An observational study investigating soluble immune checkpoints as indicators of severe COVID-19.

This study aimed to investigate the immunomodulatory behavior of soluble immune checkpoints (sICPs) and other biomarkers in the pathophysiology of SARS-CoV-2 infection. The study included 59 adult participants, 43 of whom tested positive for SARS-CoV-2. Patients were divided into three cohorts: those with moderate disease (n = 16), recovered patients with severe disease (n = 13), and deceased patients with severe disease (n = 16). In addition, 16 participants were pre-pandemic subjects negative for SARS-CoV-2. The relative activity of neutralizing antibodies (rNAbs) against SARS-CoV-2 and the values of 14 sICPs in peripheral blood were compared between the four groups. Because the increase of markers values of inflammation [NLR > 12; CRP > 150 mg/L] and venous thromboembolism [D-dimer > 0.5 mg/L] has been associated with mortality from COVID-19, the total and differential leukocyte counts, the NLR, and CRP and D-dimer values were obtained in patients with severe disease. No differences in rNAbs were observed between the cohorts. Only the levels of five sICPs, sCD27, sHVEM sTIM-3, sPD-1, and sPDL-1, were significantly higher in patients with severe rather than moderate disease. The sPDL-2 level and NLR were higher in deceased patients than in recovered patients. However, there was no difference in CRP and D-dimer values between the two groups. Of the five soluble biomarkers compared among patients with severe disease, only sPDL-2 was higher in deceased patients than in recovered patients. This suggests that immuno-inhibitory sICPs might be used as indicators for severe COVID-19, with sPDL-2 used to assess individual risk for fatality.IMPORTANCECOVID-19, the disease caused by a SARS-CoV-2 infection, generates a broad spectrum of clinical symptoms, progressing to multiorgan failure in the most severe cases. As activation of the immune system is pivotal to eradicating the virus, future research should focus on identifying reliable biomarkers to efficiently predict the outcome in severe COVID-19 cases. Soluble immune checkpoints represent the function of the immune system and are easily determined in peripheral blood. This research could lead to implementing more effective severity biomarkers for COVID-19, which could increase patients' survival rate and quality of life.

Sequencing and description of the genome of a strain of Stenotrophomonas geniculata isolated from a patient infected with COVID-19 at Hospital Regional No.1 de Charo, Michoacán, México.

Stenotrophomonas is a bacterial genus that can be found in various environments, such as water, soil, and clinical samples. Due to their high genetic and phenotypic diversity, it is difficult to properly identify and classify all isolates. The COVID-19 pandemic caused an increase in nosocomial infections, which played a major role in the high mortality rate among patients in intensive care. This is the first report of the identification of S. geniculata as a nosocomial opportunistic pathogen isolated from a patient with COVID-19. Their genome was isolated, sequenced, and assembled, and it consists of 4,488,090 bp in 24 contigs, 4,103 coding sequences, and a G+C content of 66.58%.

Advanced Oxidative Protein Products Had a Diagnostic Accuracy for Identifying Chronic Kidney Disease in Adult Population.

Chronic Kidney Disease (CKD) is a serious public health problem. Hyperglycemia stimulates the production of reactive oxygen species that cause oxidative damage to proteins. AOPPs constitute a group of oxidized dityrosine-containing proteins that are generated during periods of oxidative stress. They have proved to be a valuable early marker of oxidative tissue damage and active mediators of inflammation associated with the uremic state. To analyze if advanced oxidative protein products (AOPPs) have diagnostic accuracy for identifying chronic kidney disease (CKD) in the adult population. We conducted a diagnostic test validation study in 302 adults ≥20 years old, of both sexes, with and without T2D. After obtaining informed consent, a comprehensive clinical history, anthropometric measurements (weight, BMI) and blood pressure were recorded. Glucose, cholesterol, triglyceride, HDL-c, LDL-c and AOPPs were determinates. Glomerular filtration rate (GFR) was calculated using Cockcroft-Gault (C-G) corrected by body surface area (BSA, mL/min/1.73 m2), CKD-EPI and MDRD equations to identify five stages of CKD. This study follows the Standards for Reporting Diagnostic Accuracy Studies (STARD). The median value of AOPPs was 198.32 µmol/L (minimum-maximum value: 113.48-522.42 µmol/L). The group with patients diagnosed with T2D exhibited higher concentrations (median: 487.39 µmol/L) compared to the non-diabetic group (median: 158.50 µmol/L, p = 0.0001). The selected cut-off point was ≥200 µmol/L using the closest to the median value of AOPPs with sensitivity and specificity as follows: C-G: sensitivity 96.58%; specificity 80%; likelihood ratio: 4.83; CKD-EPI: sensitivity 95.76%; specificity 79.89%; likelihood ratio: 4.76; MDRD: sensitivity 86.55%; specificity: 73.22%; likelihood ratio: 3.23. A difference was observed between AOPPs and chronic kidney disease stage. This study provides evidence that AOPPs ≥ 200 µmol/L have diagnostic accuracy in identifying stage 4-5 CKD by C-G, MDRD and CKD-EPI equations in adults with and without T2D.

