Breastfeeding Practices and Postpartum Depression in Mexican Women during the COVID-19 Pandemic: A Cross-Sectional Study.

Background: Breastfeeding is a characteristic process of mammals that ensures delivery of an adequate nutritional supply to infants. It is the gold standard food source during an infant's first months of life. Since the onset of the COVID-19 pandemic in 2020, people in quarantine have experienced a wide range of feelings, which may make isolation challenging in terms of maternal health. This study focused on the prevalence of breastfeeding practices and postpartum depression (PPD) among Mexican women during the COVID-19 pandemic. Materials and Methods: This cross-sectional study included 586 postpartum women who completed an online survey 4-8 weeks after delivery from April to December 2020 in Guadalajara, Mexico. The aim was to identify potentially depressed mothers according to the Edinburgh Postnatal Depression Scale (EPDS) and describe their breastfeeding practices. Results: The mean maternal age was 30.4 ± 4.6 years, the mean EPDS score was 9.6 ± 5.0, and the PPD prevalence according EPDS scores was 27.1%. Exclusive breastfeeding (EBF) was reported by 32.3% of mothers in the first 48 h and by 70.3% of mothers 48 h after delivery. EBF was associated with a lower prevalence of PPD during the first 48 h (p = 0.015) and after the first 48 h (p = 0.001) after delivery. Skin-to-skin contact (SSC) was reported by 385 (65.7%) mothers. PPD was less frequent in mothers practicing SSC (20.3%) than it was in those not practicing SSC (40.3%) (p = 0.001). A higher percentage of mothers practiced SSC breastfed (66.9%) and used EBF (150, 79.4%) (p = 0.012 and 0.001, respectively). Conclusions: Results suggest that the pandemic emergency and restrictions imposed on the population significantly affected the well-being of mothers after birth, and that these effects may have posed risks to the mental health and emotional stability of postpartum mothers. Therefore, encouraging BF or EBF and SSC may improve or limit depressive symptoms in postpartum mothers.

Association between Anxiety and Sleepiness in Medical Students of the University of Guadalajara (Mexico) / Asociación entre ansiedad y somnolencia diurna en estudiantes de medicina de la Universidad de Guadalajara (México) / Associação entre ansiedade e sonolência diurna em estudantes de medicina da Universidade de Guadalajara (México)

Introduction: Medical students could potentially be considered as a vulnerable group in terms of increased risk for anxiety and sleep disorders. This could be caused by high academic demands, and high levels of stress. There is little information, however, when it comes to the relationship between anxiety and exces-sive daytime sleepiness among medical students, and the potentially negative effects this relationship could have upon student health and academic performance. The objective was to identify the association between anxiety and excessive daytime sleepiness in medical students of the University of Guadalajara (Mexico). Materials and methods: A cross-sectional study was carried out, evaluating 173 students between January and April of 2019. The Epworth Sleepiness Scale was used for the determination of excessive day-time sleepiness, while the anxiety symptoms were measured using the Beck Anxiety Inventory. According to the cut-off points for the Epworth scales, the cut-off point was from 10 and for the Beck anxiety inventory it was 8. Chi square and Fisher's exact test were used for statistical analysis. A value of p<0.05 was consid-ered statistically significant. Results: Statistically significant differences were found between the students when comparing the presence and absence of excessive daytime sleepiness and anxiety with a value of p = 0.036 and Odds Ratio of 2.161. Conclusion: A high prevalence of anxiety and insomnia was found in the group of medical students which was evaluated. Additionally, it was found that students who suffer from anxiety are more likely to develop excessive daytime sleepiness

