Efficacy of interferon beta-1a plus remdesivir compared with remdesivir alone in hospitalised adults with COVID-19: a double-bind, randomised, placebo-controlled, phase 3 trial.

BACKGROUND: Functional impairment of interferon, a natural antiviral component of the immune system, is associated with the pathogenesis and severity of COVID-19. We aimed to compare the efficacy of interferon beta-1a in combination with remdesivir compared with remdesivir alone in hospitalised patients with COVID-19. METHODS: We did a double-blind, randomised, placebo-controlled trial at 63 hospitals across five countries (Japan, Mexico, Singapore, South Korea, and the USA). Eligible patients were hospitalised adults (aged ≥18 years) with SARS-CoV-2 infection, as confirmed by a positive RT-PCR test, and who met one of the following criteria suggestive of lower respiratory tract infection: the presence of radiographic infiltrates on imaging, a peripheral oxygen saturation on room air of 94% or less, or requiring supplemental oxygen. Patients were excluded if they had either an alanine aminotransferase or an aspartate aminotransferase concentration more than five times the upper limit of normal; had impaired renal function; were allergic to the study product; were pregnant or breast feeding; were already on mechanical ventilation; or were anticipating discharge from the hospital or transfer to another hospital within 72 h of enrolment. Patients were randomly assigned (1:1) to receive intravenous remdesivir as a 200 mg loading dose on day 1 followed by a 100 mg maintenance dose administered daily for up to 9 days and up to four doses of either 44 µg interferon beta-1a (interferon beta-1a group plus remdesivir group) or placebo (placebo plus remdesivir group) administered subcutaneously every other day. Randomisation was stratified by study site and disease severity at enrolment. Patients, investigators, and site staff were masked to interferon beta-1a and placebo treatment; remdesivir treatment was given to all patients without masking. The primary outcome was time to recovery, defined as the first day that a patient attained a category 1, 2, or 3 score on the eight-category ordinal scale within 28 days, assessed in the modified intention-to-treat population, defined as all randomised patients who were classified according to actual clinical severity. Safety was assessed in the as-treated population, defined as all patients who received at least one dose of the assigned treatment. This trial is registered with ClinicalTrials.gov, NCT04492475. FINDINGS: Between Aug 5, 2020, and Nov 11, 2020, 969 patients were enrolled and randomly assigned to the interferon beta-1a plus remdesivir group (n=487) or to the placebo plus remdesivir group (n=482). The mean duration of symptoms before enrolment was 8·7 days (SD 4·4) in the interferon beta-1a plus remdesivir group and 8·5 days (SD 4·3) days in the placebo plus remdesivir group. Patients in both groups had a time to recovery of 5 days (95% CI not estimable) (rate ratio of interferon beta-1a plus remdesivir group vs placebo plus remdesivir 0·99 [95% CI 0·87-1·13]; p=0·88). The Kaplan-Meier estimate of mortality at 28 days was 5% (95% CI 3-7%) in the interferon beta-1a plus remdesivir group and 3% (2-6%) in the placebo plus remdesivir group (hazard ratio 1·33 [95% CI 0·69-2·55]; p=0·39). Patients who did not require high-flow oxygen at baseline were more likely to have at least one related adverse event in the interferon beta-1a plus remdesivir group (33 [7%] of 442 patients) than in the placebo plus remdesivir group (15 [3%] of 435). In patients who required high-flow oxygen at baseline, 24 (69%) of 35 had an adverse event and 21 (60%) had a serious adverse event in the interferon beta-1a plus remdesivir group compared with 13 (39%) of 33 who had an adverse event and eight (24%) who had a serious adverse event in the placebo plus remdesivir group. INTERPRETATION: Interferon beta-1a plus remdesivir was not superior to remdesivir alone in hospitalised patients with COVID-19 pneumonia. Patients who required high-flow oxygen at baseline had worse outcomes after treatment with interferon beta-1a compared with those given placebo. FUNDING: The National Institute of Allergy and Infectious Diseases (USA).

Low Incidence and Mortality by SARS-CoV-2 Infection Among Healthcare Workers in a Health National Center in Mexico: Successful Establishment of an Occupational Medicine Program.

Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Healthcare workers (HCWs) constitute a population which is significantly affected by SARS-CoV-2 infection worldwide. In Mexico, the Instituto Nacional de Enfermedades Respiratorias (INER) is the principal national reference of respiratory diseases. Aim: To evaluate the efficiency of the INER-POL-TRAB-COVID19 program to mitigate the SARS-CoV-2 infection risk among the INER-healthcare workers (INER-HCW). Methods: Currently, the INER has 250 beds and 200 respiratory ventilators to support COVID-19 patients in critical condition. On March 1st, 2020, the INER-POL-TRAB-COVID19 program was launched to mitigate the SARS-CoV-2 infection risk among the INER-HCW. Findings: From March 1st to October 1st, 2020, 71.5% of INER-HCWs were tested for SARS-CoV-2 infection, and 77% of them were frontline workers. Among the tested INER-HCWs, 10.4% were positive for SARS-CoV-2 infection. Nonetheless, nosocomial infection represented only 3.8% of the cases and the mortality was null. Fifty-three of INER-HCWs positive to SARS-CoV-2 had a negative test 42-56 days post-diagnosis and were returned to service. Finally, although a change in the PPE implemented on May 11th, 2020, the incidence of SARS-CoV-2 infection was not affected. Conclusion: INER has a lower incidence of HCWs infected with SARS-CoV-2 as compared to the mean of the national report. The implementation of the INER-POL-TRAB-COVID19 program is efficient to decrease the risk of infection among the HCWs. Our findings suggest that the implementation of a similar program at a national level can be helpful to provide a safe environment to HCWs and to prevent the collapse of health institutions.

Tobacco control in Mexico: a decade of progress and challenges.

Mexico was the first country in the Americas to sign and ratify the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC) in 2004. More than a decade later, it is appropriate to evaluate legislative and regulatory progress and the associated challenges; and also, to propose a roadmap to prioritize the problems to be addressed to achieve long-term sustainable solutions. Mexico has made substantial progress in tobacco control. However, regulations have been only weakly enforced. The tobacco industry continues to interfere with full implementation of the WHO-FCTC. As a result, tobacco consumption remains stable at about 17.6%, with a trend upwards among vulnerable groups: adolescents, women and low-income groups. The growing popularity of new tobacco products (electronic cigarettes or e-cigs) among young Mexicans is an increasing challenge. Our review reveals the need to implement all provisions of the WHO-FCTC in its full extent, and that laws and regulations will not be effective in decreasing the tobacco epidemic unless they are strictly enforced.

México fue el primer país de América en firmar y ratificar el Convenio Marco de la OMS para el Control del Tabaco (CMCT-OMS) en 2004. Un poco más de una década después, es relevante evaluar aspectos legislativos, regulatorios, avances y desafíos, además de proponer una ruta crítica con soluciones sustentables a largo plazo. México ha avanzado en el control del tabaco; sin embargo, las medidas se han implementado parcialmente y la industria del tabaco continúa interfiriendo con la implementación completa del CMCTOMS. Como resultado, el consumo de tabaco se mantiene estable alrededor de 17.6%, con una tendencia ascendente entre los más vulnerables: adolescentes, mujeres y grupos de bajos ingresos. La creciente popularidad de uso de los e-cig entre los jóvenes mexicanos trae nuevos y complejos desafíos. Es perentorio implementar al más alto nivel todas las disposiciones del CMCT-OMS: las leyes y los reglamentos no serán eficaces para abatir la epidemia de tabaquismo si no se aplican adecuadamente.

Tobacco control in Mexico: a decade of progress and challenges / El control de tabaco en México: una década de avances y desafíos

Abstract: Mexico was the first country in the Americas to sign and ratify the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC) in 2004. More than a decade later, it is appropriate to evaluate legislative and regulatory progress and the associated challenges; and also, to propose a roadmap to prioritize the problems to be addressed to achieve long-term sustainable solutions. Mexico has made substantial progress in tobacco control. However, regulations have been only weakly enforced. The tobacco industry continues to interfere with full implementation of the WHO-FCTC. As a result, tobacco consumption remains stable at about 17.6%, with a trend upwards among vulnerable groups: adolescents, women and low-income groups. The growing popularity of new tobacco products (electronic cigarettes or e-cigs) among young Mexicans is an increasing challenge. Our review reveals the need to implement all provisions of the WHO-FCTC in its full extent, and that laws and regulations will not be effective in decreasing the tobacco epidemic unless they are strictly enforced.