Transition to the Role of Family Caregiver of Older Adults After a Stroke: A Specific Theory / Transición del rol cuidador familiar de la persona adulta mayor post accidente cerebrovascular (ACV): teoría específica / Transição ao papel de cuidador familiar no idoso após acidente vascular cerebral (AVC): teoria específica

Introduction: Nursing professionals develop situation-specific theories to describe, explain, and provide comprehensive care during a family member's transition to the caregiver role. Objective: To develop a situation-specific theory about the transition to the role of family caregiver of older adults after a stroke. Methodology: The integrating approach by Meleis and Im was applied, which consists of five stages: 1) Description of the context and target population, 2) Verification of assumptions regarding the philosophical stance, 3) Exploration of multiple sources, 4) Theorization of concepts, and 5) Proposal of empirical indicators for validation and verification. Results: The prescriptive theory was developed in the light of Afaf Meleis' Theory of Transitions and was supported by an exhaustive literature review, with four underlying concepts: Situational transition to the family caregiver role, Care-related knowledge and skills, Self-confidence and coping in adopting the caregiver role, and Nursing therapeutic education. The following assumption emerges from these concepts: a healthy transition to the family caregiver role is directly dependent on the care-related knowledge and skills provided by Nursing therapeutic education to develop self-confidence and coping in adopting the caregiver role. Conclusions: The proposal provides a conceptual framework that identifies the transition challenges and needs faced by family caregivers to adopt the role of caregivers of older adults after a stroke.

Introducción: los profesionales de enfermería desarrollan teorías de situación específica para describir, explicar y proporcionar cuidados integrales durante la transición del familiar al rol cuidador. Objetivo: desarrollar una propuesta de teoría de situación específica sobre la transición al rol cuidador familiar de la persona adulta mayor post accidente cerebrovascular. Metodología: se aplicó el enfoque integrador de Meleis e Im, que consta de cinco etapas: 1) descripción del contexto y población blanco; 2) comprobación de suposiciones en relación con la postura filosófica; 3) exploración de múltiples fuentes; 4) teorización de conceptos; y 5) propuesta de indicadores empíricos para la validación y comprobación. Resultados: la teoría prescriptiva fue desarrollada a la luz de la teoría de las transiciones de Afaf Meleis y se apoyó en una revisión exhaustiva de literatura, con cuatro conceptos subyacentes: transición situacional del rol cuidador familiar, conocimiento y habilidad del cuidado, confianza y afrontamiento en la adopción del rol cuidador, y educación terapéutica de enfermería. A partir de estos, surge la siguiente proposición: la transición saludable al rol cuidador familiar depende directamente de los conocimientos y habilidades de cuidado que brinda la terapéutica de enfermería para el desarrollo de confianza y afrontamiento en la adopción del rol cuidador. Conclusiones: la propuesta proporciona un marco conceptual que identifica los desafíos y necesidades de transición de los cuidadores familiares para la adopción del rol cuidador de la persona adulta mayor post accidente cerebrovascular.

Introdução: os profissionais de enfermagem desenvolvem teorias específicas para descrever, explicar e prestar cuidados holísticos durante a transição do familiar para o papel de cuidador. Objetivo: desenvolver uma proposta de teoria específica sobre a transição para o papel de cuidador familiar do idoso pós-AVC. Metodologia: foi aplicada a abordagem integrativa de Meleis e Im, composta por cinco etapas: 1) descrição do contexto e da população-alvo; 2) teste de hipóteses em relação à postura filosófica; 3) exploração de múltiplas fontes; 4) teorização de conceitos; e 5) proposta de indicadores empíricos para validação e teste. Resultados: a teoria prescritiva foi desenvolvida à luz da teoria das transições de Afaf Meleis e com o suporte de uma revisão exaustiva da literatura, com quatro conceitos subjacentes: transição situacional do papel de cuidador familiar, conhecimentos e competências de cuidado, confiança e enfrentamento na adoção do papel de cuidador e educação terapêutica em enfermagem. Destes conceitos emerge a seguinte proposição: a transição saudável para o papel de cuidador familiar depende diretamente do conhecimento e das competências de cuidado proporcionadas pela enfermagem terapêutica para o desenvolvimento de confiança e capacidade de enfrentamento na adoção do papel de cuidador. Conclusões: A proposta fornece um quadro conceitual que identifica os desafios e as necessidades de transição dos cuidadores familiares na adoção do papel de cuidador do idoso após acidente vascular cerebral (AVC).

SARS-CoV-2 Variants and Clinical Outcomes: A Systematic Review.