Introducción: los estudiantes de medicina pueden ser considerados un grupo vulnerable para presentar ansiedad y trastornos del sueño, debido a las altas exigencias académicas y al estrés; sin embargo, se cuenta con pocos datos sobre la relación entre la ansiedad y la somnolencia en estudiantes de medicina, relación que podría generar complicaciones tanto académicas como de salud. El objetivo fue la asociación entre ansiedad y somnolencia excesiva diurna en estudiantes de medicina de la Universidad de Guadalajara (México). Materiales y métodos: estudio transversal con 173 estudiantes entre enero y abril del 2019. Para la determinación de somnolencia excesiva diurna se aplicó la Escala de Somnolencia de Epworth (punto de corte = 10), mientras que para evaluar los síntomas de ansiedad excesiva se utilizó el Inventario de Ansiedad de Beck (punto de corte = 8). Se emplearon chi cuadrado y la prueba exacta de Fisher para el análisis estadístico. Se consideró estadísticamente significativo un valor de p < 0.05. Resultados: se encontraron diferencias estadísticamente significativas entre los estudiantes al comparar la presencia y la ausencia de somnolencia y ansiedad con un valor de p = 0.036 y un odds ratio de 2.161. Conclusión: hay una alta prevalencia de ansiedad e insomnio en los estudiantes de medicina evaluados, y aquellos con ansiedad tienen mayor probabilidad de desarrollar somnolencia excesiva diurna

Introdução: estudantes de medicina podem ser potencialmente considerados um grupo vulnerável em ter-mos de risco aumentado para ansiedade e distúrbios do sono. Isso pode ser causado por altas demandas acadêmicas e altos níveis de estresse. No entanto, há poucas informações sobre a relação entre ansiedade e sonolência diurna excessiva entre estudantes de medicina e os efeitos potencialmente negativos que essa relação pode ter sobre a saúde e o desempenho acadêmico dos alunos. O objetivo foi identificar a associação entre ansiedade e sonolência diurna excessiva em estudantes de medicina da Universidade de Guadalajara (Mêxico). Materiais e métodos: estudo transversal, avaliando 173 alunos entre janeiro e abril de 2019. A Escala de Sonolência de Epworth (ponto de corte = 10) foi utilizada para a determina-ção da sonolência diurna excessiva, enquanto os sintomas de ansiedade foram medidos por meio do Inventário de Ansiedad de Beck (ponto de corte = 8). Qui-quadrado e prova exata Fisher foram usados para análise estatística. Um valor de p < 0,05 foi considerado estadísticamente significativo. Resultados:foram encontradas diferenças estatisticamente significantes entre os alunos ao comparar a presença e ausência de sonolência diurna excessiva e ansiedade com um valor de p = 0,036 e um Odds Ratio de 2,16. Conclusão: foi encontrada alta prevalência de ansiedade e insônia no grupo de estudantes de medicina avaliados. Além disso, verificou-se que os alunos que sofrem de ansiedade têm maior probabilidade de desenvolver sonolência diurna excessiva

Use of mNUTRIC-Score for Nutrition Risk Assessment and Prognosis Prediction in Critically Ill Patients with COVID-19: A Retrospective Observational Study.

INTRODUCTION: Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nutritional assessment in the critically ill population are scarce. This study was conducted to evaluate the modified Nutrition Risk in the Critically Ill (mNUTRIC)-Score as a mortality risk factor in mechanically ventilated patients with COVID-19. METHODS: We conducted this retrospective observational study in critically ill patients with COVID-19. Patients' characteristics and clinical information were obtained from electronic medical records. The nutritional risk for each patient was assessed at the time of mechanical ventilation using the mNUTRIC-Score. The major outcome was 28-day mortality. RESULTS: Ninety-eight patients were analyzed (mean age, 57.22 ± 13.66 years, 68.4% male); 46.9% of critically ill COVID-19 patients were categorized as being at high nutrition risk (mNUTRIC-Score of ≥5). A multivariate logistic regression model indicated that high nutritional risk has higher 28-day hospital mortality (OR = 4.206, 95% CI: 1.147-15.425, p=0.030). A multivariate Cox regression analysis showed that high-risk mNUTRIC-Score had a significantly increased full-length mortality risk during hospitalization (OR = 1.991, 95% CI: 1.219-3.252, p=0.006). CONCLUSION: The mNUTRIC-Score is an independent mortality risk factor during hospitalization in critically ill COVID-19 patients.