Resumen: México fue el primer país de América en firmar y ratificar el Convenio Marco de la OMS para el Control del Tabaco (CMCT-OMS) en 2004. Un poco más de una década después, es relevante evaluar aspectos legislativos, regulatorios, avances y desafíos, además de proponer una ruta crítica con soluciones sustentables a largo plazo. México ha avanzado en el control del tabaco; sin embargo, las medidas se han implementado parcialmente y la industria del tabaco continúa interfiriendo con la implementación completa del CMCT-OMS. Como resultado, el consumo de tabaco se mantiene estable alrededor de 17.6%, con una tendencia ascendente entre los más vulnerables: adolescentes, mujeres y grupos de bajos ingresos. La creciente popularidad de uso de los e-cig entre los jóvenes mexicanos trae nuevos y complejos desafíos. Es perentorio implementar al más alto nivel todas las disposiciones del CMCT-OMS: las leyes y los reglamentos no serán eficaces para abatir la epidemia de tabaquismo si no se aplican adecuadamente.

EV-D68 infection in children with asthma exacerbation and pneumonia in Mexico City during 2014 autumn.

BACKGROUND: Human enterovirus D68 (EV-D68) recently caused an increase in mild-to-severe pediatric respiratory cases in North America and some European countries. Even though few of these children presented with acute paralytic disease, direct causal relationship cannot yet be assumed. OBJECTIVES: The purposes of this report were to describe the clinical findings of an outbreak of EV-D68 infection in Mexico City and identify the genetic relationship with previously reported strains. PATIENTS/METHODS: Between September and December 2014, 126 nasopharyngeal samples (NPS) of hospitalized children <15 years of age with ARI were tested for the presence of respiratory viruses using a multiplex RT-qPCR and EV-D68-specific RT-qPCR. Clinical, epidemiological, and demographic data were collected and associated with symptomatology and viral infections. Phylogenetic analyses were performed using VP1 region. RESULTS: Enterovirus/rhinovirus infection was detected in 40 patients (31·7%), of which 24 patients were EV-D68-positive. EV-D68 infection prevailed over September and October 2014 and was associated with neutrophilia and lymphopenia, and patients were more likely to develop hypoxemia. Phylogenetic analyses showed that Mexican EV-D68 belongs to the new B1 clade. CONCLUSIONS: This is the first EV-D68 outbreak described in Mexico and occurred few weeks after the United States reported similar infections. Although EV-D68 belongs to new B1 clade, no neurological affection was observed.

Genetic Risk Determinants for Cigarette Smoking Dependence in Mexican Mestizo Families.

INTRODUCTION: Tobacco smoking is a leading cause of mortality in developed and developing countries. Despite antitobacco and smoke-free policies, the prevalence of active smokers in Mexican urban populations has remained stable. Mexican smokers differ from Caucasian and other ethnic groups, probably due to sociocultural and genetic background characteristics. This study explored the effect of known genetic variants on smoking behavior in Mexico City residents. METHODS: Three hundred sixty-four Mexican Mestizo Mexico City residents from 87 families with at least one smoker were assessed for association of 12 gene variants of six candidate genes (CHRNA4, CHRNB2, DRD2, ANKK1, SLC6A3, and CYP2A6) with cigarette consumption, age of initiation and smoking duration. The Family Based Association Test, an extension of the Transmission Disequilibrium Test, was used to perform family-based association analysis. RESULTS: The Family Based Association Test showed statistically significant association between the rs2072658 polymorphism of the CHRNB2 gene and smoking-related phenotypes such as: smoking status (SS), age of onset (AO), years of smoking, and psychological dependence (PD) evaluated by the Glover-Nilsson Smoking Behavior Questionnaire. After Bonferroni correction, only the association with AO remained significant (P = .003). Statistically significant association was also observed for the CYP2A6 rs28399433 T allele with SS (P = .003) and PD (P = .003). CONCLUSIONS: Our results indicate effects of the rs2072658 CHRNB2 and rs28399433 CYP2A6 gene variants on AO, SS and PD in Mexican Mestizo smokers. A mild effect of other analyzed gene variants, which may contribute to a putative polygenic predisposition for smoking, is suggested. IMPLICATIONS: The understanding of genetic and environmental determinants in the Mexican population is important for other Latin American populations as well, living in their own countries or moving to other ones, particular due to the current migration characteristics and particular genetic background like the Mexican Mestizo and other Central American populations with similar characteristics and migrating to neighbor developed countries, introducing their own smoking behavior and contributing importantly to the genetic pool of the receptor country.

Can pictorial warning labels on cigarette packages address smoking-related health disparities? Field experiments in Mexico to assess pictorial warning label content.

OBJECTIVE: The objective of this study was to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects. METHODS: Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers). Participants reported responses to different pictorial HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs. didactic) and the other involved manipulating image type (diseased organs vs. human suffering). RESULTS: Tests of mean ratings and rankings indicated that pictorial HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than pictorial HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance, and impact was found for graphic imagery of diseased organs than imagery of human suffering. CONCLUSIONS: Pictorial HWLs with didactic textual forms seem to work better than those with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases.