BACKGROUND: From the start of the COVID-19 pandemic, new SARS-CoV-2 variants have emerged that potentially affect transmissibility, severity, and immune evasion in infected individuals. In the present systematic review, the impact of different SARS-CoV-2 variants on clinical outcomes is analyzed. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Two databases (PubMed and ScienceDirect) were searched for original articles published from 1 January 2020 to 23 November 2021. The articles that met the selection criteria were appraised according to the Newcastle-Ottawa Quality Assessment Scale. RESULTS: Thirty-three articles were included, involving a total of 253,209 patients and 188,944 partial or complete SARS-CoV-2 sequences. The most reported SARS-CoV-2 variants showed changes in the spike protein, N protein, RdRp and NSP3. In 28 scenarios, SARS-CoV-2 variants were found to be associated with a mild to severe or even fatal clinical outcome, 15 articles reported such association to be statistically significant. Adjustments in eight of them were made for age, sex and other covariates. CONCLUSIONS: SARS-CoV-2 variants can potentially have an impact on clinical outcomes; future studies focused on this topic should consider several covariates that influence the clinical course of the disease.

Cancer-Related Malnutrition: Epidemiological Results from the Latin American Study of Malnutrition in the Oncology Practice.

Malnutrition can affect the patient diagnosed with, and treated for, cancer. However, until a dedicated study is completed, estimates of malnutrition rates will be disparate and unrepresentative of cancer patients' nutritional reality. Objective: To estimate the prevalence of malnutrition among patients being cared for cancer in Latin American (LATAM) hospitals by means of a multicenter, multinational study. Methods: The Latin American Study of Malnutrition in Oncology (LASOMO) was completed with 1,842 patients (Women: 56.2%; Age ≥ 60 years: 43.2%; Chemotherapy: 55.1%; Radiotherapy: 17.8%; Surgery: 27.1%) assisted at 52 health centers from 10 LATAM countries. Malnutrition prevalence was estimated from the (B + C) scores assigned to the patient with the Subjective Global Assessment by Detsky et al. (1987). Malnutrition prevalence was distributed regarding the demographic features of the patient, the primary tumor location, and the current cytoreducing treatment. Results: Malnutrition affected 59.1% of the surveyed patients. Malnutrition prevalence was higher among male patients and those with tumors of the digestive tract and the hemolymphopoietic system. Malnutrition was also associated with the current cytoreducing modality, with chemotherapy returning the highest prevalence. Conclusions: Malnutrition can be present in more than half of the patients being cared for cancer in LATAM health centers.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.2014902.

Behavior of Eosinophil Counts in Recovered and Deceased COVID-19 Patients over the Course of the Disease.

Knowledge about the immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, particularly regarding the function of eosinophils, has been steadily emerging recently. There exists controversy regarding the implications of eosinophils in the coronavirus disease 2019 (COVID-19)'s pathology. We report a retrospective cohort study including the comparison of leukocyte counts in COVID-19 patients, considering the outcomes of recovery (n = 59) and death (n = 60). Among the different types of leukocytes, the eosinophil counts were those that showed the greatest difference between recovered and deceased patients. Eosinopenia (eosinophil count < 0.01 × 109/L) was more frequently observed in deceased than recovered patients (p = 0.0012). The eosinophil counts more rapidly increased and showed a greater proportion over the course of the disease in the recovered than deceased patients. Furthermore, the estimated survival rate was greater in patients without eosinopenia than in patients with eosinopenia (p = 0.0070) during hospitalization. Importantly, recovered but not deceased patients showed high negative correlations of the eosinophils with the neutrophil-to-lymphocyte ratio (NLR) and neutrophil counts at Day 9 of the onset of clinical symptoms (p ≤ 0.0220). Our analysis suggests that eosinopenia may be associated with unfavorable disease outcomes and that the eosinophils have a beneficial function in COVID-19 patients, probably contributing by controlling the exacerbated inflammation induced by neutrophils.

Glycogen Synthase Kinase 3ß Modulates the Inflammatory Response Activated by Bacteria, Viruses, and Parasites.

Knowledge of glycogen synthase kinase 3ß (GSK3ß) activity and the molecules identified that regulate its function in infections caused by pathogenic microorganisms is crucial to understanding how the intensity of the inflammatory response can be controlled in the course of infections. In recent years many reports have described small molecular weight synthetic and natural compounds, proteins, and interference RNA with the potential to regulate the GSK3ß activity and reduce the deleterious effects of the inflammatory response. Our goal in this review is to summarize the most recent advances on the role of GSK3ß in the inflammatory response caused by bacteria, bacterial virulence factors (i.e. LPS and others), viruses, and parasites and how the regulation of its activity, mainly its inhibition by different type of molecules, modulates the inflammation.

[Creatinin as predictor value of mortality in patients with acute coronary syndrome]. / Creatinina sérica como pronóstico de mortalidad en pacientes con síndrome coronario agudo.

BACKGROUND: Cardiovascular diseases have become the leading cause of death worldwide. OBJECTIVE: To estimate serum creatinine (Cr) as a prognostic value of mortality in patients with Acute Coronary Syndrome (ACS), which was admitted to the shock room in the emergency department (ED). MATERIAL AND METHODS: A transversal, prospective study, which included 95 patients with ACS who were admitted to the shock room. The following variables were studied: laboratory tests with Cr, cardiovascular risk factors (CVRF), days of hospital stay, service to which it was derived and discharge condition (alive or dead). Statistical analysis was through SPSS v. 23. RESULTS: The diagnosis of admission was ACS without ST elevation (NSTE-ACS), 72.6%; and Acute Myocardial Infarction with ST elevation (STEMI), 27.4%. The 63.2% were discharged alive, 13.7% transferred to a third level hospital and 23.2% died. There was a difference in the level of Cr between living and deceased (p = 0.0001). CONCLUSIONS: CR on admission of the patient with SCA provides prognostic information for mortality, and can be established as a prognostic marker of easy access and available in the ED.