Multidimensional analysis of health in Mexico: implementation of fuzzy sets.

BACKGROUND: The national health and nutrition survey allows to know the state of health of the Mexican population, it provides data for the analysis of different factors and / or indicators of health, diseases and nutritional conditions, such as chronic degenerative diseases and depressive symptoms, which, in turn, if both occur simultaneously, they will have a negative impact on health. This article studies the four factors involved in the overall health of the population in Mexico: excess weight, diabetes, high blood pressure, and depressive symptoms, which are used to conduct a multidimensional characterization and analysis. METHODS: Two methodological resources are applied, a descriptive statistical characterization and the construction of a multidimensional health index with the use of fuzzy sets, through the National Health and Nutrition Survey (ENSANUT 2018-19 - for its acronym in Spanish) in Mexico. RESULTS: The results reveal a growing percentage of individuals who experience detriments to their health, that is, the factors being studied have had a negative impact and tend to follow international projections. The construction of a multidimensional index enables the interaction between the factors being studied, thus allowing for an adequate modeling for the identification of health in Mexico. CONCLUSION: This study aims to elucidate the current state of health throughout the population in Mexico by using the most current data provided by the autonomous public body of statistics and geography to build a multidimensional panorama using four elementary public health indicators (diabetes, obesity, high blood pressure, and depressive symptoms).

Anxious depression in patients with Type 2 Diabetes Mellitus and its relationship with medication adherence and glycemic control.

A relationship between anxious depression has been proposed in patients with diabetes, which may contribute to the lack of medication adherence. The aim of this study was to investigate if there is a relationship between depression and / or anxiety with medication adherence and glycemic control in patients with type 2 Diabetes Mellitus (DM2). An analytical, cross-sectional study was carried out in the internal medicine outpatient clinic of a Hospital in Mexico. Patients with DM2 participated over a period from November 2015 to January 2016. The Morisky scale for medication adherence, and the Goldberg anxiety and depression scale were conducted for each patient. Data was collected from a total of 179 patients. There was a significant difference between anxious depression and medication adherence (p < 0.001) using logistic regression with an R2 of 0.136. There was also a significant difference between anxiety and glycemic control (p < 0.001) with an R2 of 0.175, however no significant difference was found between glycemic control and anxious depression. Our findings demonstrate that patients who suffer from anxious depression also tend to have reduced medication adherence, and anxiety was associated with poor glycemic control in patients with DM2 within the Mexican population.

Loss of muscle strength in patients under hemodialysis evaluated by dynamometry in the Mexican population / Pérdida de fuerza muscular en pacientes en hemodiálisis evaluados mediante dinamometría en la población mexicana

INTRODUCTION: chronic kidney disease contributes to decreased muscle strength and physical function through a decrease in muscle mass. Current evidence suggests that hemodialysis can accentuate this complication, as well as lead to deterioration of the patient's overall health. The aim of this study is to compare muscle strength in a group of Mexican patients undergoing hemodialysis, evaluated by dynamometry, with available reference values. MATERIALS AND METHODS: a cross-sectional study was conducted in male and female patients between 20 and 81 years of age, with stage-5 chronic kidney disease, from the outpatient Hospital General Regional No 46 of the Mexican Social Security Institute. Muscle strength was assessed by means of a mechanical dynamometer. The average value classified by age and gender was compared with the 50th percentile of a reference study. Inter-group differences were calculated with the nonparametric Mann-Whitney U-test, and correlation using Pearson's test, logistic regression, and chi-squared test. All patients signed an informed consent form. RESULTS: a total of 150 patients, 97 (64.7 %) men and 53 (35.3 %) women, were included in the study. The mean dynamometric value for muscle strength was 21.5 ± 10.1 kg, and a significant correlation was found with age, weight, and hemoglobin concentration. CONCLUSION: patients undergoing hemodialysis treatment for chronic kidney disease were found to be at the 10th percentile for muscle strength, as measured by dynamometry, thus demonstrating a marked decrease in muscle strength. This result could, however, also have been affected by different variables such as patient age, height, weight, glomerular filtration rate (GFR), hemoglobin concentration, serum creatinine, serum glucose, and the subjective global assessment, given that a significant association was also found between these and muscle strength

