brazil, China, Colombia, Italy, Mexico, the Netherlands, Norway, Spain, the UK, and USA, N = 5,619), participants rated the relevance of wellbeing goals during the pandemic, and the effectiveness of different activities in obtaining these goals. Music was found to be the most effective activity for three out of five wellbeing goals: enjoyment, venting negative emotions, and self-connection. For diversion, music was equally good as entertainment, while it was second best to create a sense of togetherness, after socialization. This result was evident across different countries and gender, with minor effects of age on specific goals, and a clear effect of the importance of music in people's lives. Cultural effects were generally small and surfaced mainly in the use of music to obtain a sense of togetherness. Interestingly, culture moderated the use of negatively valenced and nostalgic music for those higher in distress.

High prevalence of human papillomavirus type 66 in low-grade cervical lesions of Mexican women.

Our aim was to analyze the prevalence of high-risk human papillomavirus (HR-HPV) and its association with risk factors related to cervical lesions. We used 362 cervical samples from a transversal study to detect nineteen types from the high-risk HPV clade by highly sensitive PCR. Unexpectedly, we found a very high prevalence of HPV type 66 (32.8%), particularly in low-grade squamous intraepithelial lesions. A significant association of HPV66 with previously sexually transmitted disease was observed (p < 0.05). Our results strongly suggest that HPV66 might be indicative of cervical lesions that will not progress to cancer. HPV genotyping by methods that grouped type 66 with other HR-HPV clade types should be interpreted with caution.

Telomere length and oxidative stress variations in a murine model of Alzheimer's disease progression.

Alzheimer's disease (AD) is the most common cause of dementia, and ageing is its major risk factor. Changes in telomere length have been associated with ageing and some degenerative diseases. Our aim was to explore some of the molecular changes caused by the progression of AD in a transgenic murine model (3xTg-AD; B6; 129-Psen1 Tg (APPSwe, tauP301L) 1Lfa). Telomere length was assessed by qPCR in both brain tissue and peripheral blood cells and compared between three age groups: 5, 9 and 13 months. In addition, a possible effect of oxidative stress on telomere length and AD progression was explored. Shorter telomeres were found in blood cells of older transgenic mice compared to younger and wild-type mice but no changes in telomere length in the hippocampus. An increase in oxidative stress with age was found for all strains, but no correlation was found between oxidative stress and shorter telomere length for transgenic mice. Telomere length and oxidative stress are affected by AD progression in the 3xTg-AD murine model. Changes in blood cells are more noticeable than changes in brain tissue, suggesting that systemic changes can be detected early in the disease in this murine model.

Information and Communication Technology, Mobile Devices, and Medical Education.

Information and communication technologies (ICT) are practical and highly available tools. In medical education, ICTs allow physicians to update their knowledge and remember the necessary information within reach of current mobile devices. ICTs as preparation tools for medical education have not been reported for medical students in Mexico. To assess the use of mobile devices as ICTs with medical education purposes, we distributed a questionnaire through an online survey management system to all the medical students (n = 180) from a private university in Mexico City, 100% agreed to participate. We developed a questionnaire based on previous surveys and adapted it to our university. All participants reported possession of an electronic mobile device, and 95% used it regularly for learning purposes. Regardless of the school year, the most frequent usage given to these devices was the search and reading of medical articles, the use of medical calculators, and taking notes. As the levels in career advances, there was a reduction in the use of electronic devices. According to the students, the main barriers towards using mobile devices for learning purposes were both the lack of access to the Internet and permission from the professor to use them. Most medical students use mobile devices for learning purposes, but usage changes during their education. It is convenient to encourage the use of mobile devices and the development of ICT skills as tools for educational purposes rather than banning their use in schools and hospitals.

Non-Hodgkin Lymphoma Epidemiology in Children From 2 Socioeconomic Regions in Mexico: 20-Year Registry (1996-2015).