INTRODUCCIÓN: las enfermedades cardiovasculares se han convertido en la principal causa de muerte a nivel mundial. OBJETIVO: estimar la creatinina (Cr), sérica como valor pronóstico de mortalidad en pacientes con síndrome coronario agudo (SCA) que ingresaron a sala de choque en el servicio de urgencias (SU). MATERIAL Y MÉTODOS: estudio prospectivo, transversal, que incluyó a 95 pacientes con SCA ingresados en sala de choque. Se estudiaron las siguientes variables: estudios de laboratorio con Cr, factores de riesgo cardiovascular (FRCV), días de estancia hospitalaria, servicio al que se derivó y condición de egreso (vivo/ muerto). El análisis estadístico fue mediante SPSS v. 23. RESULTADOS: el diagnóstico de ingreso fue de SCA sin elevación del ST (SCASEST), 72.6%; e infarto agudo al miocardio con elevación del segmento ST (IAMCEST), 27.4%. Egresaron vivos el 63.2%, fueron trasladados a hospital de tercer nivel el 13.7% y falleció el 23.2%. Se encontró una diferencia en el nivel de Cr entre vivos y fallecidos (p = 0.0001). CONCLUSIONES: la Cr al ingreso del paciente con SCA proporciona información pronostica para mortalidad, y se puede establecer como un marcador pronóstico de acceso fácil y disponible en el SU.

Copeptin Plasma Levels are Associated with Decline of Renal Function in Patients with Type 2 Diabetes Mellitus.

BACKGROUND: Chronic kidney disease (CKD) is a leading complication of type 2 diabetes mellitus (T2DM) and is considered as a public health problem. Copeptin is a surrogate marker of arginine vasopressin (AVP) system and is proposed as a biomarker of decline renal function. OBJECTIVE: Evaluate whether plasma copeptin levels may be used as a biomarker of decline renal function in patients with T2DM. RESEARCH DESIGN AND METHODS: A total of 480 patients with T2DM and different stages of CKD were included. Plasma levels of copeptin, cystatin-C, and other biochemical parameters were measured. The correlation between copeptin and glomerular filtration rate (GFR), estimated based on plasma cystatin-C levels, was investigated. RESULTS: Plasma copeptin levels were gradually increased from the stage 1-5 of CKD in the patients with T2DM. In univariate linear regression analysis, high plasma levels of copeptin were associated with lower GFR (Standardized ß = -0.535, R2 = 0.287, p <0.0001). This association remained significant even after being adjusted for glucose levels and years of T2DM diagnosis, mean blood pressure, pharmacological treatment, gender, and age. CONCLUSIONS: The results show that high plasma copeptin levels are associated with the decline of renal function in patients with T2DM and, therefore, copeptin may be considered as a biomarker of renal function. Further evaluation of plasma copeptin levels to predict morbidity and mortality of T2DM patients, with or without CKD, has been taken into our consideration.

Productos avanzados de oxidación proteica (PAOP) y su relación con los factores de riesgo cardiovascular en jóvenes aparentemente sanos / Advanced oxidation protein products and their relationship with cardiovascular risk factors in young apparently healthy people

Introducción: Los productos avanzados de oxidación proteica (PAOP) son un marcador para estimar estrés oxidativo en proteínas plasmáticas. El estrés oxidativo se considera un factor de riesgo cardiovascular (FRCV), relacionado con el aumento de presión arterial y la dislipidemia. Este trabajo tuvo por objetivo evaluar la asociación entre las concentraciones plasmáticas de PAOP y los FRCV en adultos jóvenes aparentemente sanos. Métodos: Estudio transversal comparativo prospectivo en 120 estudiantes de la Facultad de Químico Farmacobiología de la UMSNH, a los que se les determinó IMC, presión arterial, así como PAOP, glucosa, colesterol total, lipoproteínas (de alta, baja y muy baja densidad) y triglicéridos. Resultados: Los grupos de jóvenes con y sin FRCV presentaron diferencias significativas respecto a IMC, cintura, grasa corporal (p<0,05) y perfil lipídico (p<0,0001). Se presentaron cifras más altas de PAOP en el grupo de jóvenes con 3 y 4 FRCV (F: 4,651; p=0,002). Los PAOP correlacionaron negativamente con el colesterol LDL (r=-0,364; p=0,0001). Conclusiones: Se identificó que las concentraciones de PAOP se ven incrementadas conforme aumentan los FRCV en los jóvenes, por lo que estos podrían considerarse un factor importante de riesgo debido a que su depósito en la placa de ateroma favorece el proceso aterogénico y así el desarrollo de enfermedades cardiovasculares. La cuantificación de PAOP contribuye a la determinación indirecta del estado oxidativo en el organismo. El estudio del estado metabólico y oxidativo de jóvenes de aspecto saludable es de importancia en la prevención de enfermedades cardiovasculares en etapas posteriores de la vida, sin embargo, se requieren estudios longitudinales para estudiar su evolución (AU)