INTRODUCCIÓN: la enfermedad renal crónica contribuye a disminuir la fuerza muscular y la función física a través de una disminución de la masa muscular. De acuerdo con la evidencia, la hemodiálisis puede acentuar esta complicación, así como llevar al paciente a un deterioro del estado general de salud. El objetivo de la investigación fue comparar la fuerza muscular de pacientes con hemodiálisis, evaluada mediante dinamometría en una población mexicana, con los valores de referencia. MATERIAL Y MÉTODOS: se realizó un estudio transversal en pacientes masculinos y femeninos de 20 a 81 años, con enfermedad renal crónica en estadio 5, del área de consulta externa del Hospital General Regional No 46 del Instituto Mexicano del Seguro Social. La fuerza muscular se evaluó por medio de un dinamómetro mecánico. El valor promedio clasificado por rango de edad y género se comparó con el percentil 50 de un estudio de referencia. Las diferencias intergrupales se calcularon con la prueba no paramétrica de la U de Mann-Whitney y la correlación mediante la prueba de Pearson. Todos los pacientes firmaron la carta de consentimiento informado. RESULTADOS: la muestra del estudio fue de 150 pacientes, 97 (64,7 %) hombres y 53 (35,3 %) mujeres. De acuerdo con la dinamometría, la media fue de 21,5 ± 10,1 kg; se demostró una correlación significativa entre la edad, el peso y la hemoglobina. CONCLUSIÓN: se encontró que los pacientes con enfermedad renal crónica sometidos a hemodiálisis se encontraban en el percentil 10 de fuerza muscular, medido por dinamometría, lo que demuestra una disminución marcada de dicha fuerza muscular. Sin embargo, este resultado también podría verse afectado por diferentes variables, como la edad del paciente, la altura, el peso, la tasa de filtración glomerular (TFG), la concentración de hemoglobina, la creatinina sérica, la glucosa sérica y la evaluación global subjetiva, dado que se encontró una asociación significativa entre estos factores y la fuerza muscular

Loss of muscle strength in patients under hemodialysis evaluated by dynamometry in the Mexican population.

INTRODUCTION: Introduction: chronic kidney disease contributes to decreased muscle strength and physical function through a decrease in muscle mass. Current evidence suggests that hemodialysis can accentuate this complication, as well as lead to deterioration of the patient's overall health. The aim of this study is to compare muscle strength in a group of Mexican patients undergoing hemodialysis, evaluated by dynamometry, with available reference values. Materials and methods: a cross-sectional study was conducted in male and female patients between 20 and 81 years of age, with stage-5 chronic kidney disease, from the outpatient Hospital General Regional No 46 of the Mexican Social Security Institute. Muscle strength was assessed by means of a mechanical dynamometer. The average value classified by age and gender was compared with the 50th percentile of a reference study. Inter-group differences were calculated with the nonparametric Mann-Whitney U-test, and correlation using Pearson's test, logistic regression, and chi-squared test. All patients signed an informed consent form. Results: a total of 150 patients, 97 (64.7 %) men and 53 (35.3 %) women, were included in the study. The mean dynamometric value for muscle strength was 21.5 ± 10.1 kg, and a significant correlation was found with age, weight, and hemoglobin concentration. Conclusion: patients undergoing hemodialysis treatment for chronic kidney disease were found to be at the 10th percentile for muscle strength, as measured by dynamometry, thus demonstrating a marked decrease in muscle strength. This result could, however, also have been affected by different variables such as patient age, height, weight, glomerular filtration rate (GFR), hemoglobin concentration, serum creatinine, serum glucose, and the subjective global assessment, given that a significant association was also found between these and muscle strength.