PURPOSE: We analyzed the epidemiologic characteristics of different types of non-Hodgkin Lymphoma (NHL), excluding Burkitt Lymphoma, in 2 Mexican regions with different socioeconomic status. MATERIALS AND METHODS: In this surveillance study, we analyzed the incidence rates (cases per million children/year) of different types of NHL according to the ICCC3, registered in 1996-2015, from 2 different socioeconomic regions in Mexico: central and southern, with higher and lower status, respectively. RESULTS: The principal NHL subgroups were precursor (IIb1), mature B cell (IIb2), mature T/NK cell, and no other specification (NOS; 42.3%, 15.8%, 14.1%, and 27.8%, respectively). In both regions, the overall incidence rates were similar (central=5.3, 95% confidence interval [CI], 4.6-6.1 vs. southern=6.3, 95% CI, 4.6-8.4); also, there were no differences by types (precursor cell LNH, 2.3 vs. 2.5; mature B cell, 0.9 vs. 0.8; mature T/NK cells, 0.8 vs. 0.8; and NOS, 1.4 vs. 2.3). In both regions, a decreasing trend was found (central= -0.17%, 95% CI, -0.03 to -0.3, P=0.04; southern= -0.32%, 95% CI, -0.07 to -0.57, P=0.02), with major reduction of NHL NOS from 1996 to 2000. In both regions, men predominated (2.1:1). CONCLUSIONS: Socioeconomic status did not influence the incidence rates of NHL. In this study, we found a reduction of NHL NOS, possibly due to better typing.

[Bayesian analysis. Basic and practical concepts for its interpretation and use]. / Análisis bayesiano. Conceptos básicos y prácticos para su interpretación y uso.

Bayesian statistics is based on subjective probability. It works with evidence updating considering the knowledge acquired prior to an investigation, plus the evidence obtained thereof. Results' interpretation requires for the hypotheses to be tested to be specified and their a priori probability to be estimated before the study. Study evidence is measured with the Bayes factor (compatibility ratio of the data under the proposed hypotheses). The conjunction of hypotheses a priori probabilities with the Bayes factor allows calculating the a posteriori probability of each one of them. The hypothesis with the highest degree of certainty at its update is the one that is accepted for decision making. In this review, three examples of hypothesis to be tested are shown: difference of means, correlation and association.

La estadística bayesiana se basa en la probabilidad subjetiva, trabaja con la actualización de la evidencia considerando los conocimientos adquiridos previos a una investigación, más la evidencia obtenida con esta. La interpretación de los resultados requiere la especificación de las hipótesis por contrastar y su probabilidad a priori antes del estudio. La evidencia del estudio se mide con el factor Bayes (razón de la compatibilidad de los datos bajo las hipótesis propuestas). La conjunción de las probabilidades a priori de las hipótesis con el factor Bayes permite calcular la probabilidad a posteriori de cada una. La hipótesis con mayor grado de certidumbre en su actualización es la aceptada para la toma de la decisión. En esta revisión se muestran tres ejemplos de hipótesis por contrastar: diferencia de promedios, correlación y asociación.

[Clinical significance vs statistical significance. How to interpret the confidence interval at 95]. / Significancia clínica sobre significancia estadística. Cómo interpretar los intervalos de confianza a 95.

The validity of a study depends on its proper planning, execution and analysis. If these are sufficiently correct, the decision to apply the recommendations issued depends on the expected clinical effect. This effect may have random variations, hence the need to use statistical inference. For years the p-value has been used to determine this statistical significance and the confidence intervals to measure the magnitude of the effect. In this review we present a proposal of how to interpret the 95 % confidence intervals (CI 95 %) as estimators of the expected effect variability based on considering the threshold or value of clinical significance and the null value of the difference or rejection of statistical significance. Thus, an association or effect where the CI 95 % includes the null value (no effect or difference) is interpreted as inconclusive; one between the null value and the clinical threshold (without including them) as possibly inconsequential; one that does not include the null value but the clinical threshold as yet not conclusive and one beyond the clinical threshold as conclusive.