Introduction: Advanced oxidation protein products (AOPPs) are used as a marker to estimate oxidative stress in plasma proteins. Oxidative stress is considered a factor of cardiovascular risk (CVRF) related to increased blood pressure, and dyslipidaemia. The aim of this study was to evaluate the association between plasma AOPPs and CVRF in apparently healthy young adults. Methods: A prospective cross-sectional study was conducted on 120 students of the Faculty of Chemical-Pharmacobiology of the UMSNH. Body mass index (BMI) and blood pressure were determined. A blood specimen was also collected to quantify AOPPs, glucose, total cholesterol, lipoproteins (high, low, and very low density), and triglycerides. Results: Differences were observed in the groups with and without CVRF, with significant differences in BMI, waist, body fat (P<.05), and lipid profile (P<.0001). AOPPs were higher in the group of young people with three and four CVRF (F: 4.651; P=.002). A negatively correlation was found between AOPPs and LDL cholesterol (r=-0.364; P=.0001). Conclusions: It was observed that AOPPs concentrations are increased as CVRF increase in young adults. Thus, this could be considered an important risk factor, because their deposition in the atherosclerotic plaque favours the atherogenic process, and thus the development of cardiovascular disease. Quantification of AOPPs contributes to the indirect determination of oxidative status in the body. The study of metabolic and oxidative state of apparently healthy young adults is important in the prevention of cardiovascular disease in later life. More longitudinal studies are required to study its evolution (AU)

Advanced oxidation protein products and their relationship with cardiovascular risk factors in young apparently healthy people. / Productos avanzados de oxidación proteica (PAOP) y su relación con los factores de riesgo cardiovascular en jóvenes aparentemente sanos.

INTRODUCTION: Advanced oxidation protein products (AOPPs) are used as a marker to estimate oxidative stress in plasma proteins. Oxidative stress is considered a factor of cardiovascular risk (CVRF) related to increased blood pressure, and dyslipidaemia. The aim of this study was to evaluate the association between plasma AOPPs and CVRF in apparently healthy young adults. METHODS: A prospective cross-sectional study was conducted on 120 students of the Faculty of Chemical-Pharmacobiology of the UMSNH. Body mass index (BMI) and blood pressure were determined. A blood specimen was also collected to quantify AOPPs, glucose, total cholesterol, lipoproteins (high, low, and very low density), and triglycerides. RESULTS: Differences were observed in the groups with and without CVRF, with significant differences in BMI, waist, body fat (P<.05), and lipid profile (P<.0001). AOPPs were higher in the group of young people with three and four CVRF (F: 4.651; P=.002). A negatively correlation was found between AOPPs and LDL cholesterol (r=-0.364; P=.0001). CONCLUSIONS: It was observed that AOPPs concentrations are increased as CVRF increase in young adults. Thus, this could be considered an important risk factor, because their deposition in the atherosclerotic plaque favours the atherogenic process, and thus the development of cardiovascular disease. Quantification of AOPPs contributes to the indirect determination of oxidative status in the body. The study of metabolic and oxidative state of apparently healthy young adults is important in the prevention of cardiovascular disease in later life. More longitudinal studies are required to study its evolution.

[Neurodevelopment in patients with retinopathy of prematurity treated with intravitreal bevacizumab. Case series]. / Neurodesarrollo en pacientes con retinopatía del prematuro tratados con bevacizumab intravítreo. Serie de casos.

BACKGROUND: Retinopathy of prematurity (ROP) is an eye disease caused by an alteration in retinal vasculogenesis that may lead to partial or complete vision loss with a harmful impact in terms of neurodevelopment. The purpose of the present study was to determine the neurodevelopment in patients with type i retinopathy of prematurity treated with intravitreal bevacizumab. MATERIAL AND METHODS: Case series. The inclusion criteria were: patients with type I ROP treated with a dose of 0.625mg/0.025ml of intravitreal bevacizumab. Demographic data and comorbidities were documented. Neurodevelopment was evaluated with the screening test of the Bayley Scale of Infant Development (BSID) in all patients between 11 and 28 weeks of age. RESULTS: Seven patients were included in the study. Four patients showed normal neurodevelopment according to the overall scores of the BSID scale. The distribution of high risk for neurodevelopmental delay in the different areas evaluated were as follows: 3 patients presented it in the cognitive area, one in the receptive communication area, one in the expressive area, one in the fine motor skills and 3 patients in the gross motor skills area. CONCLUSIONS: In these case series, the majority of patients treated with intravitreal bevacizumab for ROP showed normal neurodevelopment scores.