[The role of the National Office for Tobacco Control in Mexico]. / La función de la Oficina Nacional para el Control del Tabaco en México.

Tobacco smoking as the first cause of preventable dead in the world requires the implementation of proper public policies. The WHO Framework Convention on Tobacco Control (FCTC) sets the basis for this purpose at the national level. But the successful implementation of FCTC depends on a series of actions of every single member of the convention for the development of National Capacity. Building capacity implies the construction of human resources and organizational engineering or "institutional building" in order to enforce and guarantee the Plan of Action for the implementation of FCTC. The creation of the National Office for Tobacco Control of México will allow the enforcement of Mexican government initiatives on implementation of policies for tobacco control, according with FCTC on a sustainable and permanent platform. This essay presents the importance on the office, their main functions and their medium and long term objectives.

La función de la oficina nacional para el control del tabaco en México / The role of the national office for tobacco control in Mexico

El tabaquismo, como la primera causa de muerte prevenible en el mundo, impone la implementación de políticas públicas acordes a la dimensión el problema. El Convenio Marco para el Control del Tabaco (CMCT) de la Organización Mundial de la Salud establece una guía para este propósito. El solo hecho de haber firmado y ratificado el convenio no garantiza la consecución de los objetivos centrales, su éxito depende del compromiso y de las acciones implementadas por cada uno de los países que lo han adoptado. Es necesaria la construcción de las capacidades necesarias para el desarrollo de políticas sustentables de control del tabaco. La "capacidad nacional" consiste en el desarrollo de recursos humanos expertos y la creación de una estructura de ingeniería organizacional que le dé sustento a los programas sobre los que operará la implementación del tratado. La creación de la Oficina Nacional para el Control del Tabaco (ONCT) permitirá fortalecer las acciones del Gobierno Federal encaminadas a la aplicación de políticas públicas de acuerdo con los lineamientos del CMCT de manera sustentable y permanente. En este ensayo se plantea la importancia de la ONCT para la implementación de políticas públicas para el control del tabaco, las funciones que desempeñará y los objetivos a mediano y largo plazo.

Tobacco smoking as the first cause of preventable dead in the world requires the implementation of proper public policies. The WHO Framework Convention on Tobacco Control (FCTC) sets the basis for this purpose at the national level. But the successful implementation of FCTC depends on a series of actions of every single member of the convention for the development of National Capacity. Building capacity implies the construction of human resources and organizational engineering or "institutional building" in order to enforce and guarantee the Plan of Action for the implementation of FCTC. The creation of the National Office for Tobacco Control of México will allow the enforcement of Mexican government initiatives on implementation of policies for tobacco control, according with FCTC on a sustainable and permanent platform. This essay presents the importance on the office, their main functions and their medium and long term objectives.

Indicadores de síntomas de abstinencia en un grupo de fumadores mexicanos / Withdrawal symptoms indicators in a group of mexican smokers

OBJETIVO: Identificar indicadores de abstinencia en fumadores de la Clínica Anti-Tabaco en un hospital de referencia. Evaluar los síntomas según el nivel de adicción a la nicotina mediante la escala de Fagerstrõm (EDNF). MATERIAL Y MÉTODOS: Se incluyeron fumadores de la Clínica Anti-Tabaco y no-fumadores visitantes. Fumadores y no-fumadores completaron una entrevista estandarizada y diario de síntomas. RESULTADOS: Se incluyeron 185 fumadores (edad 40.93 años, DE, 10.22, 93 hombres/92 mujeres) y 102 no-fumadores (edad 38.22 años, DE 9.40, 41 hombres/61 mujeres). La mediana del índice paquetes-año fue de 13 (rango 1-72), el promedio de la EDNF fue de 6 (DE, 2.35). Los síntomas asociados con la dependencia fueron: ansiedad, RM 1.21 (IC95 por ciento 1.03-1.43); depresión, RM 2.75 (IC95 por ciento1.07-7.04), la depresión es más común entre las mujeres, RM 2.03 (IC95 por ciento 1.10 - 3.75); deseos de fumar, RM 1.53 (IC95 por ciento 1.19-1.97) y sudoración, RM 2.73 (IC95 por ciento 1.07-6.95). CONCLUSIONES: Los indicadores de abstinencia de nicotina en un grupo de fumadores mexicanos fueron deseos de fumar, ansiedad, depresión y diaforesis; estos síntomas se correlacionan con el nivel de dependencia a la nicotina.

