High mortality at the beginning of the COVID-19 pandemic in a referral center in the metropolitan area of Mexico City.

INTRODUCTION: There is limited information about the coronavirus disease 2019 (COVID-19) disease in Latin-American countries. Our objective was to describe the clinical characteristics and outcomes of COVID-19 patients in Mexico. METHODOLOGY: We conducted a retrospective cohort study with 333 consecutive patients who were admitted to Hospital de Especialidades "Dr. Antonio Fraga Mouret" in Mexico City with COVID-19 between April 1, 2020, and June 30, 2020. Demographic, clinical, laboratory data, treatment details and 30-day outcomes were analyzed. RESULTS: The patients studied included 52% men (172/233) and the median age was 45 years. Up to 75% (250/333) of patients were classified as overweight or obese. There were 185 (56%) inpatients; 85% (158/185) were hospitalized in the general ward, and 15% (27/185) in the Intensive Care Unit (ICU). Laboratory measurements showed significant differences between inpatients and outpatients such as lymphocyte-count (median 0.8 vs 1.2×109/L, p < 0.001), LDH (median 650 vs 294 U/L, p < 0.001), CRP (median 147 vs 5 mg/L, p = 0.007), CK-MB (median, 15 vs 10 U/L, p = 0.008), ferritin (median, 860 vs 392 ng/mL, p = 0.02), and D-dimer (median, 780 vs 600 ng/mL, p = 0.15). These differences were seen between survivor and non-survivor patients as well. The rate of death in mechanically ventilated patients was 94% (67/71). Mortality at 30-day follow-up was 57% (105/185). CONCLUSIONS: We observed that majority of the non-survivors were obese and young. Complications leading to death was observed in majority of the cases.

Validation of a predictive index of neoplasia in unexplained weight loss / Validación de un índice predictivo de neoplasia en pérdida de peso inexplicada

Background: Involuntary weight loss (IWL) is associated with a bad prognosis. A causal diagnosis is difficult and the priority is to identify those patients at risk of a serious underlying disease, such as malignant neoplasia. Objective: External validation of a prognostic index of neoplasia in patients with IWL. Methods: Patients referred for IWL from 2005 to 2014 to the Department of Internal Medicine, of a specialty care hospital in Mexico City were studied. Al of them underwent an evaluation consisting of medical history, physical examination and basic laboratory studies, those patients without an apparent cause of IWL, were included. A probability of neoplasia according to Hernández prognostic index was calculated. Complementary diagnostic studies were performed until a causal diagnosis was reached, or the cases were classified as "unknown cause", if the etiology was not possible to find after one year of follow-up. A binarian logistic model was constructed with five variables age, leucocyte count, albumin, lactic dehydrogenase and alkaline phosphatase levels, and a prediction rule was developed. Results: 130 Patients were included and 45 of them (30%) had a neoplastic cause of IWL. The prediction rule according to Hernández criteria, correctly classified 65% of the patients (sensitivity 29%, Specificity 85%, positive predictive value 50% and negative predictive value 69%). When the original index was modified in two categories (high and low probability), it showed a sensitivity of 84.4% and a negative predictive value of 85.7%. Conclusion: The Hernández index has a limited value as a screening tool.

Introducción: la pérdida involuntaria de peso es un factor de mal pronóstico. Su diagnóstico causal es difícil y es prioritario identificar los casos que tienen una enfermedad grave subyacente. Objetivo: validar un índice pronóstico de neoplasia en pacientes con pérdida involuntaria de peso. Métodos: pacientes referidos por pérdida involuntaria de peso de 2005 a 2014, fueron evaluados mediante historia clínica y exámenes básicos de laboratorio; en el estudio fueron incluidos los pacientes sin causa aparente después de la evaluación. Se calculó la probabilidad de neoplasia, según el índice de Hernández. Se realizaron estudios complementarios hasta identificar una causa o fueron clasificados como "causa desconocida", si no se encontró la etiología después de un año de seguimiento. Se construyó un modelo de regresión logística binaria con las variables edad, cifras de leucocitos, albúmina, deshidrogenasa láctica y fosfatasa alcalina; con la ecuación resultante se predijo neoplasia como causa de pérdida involuntaria de peso. Resultados: se incluyeron 130 pacientes, 45 tuvieron causa neoplásica (30%). La ecuación de predicción clasificó correctamente a 65% de los sujetos analizados (especificidad 85%, sensibilidad 29%, valor predictivo positivo 50%, valor predictivo negativo 69%). Al modificarse el índice original en dos categorías (probabilidad alta y baja), mostró una sensibilidad del 84.4% y un valor predictivo negativo del 85.7%. Conclusión: el índice tuvo baja sensibilidad, lo que limita su uso como prueba de tamizaje.