La validez de un estudio depende de su adecuada planeación, ejecución y análisis. Si estas son suficientemente correctas, la decisión de aplicar las recomendaciones emitidas depende del efecto clínico esperado. Este efecto puede tener variaciones aleatorias, de ahí la necesidad de usar la inferencia estadística. Durante años se ha usado el valor de p para determinar esta significancia estadística y los intervalos de confianza para medir la magnitud del efecto. En esta revisión se presenta una propuesta de cómo interpretar los intervalos de confianza a 95 % (IC 95 %) como estimadores de la variabilidad del efecto esperado, con base en considerar el umbral o valor de significancia clínica y el valor nulo de diferencia o rechazo de significancia estadística. Con ello, una asociación en la cual el IC 95 % incluye el valor nulo (no efecto o diferencia) es interpretado como no concluyente; uno entre el valor nulo y el umbral clínico (sin incluirlos) como posiblemente intrascendente; uno que no incluye al valor nulo, pero sí al umbral clínico como aún no contundente y uno más allá del umbral clínico como contundente.

Association Between the Brain-derived Neurotrophic Factor Val66Met Polymorphism and Overweight/Obesity in Pediatric Population.

BACKGROUND: The brain-derived neurotrophic factor (BDNF) rs6265 (G196A; Val66Met) single nucleotide polymorphism has been associated with BMI and obesity in distinct populations, both adult and pediatric, with contradictory results involving either Val or Met as the risk variant. AIM OF THE STUDY: To determine the association between the BDNF Val66Met polymorphism and BMI in Mexican children and adolescents. METHODS: BDNF Val66Met genotyping by restriction fragment length polymorphism and nutritional status characterized by their BMI-for-age z-scores (BAZ) from pediatric volunteers (n = 498) were analyzed by Fisher's exact test association analysis. Standardized residuals (R) were used to determine which genotype/allele had the major influence on the significant Fisher's exact test statistic. Odds ratios were analyzed to measure the association between genotype and normal weight (≥-2 SD < + 1 SD) and overweight (≥ + 1 SD, including obesity, Ow + Ob) status with 95% confidence intervals to estimate the precision of the effect as well as 95% credible intervals to obtain the most probable estimate. RESULTS: Comparisons between GG (Val/Val), GA (Val/Met) and AA (Met/Met) genotypes or Met homozygotes vs. Val carriers (combination of GG and GA genotypes) showed significant differences (p = 0.034 and p = 0.037, respectively) between normal weight and the combined overweight and obese pediatric subjects. Our data showed that children/adolescents homozygous for the A allele have increased risk of overweight compared to the Val carriers (Bayes OR = 4.2, 95% CI**[1.09-33.1]). CONCLUSION: This is the first study showing the significant association between the BDNF rs6265 AA (Met/Met) genotype and overweight/obesity in Mexican pediatric population.

Brain-derived neurotrophic factor, food intake regulation, and obesity.

Brain-derived neurotrophic factor (BDNF) is a neurotrophin that plays a fundamental role in development and plasticity of the central nervous system (CNS). It is currently recognized as a major participant in the regulation of food intake. Multiple studies have shown that different regulators of appetite such as leptin, insulin and pancreatic polypeptide (PP) potentially exert anorexigenic effects through BDNF. Low circulating levels of BDNF are associated with a higher risk of eating disorders such as anorexia nervosa (AN) and bulimia nervosa (BN). Strict food restriction reduces BDNF and may trigger binge-eating episodes and weight gain. The existence of mutations that cause haploinsufficiency of BDNF as well as some genetic variants, notably the BDNF p.Val66Met polymorphism, are also associated with the development of obese phenotypes and hyperphagia. However, association of the Met allele with AN and BN, which have different phenotypic characteristics, shows clearly the existence of other relevant factors that regulate eating behavior. This may, in part, be explained by the epigenetic regulation of BDNF through mechanisms like DNA methylation and histone acetylation. Environmental factors, primarily during early development, are crucial to the establishment of these stable but reversible changes that alter the transcriptional expression and are transgenerationally heritable, with potential concomitant effects on the development of eating disorders and body weight control.