OBJECTIVE: To describe symptoms of AS in a group of Mexican smokers attending a third referral clinic, to evaluate symptoms according to degree of nicotine dependence using the Fagerstrõm Test (FTND). MATERIAL AND METHODS: A self-reported standardized questionnaire was administered to smokers and non-smokers during three consecutive days. None of the smokers received treatment during this period. RESULTS: A total of 185 smokers and 102 non-smokers were included. No differences in age or gender were observed. Among smokers, median tobacco consumption was 13 pack-years (range 1 to 72) and the mean (SD) FTND was six (2.35). Symptoms related to nicotine withdrawal were anxiety (OR 1.21, 95 percentIC 1.03-1.43), depression (OR 2.75, 95 percentIC 1.07-7.04), which was more common in women (OR 2.03, 95 percentIC 1.10-3.75), urge to smoke (OR 1.53, 95 percentIC 1.19-1.97), and sweating (OR 2.73, 95 percentIC 1.07-6.95). CONCLUSIONS: The most frequent symptoms related to nicotine abstinence in Mexican smokers were: anxiety, urge to smoke, depression and sweating. These symptoms correlate with the degree of addiction.

Tratamiento actual del tabaquismo / Current treatment for smoking

El tabaquismo es una afección médica de carácter crónico caracterizada por la adicción a la nicotina. El 70 por ciento de los fumadores desea dejar de fumar, aunque sólo 30 por ciento lo intenta en un año. A los fumadores motivados se les debe ofrecer alguno de los tratamientos disponibles. Dentro del tratamiento farmacológico se distinguen los compuestos sin nicotina y la terapia de reemplazo con nicotina (TRN). En el primer grupo destacan el tartrato de vareniclina y los medicamentos antidepresivos como bupropión y nortriptilina. Dentro de la TRN se encuentran los parches, goma de mascar, tabletas sublinguales y orales, dispositivo de inhalación oral y aerosol nasal. El tartrato de vareniclina es un agonista parcial de los receptores nicotínicos cerebrales alfa4beta2 que reduce los síntomas de abstinencia, así como el deseo y urgencia por fumar. Los estudios muestran que vareniclina es superior a placebo (RM 3.22, IC95 por ciento 2.43-4.27) y también el bupropión (RM 1.66, IC95 por ciento 1.28-2.16). Todas las modalidades de TRN resultan efectivas (RM 1.78, IC95 por ciento 1.60-1.99) aunque, en casos particulares, alguna presentación puede resultar más conveniente. El potencial adictivo de los sustitutos de nicotina es menor que el del cigarrillo y además carece de los efectos tóxicos del humo. El bupropión estimula la función noradrenérgica y dopaminérgica y duplica la tasa de abstinencia en comparación con el parche de nicotina (RM 1.94, IC95 por ciento 1.72-2.19). La nortriptilina también se relaciona con aumento de las tasas de abstinencia (RM 2.34, IC95 por ciento 1.61-3.41). Otros tratamientos han mostrado cierta eficacia, entre los cuales destacan los bloqueadores de los receptores endocanabinoides, como el rimonabant. De los tratamientos no farmacológicos, el consejo médico es una herramienta útil, cuyo éxito puede ser de 2 a 4 por ciento, pero sólo 35 por ciento de los médicos lo aplican (RM 1.74, IC95 por ciento 1.48-2.05). La...

Smoking is a chronic medical condition characterized by the addiction to nicotine. Seventy percent of smokers want to quit smoking, although only 30 percent per year make the attempt. Some of the available treatments should be offered to smokers who are motivated to quit. Among the pharmaceutical treatments, nicotine-free tobacco and nicotine replacement therapy (NRT) stand out. In the first group, varenicline tartrate and anti-depression medications such as bupropion and nortriptyline are notable. NRTs include patches, chewing gum, sublingual and oral tablets, oral inhalation and nasal aerosol devices. Varenicline tartrate is an alpha4beta2 nicotinic receptor partial agonist that reduces withdrawal symptoms as well as the desire and urge to smoke. Studies show that varenicline is better than a placebo (RM 3.22, IC95 percent 2.43-4.27) and better than bupropion (RM 1.66, IC95 percent 1.28-2.16). All NRT modalities are effective (RM 1.78, IC95 percent 1.60-1.99), although in particular cases one may be more appropriate than another. The addictive potential of nicotine substitutes is less than that of cigarettes and, in addition, they lack the toxic effects of smoke. Bupropion stimulates noradrenergic and dopadrenergic functions and doubles the abstinence rate as compared with the nicotine patch (RM 1.94, IC95 percent 1.72-2.19). Nortriptyline is also associated with an increase in abstinence rates (RM 2.34, IC95 percent 1.6-3.41). Other treatments have shown a certain degree of efficacy, such as the endocannabinoids receptors blocker, rimonabant. As for non-pharmaceutical treatments, medical advice is a useful tool whose success can range from 2 to 4 percent, but only 35 percent of medical professionals provide it (RM 1.74, IC95 percent 1.48-2.05). Group psychological therapy helps to modify the perception of cigarettes and its noxious effects. The success of this modality is between 20 percent and 35 percent per year (RM 2.17, IC95 percent...