BNP predicts mortality of cardiovascular disease in patients with end-stage renal disease treated / BNP predictor de mortalidad cardiovascular en pacientes con enfermedad renal crónica terminal

BACKGROUND: Mortality for cardiovascular disease (CVD) in patients with chronic kidney disease (CKD) is higher. In the end-stage renal disease (ESRD) the mortality is 20 times greater in comparison with general population. Natriuretic peptides, particularly type-B natriuretic peptide (BNP) have been studied as potential markers of risk of cardiovascular (CV) mortality. The aim of this paper is to determine whether BNP acts as a prognostic marker for CV mortality in patients with ESRD. METHODS: We studied 53 patients with ESRD prevalent in peritoneal dialysis without clinical evidence of heart failure at baseline was studied. The impact of variables was performed with linear regression model. The probability of survival was estimated by Kaplan-Meir analysis and the difference between survivals between groups with log-rank test according the levels of BNP. Adjusted hazard ratios were calculated with Cox proportional hazards analysis. RESULTS: BNP strongly predicts CVD mortality. The Cox regression model showed that BNP is a predictor of death from CVD. Patients with high levels of BNP were at increased risk of death. Several pathophysiological mechanisms not well defined are involved. CONCLUSIONS: BNP predicts CVD mortality in patients with ESRD. Serum measurement of this peptide can be useful for risk stratification in these patients and adjust treatment.

INTRODUCCIÓN: la mortalidad por enfermedad cardiovascular (ECV) en pacientes con enfermedad renal crónica (ERC) es alta. En la población con ERC terminal (ERCT) la mortalidad es hasta 20 veces mayor en comparación a la población general. Los péptidos natriuréticos, especialmente el péptido natriurético tipo-B (BNP), han sido estudiados como posibles marcadores de riesgo de mortalidad por ECV. El objetivo de este trabajo es determinar si el BNP actúa como un marcador pronóstico para mortalidad por ECV en pacientes con ERCT. MÉTODOS: se estudiaron 53 pacientes con ERCT prevalentes en diálisis peritoneal sin evidencia clínica de insuficiencia cardiaca al inicio del estudio. El impacto de las variables se realizó con el modelo de regresión lineal. La probabilidad de sobrevida fue estimada con el análisis de Kaplan-Meier y la diferencia entre grupos con el test de Log-Rank, acorde a los niveles de BNP dividido en tertiles. La asociación de riesgo fue calculada con el análisis proporcional de Cox ajustado. RESULTADOS: el BNP fuertemente predice la mortalidad por ECV. El modelo de regresión de Cox mostró que el BNP es un predictor de muerte por ECV. Pacientes con niveles altos de BNP tuvieron mayor riesgo de muerte. Varios mecanismos fisiopatológicos no bien definidos están involucrados. CONCLUSIONES: el BNP predice la mortalidad por ECV en pacientes con ERCT. La medición sérica de este péptido puede ser útil para la estratificación de riesgo en estos pacientes y ajustar el plan terapéutico

[Not Available]. / Nutritional assessment of hospitalized patients in Latin America: association with prognostic variables. The ENHOLA study.

BACKGROUND AND AIM: The prevalence of hospital malnutrition (HM) is variable, explained by the variability of patients, the nutritional evaluation method used among others. The aim is to determine the frequency of malnutrition in hospitals in Latin America, and estimate its association with mortality and length of hospital stay. METHODS: This is an analytical, observational cohort study that included 7,973 patients of both genders, 18 and older, who provided their consent. The survey was administered during the first three days of admission. The nutritional status was estimated using Subjective Global Assessment (SGA) and the Nutrition Risk Screening (NRS), body mass index (BMI), percentage of change of weight (PCW) and co-morbidities. Serum albumin was obtained from the clinical chart. Length of stay (LOS) and the survival status at discharge (dead or alive) were also recorded. RESULTS: By SGA: 10.9% had severe malnutrition and 34% moderate malnutrition. By NRS: 36.9% had nutritional risk. Univariate analysis showed that NRS score and serum albumin were prognostic factors for mortality: NRS 3-4 (OR: 2.3, 95% CI: 1.9-2.8), NRS 5-7 (OR: 5.8, 95% CI: 4.9-6.9), serum albumin < 2.5 g/dl, (OR: 2.9, 95% CI: 2.2-3.8). These results were consistent and similar to a multivariate analysis. Both NRS and serum albumin were also independently and clinically associated to LOS. CONCLUSIONS: The prevalence of hospital malnutrition in Latin America is high. Our results show that screening with NRS and serum albumin can identify hospital malnutrition as well as providing clinically relevant prognostic value.

Nutritional assessment of hospitalized patients in Latin America: association with prognostic variables. The ENHOLA study / Valoración nutricional en pacientes hospitalizados en hospitales latinoamericanos: asociación con factores pronóstico. El estudio ENHOLA