[Effect of pravastatine plus ezetimibe on carotid intima media thickness in patients with lupus erythematosus]. / Efecto de pravastatina más ezetimibe en el grosor intima-media carotídea en pacientes con lupus eritematoso.

BACKGROUND: Patients with systemic lupus erythematosus (SLE) have accelerated atherosclerosis that can be assessed by the carotid intima media thickness (CIMT) measurement. A prompt hypolipidemic treatment should be a part of the integral management. The aim of this study is to determine the effect of therapy with pravastatin plus ezetimibe on the CIMT in SLE patients. METHODS: Longitudinal, prospective, quasi-experimental trial. Out of 60 SLE patients in whom a carotid ultrasound was performed, we chose 22 with a CIMT>0.7 mm who were administered pravastatin plus ezetimibe during 6 months with determination of CIMT at the end of the study. We performed the following tests: total cholesterol (TC), HDL-cholesterol, LDL-cholesterol, tryglicerides, C-reactive protein (CRP), liver function, muscle enzimes and glucose, basal and at the end of treatment. STATISTICAL ANALYSIS: descriptive statistics and Wilcoxon test were used. RESULTS: There were 22 women with an age of 42±6.3 years, average disease evolution 7.5±6.6 years, of whom, 18 concluded the study. Right basal CIMT was 0.829±0.1448 vs. final 0.688±0.1453, p<0.003; left CIMT was 0.820±0.1312 vs. 0.724±0.1348, p<0.004. TC 208 mg/dl vs 168 mg/dl, LDL-C 125 mg/dl vs. 72 mg/dl, p=0.0004. CRP 3.12 vs. 2.25 p=0.004. In 2 cases there were gastrointestinal, skin and muscle adverse effects. CONCLUSIONS: Treatment with pravastatin plus ezetimibe decreases the CIMT with improvement in the concentration of total cholesterol, LDL-C and CRP levels with good toleration.

Introducción: Los pacientes con lupus eritematoso sistémico (LES) cursan con ateroesclerosis acelerada que puede ser evaluada mediante el grosor íntima-media carotídea (IMC). El uso de hipolipemiantes debe ser parte de su tratamiento. El objetivo de este estudio fue determinar el efecto de la terapia con pravastatina más ezetimibe en el grosor IMC en pacientes con LES.Métodos: estudio prospectivo, longitudinal, cuasi-experimental. De 60 paciente con LES a quienes se le realizó ultrasonido carotídeo, de los cuales se eligieron a 22 con grosor IMC > 0.7 mm y se les administró pravastatina más ezetimibe durante seis meses y posteriormente se determinó el grosor IMC. Se les determinó colesterol total (CT), colesterol HDL (c-HDL), colesterol LDL (c-LDL), triglicéridos, proteína C-reactiva (PCR), pruebas de funcionamiento hepático, enzimas musculares y glucosa basales y posterior al tratamiento. Análisis estadístico: estadística descriptiva y prueba de Wilcoxon.Resultados: se incluyeron 22 mujeres con edad 42 ± 6.3 años y evolución promedio 7.5± 6.6 años, de las cuales concluyeron el estudio 18 pacientes. El grosor IMC derecha basal fue de 0.829 ± 0.1448 frente a final 0.688 ± 0.1453, p < 0.003; el izquierdo 0.820±0.1312 frente a 0.724±0.1348, p < 0.004. El CT 208 mg/dl frente a 168 mg/dl, y el c-LDL 125 mg/dl frente a 72 mg/dl, p = 0.0004. Niveles de PCR 3.12 frente a 2.25 p = 0.004.Conclusiones: el tratamiento con pravastatina más ezetimibe disminuye el grosor IMC con mejoría en las concentraciones de colesterol total, colesterol LDL y niveles de PCR, así como buena tolerancia.