[Effect of tobacco smoking, respiratory symptoms and asthma on spirometry among adults attending a check-up clinic in Mexico City]. / Efecto del tabaquismo, los síntomas respiratorios y el asma sobre la espirometría de adultos de la Ciudad de México.

OBJECTIVE: To evaluate the effect of tobacco smoking, respiratory symptoms, and asthma on lung function among Mexican adults who were evaluated during a medical exam in a private health clinic. MATERIAL AND METHODS: Reference prediction equations were generated for spirometry parameters [forced vital capacity (FVC), forced expired volume in one second (FEV1) and FEV1/FVC] based on multiple linear regression models. The effect of tobacco smoking, respiratory symptoms and asthma on these equations were explored. RESULTS: Spirometry tests were performed on 919 subjects from 14 to 86 years of age. Asthma decreased FVC and FEV1 in men with a R2 change <1%. Respiratory symptoms decreased the FEV1/FVC ratio in both sexes. Tobacco smoking was associated with a significant reduction in FEV in women. CONCLUSIONS: Asthma lightly reduced lung function in males while tobacco smoking decreased FEV, particularly in females.

Frequency and correlates of adverse events in a respiratory diseases hospital in Mexico city.

OBJECTIVES: To estimate the frequency of severe adverse events (AEs) during hospital stay as well as their type and correlates in a referral hospital for respiratory diseases, using methods similar to those used in the Harvard Medical Malpractice Study. DESIGN: Retrospective review of medical records in a stratified sample of 836 patients drawn from a total of 4,555 hospital admissions registered during the year 2001. SETTING: A referral tertiary-care hospital for patients with respiratory diseases located in Mexico City. MAIN OUTCOME MEASURES: Weighted prevalence of AEs and odds ratios for correlates. RESULTS: The overall weighted prevalence for AEs was 9.1% (95% confidence interval, 7.5 to 10.4%). Of these patients, 17% had a related transient disability, 52% had a prolonged hospital stay, and 26% had an AE that according to the reviewers contributed to their death. Of the total number of AEs, 74% were qualified as potentially preventable. Among all types of AEs, we identified as most relevant for a chest hospital the delayed surgical treatment of empyema, representing 11% of the total. CONCLUSIONS: The frequency of AEs in a tertiary-care respiratory hospital is similar to that reported in general hospitals. A strategy to improve the treatment of empyema is needed.

[Characteristics of Mexican asthmatic subjects attending an outpatient service]. / Características de pacientes asmáticos mexicanos atendidos en consulta externa.

BACKGROUND: Despite the high prevalence of asthma in Mexico, studies describing general characteristics of these patients are scarce. OBJECTIVE: To analyze the sociodemographic, clinical and respiratory functional profile of asthmatic patients attending for the first time the outpatient service of a tertiary-level hospital, as well as to investigate treatments already received and the abandonment rate. METHODS: Adolescent and adult asthmatic subjects seen from February 2000 to November 2002 in the outpatient service of the National Institute of Respiratory Diseases, in Mexico City, were prospectively studied. Sociodemographic information was gathered and clinical and spirometric evaluations were carried out. The severity of the disease was classified according to international criteria. RESULTS: A total of 1403 patients between 12 and 82 years of age, with predominance of the female gender, were included in the analysis. An 88.7% of patients had the mildest forms of the disease, 10% had moderate asthma, and 1.3% had severe asthma. While 21.4% had never received anti-asthma treatment, about one third of the remaining patients had received corticosteroids, independently of the asthma severity, indicating an over-treatment of the intermittent form of the disease and an under-treatment of persistent forms. A high abandonment rate (65.7%) was observed. A positive bronchodilator test was observed in 30.3% of patients with intermittent asthma, though this proportion increased to about 67% in those with moderate and severe asthma. CONCLUSION: Mildest forms of the disease predominate among asthmatic patients attending for the first time an outpatient service, with a still very high frequency of inadequate use of corticosteroids.