Background and aim: The prevalence of hospital malnutrition (HM) is variable, explained by the variability of patients, the nutritional evaluation method used among others. The aim is to determine the frequency of malnutrition in hospitals in Latin America, and estimate its association with mortality and length of hospital stay. Methods: This is an analytical, observational cohort study that included 7,973 patients of both genders, 18 and older, who provided their consent. The survey was administered during the first three days of admission. The nutritional status was estimated using Subjective Global Assessment (SGA) and the Nutrition Risk Screening (NRS), body mass index (BMI), percentage of change of weight (PCW) and co-morbidities. Serum albumin was obtained from the clinical chart. Length of stay (LOS) and the survival status at discharge (dead or alive) were also recorded. Results: By SGA: 10.9% had severe malnutrition and 34% moderate malnutrition. By NRS: 36.9% had nutritional risk. Univariate analysis showed that NRS score and serum albumin were prognostic factors for mortality: NRS 3-4 (OR: 2.3, 95% CI: 1.9-2.8), NRS 5-7 (OR: 5.8, 95% CI: 4.9- 6.9), serum albumin < 2.5 g/dl, (OR: 2.9, 95% CI: 2.2-3.8). These results were consistent and similar to a multivariate analysis. Both NRS and serum albumin were also independently and clinically associated to LOS. Conclusions: The prevalence of hospital malnutrition in Latin America is high. Our results show that screening with NRS and serum albumin can identify hospital malnutrition as well as providing clinically relevant prognostic value (AU)

Introducción y objetivo: la prevalencia de la malnutrición hospitalaria (MH) es variable y puede explicarse por la variabilidad de los pacientes, el método de evaluación nutricional entre otros. El propósito de esta investigación es determinar la frecuencia de malnutrición en hospitales de Latinoamérica y estimar su asociación con mortalidad y estancia hospitalaria. Métodos: es un estudio analítico, observacional de cohorte que incluyó a 7.973 pacientes de ambos géneros, mayores de 18 años y que estuvieron de acuerdo en participar en el estudio. La evaluación fue aplicada durante los primeros tres días de admisión al hospital. El estado nutricional fue estimado usando la evaluación global subjetiva (SGA) y el score de riesgo nutricional (NRS-2002). Se evaluó el índice de masa corporal (IMC), el porcentaje de cambio de peso (PCW) y las comorbilidades. La albúmina sérica se obtuvo del expediente clínico. La estancia hospitalaria (LOS) y las condiciones del egreso (vivo o muerto) fueron también registrados. Resultados: por SGA: 10,9% tuvieron malnutrición severa y 34% malnutrición moderada. Por NRS: 36,9% tuvieron riesgo nutricional. El análisis univariado mostró que el NRS y la albúmina sérica fueron factores pronósticos de mortalidad: NRS 3-4 (OR: 2,3, 95%CI: 1,9-2,8), NRS 5-7 (OR: 5,8, 95% CI: 4,9-6,9), albúmina sérica < 2,5 g/dl, (OR: 2,9, 95% CI: 2,2-3,8); estos resultados fueron coherentes y similares al análisis multivariado. Tanto el NRS y como la albúmina sérica fueron también independientemente y clínicamente asociados a la estancia hospitalaria prolongada. Conclusión: la prevalencia de malnutrición hospitalaria en Latinoamérica es alta. Nuestros resultados muestran que el tamizaje con NRS y la albúmina sérica inicial pueden identificar la malnutrición hospitalaria, así como proporcionar un valor clínico relevante (AU)

Myeloperoxidase is associated with insulin resistance and inflammation in overweight subjects with first-degree relatives with type 2 diabetes mellitus.

BACKGROUND: Family history of type 2 diabetes mellitus (T2DM) is one of risk factors for that in future a subject can develop diabetes. Insulin resistance (IR) is important in the pathogenesis of T2DM. There is evidence that oxidative stress plays an important role in the etiology and/or progression of diabetes. Myeloperoxidase (MPO) participates in developing of inflammation. The objective was to investigate if MPO is associated with IR and inflammation in individuals with first-degree relatives of T2DM. METHODS: Cross-sectional study in 84 overweight individuals with family history of T2DM divided in two groups according to IR, group with IR (homeostasis model assessment [HOMA] ≥2.5; n=43) and control group (CG; HOMA <2.5; n=41). Complete clinical history and a venous blood sample were collected for measuring glucose and lipids profile, insulin, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), MPO, glutathione reductase (GRd), glutathione peroxidase, and superoxide dismutase. RESULTS: MPO, TNF-α, and IL-6 were higher in patients with IR than in CG (MPO: 308.35 [190.85 to 445.42] vs. 177.35 [104.50 to 279.85], P=0.0001; TNF-α: 13.46 [10.58 to 18.88] vs. 9.39 [7.53 to 11.25], P=0.0001; IL-6: 32.93 [24.93 to 38.27] vs. 15.60 [12.93 to 26.27]; P=0.0001, respectively). MPO was associated with IR (rho de Spearman=0.362, P=0.001). In the analysis of lineal regression, MPO predicts IR (ß, 0.263; t, 2.520; P=0.014). In the univariate analysis, MPO had an odds ratio of 9.880 for risk of IR (95% confidence interval, 2.647 to 36.879). CONCLUSION: MPO had relation with IR and inflammation parameters in overweight subjects with first-degree relatives of T2DM. We need studies on a casual relationship and molecular mechanisms among the increased serum MPO levels, inflammation markers, and IR.

Factors associated with early platelet activation in obese children.

OBJECTIVE: To investigate the factors associated with platelet activation in obese children. DESIGN: Cross-sectional study. SETTING: Department of Pediatrics of Regional Hospital N∘ 1 of Mexican Institute of Social Security in Morelia, Michoacán, Mexico. PARTICIPANTS: 79 obese and 64 non-obese children between the ages of 5 and 10 years. MAIN OUTCOMES MEASURES: Obese children (body mass index [BMI] >85 in growth curves for Centers for Disease Control/National Center for Health Statistics), and the control group of 64 non-obese children (percentile <85), % body fat, platelet activation was assessed by sP-selectin. Other measures were leptin, uric acid (UA), von Willebrand Factor (vWF), plasminogen activator inhibitor (PAI-1), lipid profile, and glucose. RESULTS: Obese children displayed higher plasma sP-selectin, leptin, PAI-1, and vWF than non-obese children. In the univariate logistic regression analysis, leptin, vWF, UA, and high density lipoprotein (HDL), but not with PAI-1, were factors associated with platelet activation. By stepwise linear regression analysis adjusted by sex and age, the best predictor variables for platelet activation were leptin (ß:0.381; t:4.665; P=0.0001), vWF (ß:0.211; t:2.926; P=0.004), UA (ß:0.166; t:2.146; P=0.034), and HDL (ß:-0.215; t:-2.819; P=0.006). CONCLUSIONS: Obese children have a higher risk of developing early platelet activation. Factors associated with platelet activation were Leptin, vWF, UA, and HDL. Further studies involving larger numbers of patients over a longer duration are needed to understand the possible molecular mechanism underlying the association between leptin, vWF, and UA and endothelial activation and/or endothelial damage/dysfunction in obese children and its influence in cardiovascular disease in adults.

Homocisteína (HCY), ácido úrico y su relación con c-HDL en pacientes con enfermedad coronaria / Homocysteine (HCY), uric acid and their relationship with HDL in patients with coronary artery disease

Introducción: La enfermedad coronaria (EC) es la principal causa de muerte en México. La homocisteína (HCY), ácido úrico (AU) y el colesterol (c-HDL) se conocen como factores independientes de riesgo para enfermedad cardiovascular. Objetivo: Investigar la relación entre HCY, AU y c-HDL en pacientes con enfermedad coronaria. Material y métodos: Estudio transversal comparativo en 75 pacientes con EC, sin diuréticos, alopurinol, ácido fólico, complejo B y sin enfermedad renal o tiroidea. A cada paciente se le colectó muestra venosa para cuantificación de HCY, AU, glucosa y perfil de lípidos. El análisis estadístico se realizó en SPSS V18. Resultados: Edad promedio: 60.96 ± 16.22 años, 58.45% tuvieron diabetes mellitus tipo 2 (DM2) y/o hipertensión arterial sistémica (HTA). Los pacientes se distribuyeron en dos grupos: AU ≥ 7 mg/dL y AU < 7 mg/dL; se encontraron diferencias en HCY, c-HDL, tensión arterial sistólica y diastólica (p < 0.05). AU correlacionó con c-HDL (r = -0.307; p = 0.010) y HCY con c-HDL (r = -0.283; p = 0.019). Por regresión lineal se encontró HCY como factor predictor del AU (coeficiente estandarizado β: 0.294; t: 2.458; p = 0.017) y de c-HDL (coeficiente estandarizado β: 0.269; t: 2.232; p = 0.029). Conclusiones: Existe relación entre AU y HCY con c-HDL. La HCY es factor predictor de hiperuricemia y de baja c-HDL en pacientes con EC. Se recomienda incluir la HCY como determinación de rutina en pacientes de alto riesgo, historia familiar y/o EC prematura.

Introduction: Coronary heart disease (CHD) is the main cause of death in Mexico. Homocisteine (HCY), uric acid (UA) and cholesterol (c-HDL) are known independent factors for cardiovascular disease. Objective: To investigate the relationship between HCY, UA and c-HDL in patients with Coronary Heart Disease (CHD). Material and methods: Comparative cross-sectional study in 75 patients with CHD, without diuretics, allopurinol, folic acid, B complex and without kidney or thyroid disease. To each patient was collected a fasting blood sample for quantification of HCY, UA, glucose and lipid profile. The statistical analysis was realized in SPSS V18. Results: Mean age was 60.96 ± 16.22 years. 58.45% had type 2 diabetes and/or hypertension. Patients were divides in 2 groups: UA ≥ 7 mg/dL y UA < 7 mg/dL. We found differences in HCY, c-HDL, systolic and diastolic blood pressure (p < 0.005). The UA correlated with c-HDL(r = -0.307, p = 0.010) and HCY with c-HDL (r = -0.283, p = 0.019). In the linear regression analysis was found to HCY as predictor of UA (standardized coefficient β:0.294, t:2.458, p = 0.017) and c-HDL (standardized coefficient β:0.269, t:2.232, p = 0.029). Conclusions: There is relationship between HCY, UA with c-HDL and c-HDL. HCY is a predictor of hyperuricemia, low c-HDL levels in patients with CHD. It is recommended to include the determination of HCY as routine in patients with a family history of CHD.