Efecto del tabaquismo, los síntomas respiratorios y el asma sobre la espirometría de adultos de la Ciudad de México / Effect of tobacco smoking, respiratory symptoms and asthma on spirometry among adults attending a check-up clinic in Mexico City

OBJETIVO: Evaluar el efecto del tabaquismo, los síntomas respiratorios y el asma sobre la función pulmonar espirométrica en población adulta mexicana. MATERIAL Y MÉTODOS: Se generaron ecuaciones de predicción basadas en modelos de regresión lineal múltiple para la capacidad vital forzada (FVC), el vollumen espiratorio forzado al primer segundo (FEV1) y FEV1/FVC de espirometrías obtenidas de adultos que acuden a evaluación de salud y se determinó el efecto del tabaquismo, los síntomas respiratorios y el asma sobre los modelos de estos parámetros. RESULTADOS: Se estudiaron 919 sujetos de entre 14 y 86 años de edad. El asma disminuye la FVC y el FEV1 en hombres con un cambio en la R² <1 por ciento. Los síntomas respiratorios reducen FEV1/FVC en ambos sexos. El tabaquismo disminuye significativamente el FEV1 en las mujeres. CONCLUSIONES: El antecedente de asma disminuyó discretamente la función pulmonar en hombres, mientras que la historia de tabaquismo redujo el FEV1, particularmente en las mujeres de la población que se estudió.

Características de pacientes asmáticos mexicanos atendidos en consulta externa / Characteristics of Mexican asthmatic subjects attending an outpatient service

Background. Despite the high prevalence of asthma in Mexico, studies describing general characteristics of these patients are scarce. Objective.To analyze the sociodemographic, clinical and respiratory functional profile of asthmatic patients attending for the first time the outpatient service of a tertiary-level hospital, as well as to investigate treatments already received and the abandonment rate. Methods.Adolescent and adult asthmatic subjects seen from February 2000 to November 2002 in the outpatient service of the National Institute of Respiratory Diseases, in Mexico City, were prospectively studied. Sociodemographic information was gathered and clinical and spirometric evaluations were carried out. The severity of the disease was classified according to international criteria. Results. A total of 1403 patients between 12 and 82 years of age, with predominance of the female gender, were included in the analysis. An 88.7% of patients had the mildest forms of the disease, 10% had moderate asthma, and 1.3% had severe asthma. While 21.4% had never received anti-asthma treatment, about one third of the remaining patients had received corticosteroids, independently of the asthma severity, indicating an over-treatment of the intermittent form of the disease and an under-treatment of persistent forms. A high abandonment rate (65.7%) was observed. A positive bronchodilator test was observed in 30.3% of patients with intermittent asthma, though this proportion increased to about 67% in those with moderate and severe asthma. Conclusion.Mildest forms of the disease predominate among asthmatic patients attending for the first time an outpatient service, with a still very high frequency of inadequate use of corticosteroids.

Antecedentes. A pesar de que en México existe una alta prevalencia de asma, hay pocos estudios que describan las características generales de estos pacientes. Objetivo. Conocer el perfil sociodemográfico, clínico y funcional respiratorio de pacientes asmáticos que acuden por primera vez a consulta externa de un hospital de tercer nivel de atención, así como los tratamientos recibidos y su tasa de abandono. Métodos. Se estudiaron, prospectivamente, sujetos asmáticos adolescentes y adultos, atendidos de febrero del 2000 a noviembre del 2002 en el servicio de consulta externa del Instituto Nacional de Enfermedades Respiratorias, de la ciudad de México. Se recabó información sociodemográfica y se realizó evaluación clínica y por espirometría. La gravedad del asma se clasificó de acuerdo con criterios internacionales. Resultados. Se incluyeron 1,403 pacientes de 12 a 82 años de edad, con predominio del sexo femenino. El 88.7% de los pacientes tenían formas leves de la enfermedad, 10% asma moderada, y 1.3% asma grave. El 21.4% no había recibido tratamiento antiasmático. Entre los demás, cerca de una tercera parte recibió corticosteroides, independientemente de la gravedad del asma, indicando sobretratamiento del asma intermitente y subtratamiento de las formas persistentes. Encontramos una alta tasa de deserción (65.7%). Una respuesta positiva a la prueba con broncodilatador se observó en 30.3% de los pacientes con asma intermitente, cifra que se elevó a cerca de 67% en las formas moderada y grave. Conclusión. Entre los pacientes asmáticos que acuden a consulta externa, predominan las formas leves, detectándose que todavía existe una alta frecuencia del uso inadecuado de los corticosteroides.

Consumo de tabcoo, una enfermedad social

Pese al esfuerzo organizado para controlar la malignidad derivada del tabaquismo, éste no ha sido suficiente. Conviene hacerle caso al fuerte componente de enfermedad social que tiene. El modo de frenarlo es todo un proceso y hoy está en maduración social. La dinámica de intervención ha de retroalimentarse por sus resultados. Los indicadores de morbimortalidad, riesgos y tendencias de la vigilancia epidemiológica demuestran el grado en que se involucra la sociedad. Se cuenta con un cuerpo de evidencias que relaciona la conducta de las personas individualmente y la influencia del medio social. También hay un Convenio Marco Legal que México ha suscrito y ayudará a aumentar la presión social. El tabaquismo es una enfermedad grave que requiere cuidados individuales y comunitarios en la población desde la edad escolar. Urge despertar la conciencia social y mantener el interés por cuidarse, al grado en que lo han advertido quienes por ello han perdido salud y bienestar. Los profesionales de la salud dan testimonio de las enfermedades, miserias y muerte; no pueden renunciar a dar el ejemplo pertinente en cuanto a cuidado. Además, hay otras profesiones que también deben estar involucrados. Es necesario innovar estrategias, investigar al detalle y ensayar acciones-costo efectivas. Hay que atender las implicaciones del cambio con fines preventivos: hacer ajustes al concepto donde se acepte el tabaquismo como enfermedad debida a una conducta desviada, individual y colectivamente; atender los riesgos como enfermedad social e innovar estrategias de promoción de la salud y bienestar desde el punto de vista de la idiosincrasia. La participación conjunta de la comunidad tiene sus ventajas. Bajo el entorno de armonía y buena voluntad es más probable conseguir la meta que sin contar con éstos.

Organized effort to control tobacco consumption and its malignant effects has not been enough. It is therefore convenient to focus on the strong social disease component it encloses. To stop this disease it must undergo a social maturing process. The dynamics of intervention should be fed back by their results. Mortality, morbidity, trends and risks are good indicators of the degree of social involvement. Today, there is a body of evidence about the interrelationship between individual behavior and the social environment. Also, Mexico has formally accepted the Framework Convention on Tobacco Control, which will help to increase social pressure. Smoking requires individual and social care at all ages starting from elementary school. It is urgent to raise public awareness and encourage the concern for taking care. Health professionals, who are the best witnesses of smoking consequences: diseases, miseries and deaths, should be more concerned and give the good example. Other professions should also be involved. It is necessary to innovate strategies and continue looking for cost - effective trials. There is a need to modify the present concept with preventive implications such as: adjusting the present concept, considering tobacco consumption a consequence of a deviation of individual and social behavior; taking care of the new social disease risks; improving health and well-being promotion programs in a cultural environment. Shared community actions are advantageous. A harmonic environment contributes to reach the goal.

Spirometric variability in a longitudinal study of school-age children.

OBJECTIVES: To describe spirometric reproducibility in a longitudinal study of students from Mexico City, and also the frequency of subjects fulfilling quality criteria proposed for children. SUBJECTS AND METHODS: Three thousand three hundred forty-seven participants from the third through sixth grades of elementary school were recruited to perform biannual spirometry, yielding a maximum of seven evaluations and a total of 15,563 tests. Standard recommendations of the American Thoracic Society (ATS) were followed, using dry rolling-seal volume spirometers. RESULTS: During their first spirometric test, > 95% of the subjects fulfilled each of the quality criteria proposed by ATS for adults, though not all of them did so simultaneously. For example, only 72.4% obtained three acceptable maneuvers, reproducibility for FEV(1) and FVC to < 200 mL, and a small back-extrapolated volume that increased to 92.3% by the second test. Between phase 1 and phase 7 of the study, spirometry quality increased significantly, as a result of subject and technician training. Intratest and intertest (with a 6-month difference) spirometric variability was less in boys than in girls. Intratest variability was also lower in younger and taller subjects. Technicians contributed significantly to intratest and intertest variability, the latter decreasing if the same technician performed both evaluations. CONCLUSION: Children > 7 years old can fulfill ATS criteria of quality after the first spirometric evaluation. To maintain quality of spirometric tests in longitudinal studies of children, a strict control is required, especially of technician performance.