INTRODUCCIÓN: Introducción: la enfermedad renal crónica contribuye a disminuir la fuerza muscular y la función física a través de una disminución de la masa muscular. De acuerdo con la evidencia, la hemodiálisis puede acentuar esta complicación, así como llevar al paciente a un deterioro del estado general de salud. El objetivo de la investigación fue comparar la fuerza muscular de pacientes con hemodiálisis, evaluada mediante dinamometría en una población mexicana, con los valores de referencia. Material y métodos: se realizó un estudio transversal en pacientes masculinos y femeninos de 20 a 81 años, con enfermedad renal crónica en estadio 5, del área de consulta externa del Hospital General Regional No 46 del Instituto Mexicano del Seguro Social. La fuerza muscular se evaluó por medio de un dinamómetro mecánico. El valor promedio clasificado por rango de edad y género se comparó con el percentil 50 de un estudio de referencia. Las diferencias intergrupales se calcularon con la prueba no paramétrica de la U de Mann-Whitney y la correlación mediante la prueba de Pearson. Todos los pacientes firmaron la carta de consentimiento informado. Resultados: la muestra del estudio fue de 150 pacientes, 97 (64,7 %) hombres y 53 (35,3 %) mujeres. De acuerdo con la dinamometría, la media fue de 21,5 ± 10,1 kg; se demostró una correlación significativa entre la edad, el peso y la hemoglobina. Conclusión: se encontró que los pacientes con enfermedad renal crónica sometidos a hemodiálisis se encontraban en el percentil 10 de fuerza muscular, medido por dinamometría, lo que demuestra una disminución marcada de dicha fuerza muscular. Sin embargo, este resultado también podría verse afectado por diferentes variables, como la edad del paciente, la altura, el peso, la tasa de filtración glomerular (TFG), la concentración de hemoglobina, la creatinina sérica, la glucosa sérica y la evaluación global subjetiva, dado que se encontró una asociación significativa entre estos factores y la fuerza muscular.

Comparison of nutritional screening tools to assess nutritional risk and predict clinical outcomes in Mexican patients with digestive diseases.

BACKGROUND: The prevalence of malnutrition remains high in hospitals but no "gold standard" has been established to identify nutritional risks adequately. The Nutrition Risk Screening-2002 (NRS-2002), Subjective Global Assessment (SGA), and Controlling Nutritional Status Index (CONUT) are widely used screening tools, but their efficacy has not yet been compared in Mexican patients. Here, we aimed to compare the efficacy of these tools in identifying nutritional risks within the first 48 h of admission in a group of patients with gastrointestinal diseases. METHODS: This was a cross-sectional study of 196 patients. The results of the screening tools, length of hospital stay, serum albumin and cholesterol concentrations, lymphocyte counts, age, body mass index (BMI), complications, and mortality were analyzed. Kappa (κ) statistics were applied to determine the degree of agreement between tools. The performances of the screening tools in predicting complications and mortality were assessed using binary logistic regression. RESULTS: The NRS-2002, SGA, and CONUT tools identified nutritional risk in 67, 74, and 51% of the patients, respectively. The observed agreements between tools were: NRS2002/SGA, κ = 0.53; CONUT/NRS-2002, κ = 0.42; and SGA/CONUT, κ = 0.36. Within age groups, the best agreement was found in those aged 51-65 years (κ = 0.68). CONUT and length of stay were both predictive for the number of complications. The number of complications and serum cholesterol concentrations were predictive for mortality. CONCLUSIONS: The proportion of patients identified as having nutritional risk was high using all three screening tools. SGA, NRS-2002, and CONUT had similar capacities for screening risk, but the best agreement was observed between NRS-2002 and SGA. Only CONUT predicted complications, but none of these tools performed well in predicting mortality.

Effect of Linagliptin Versus Metformin on Glycemic Variability in Patients with Impaired Glucose Tolerance.

BACKGROUND: Impaired glucose tolerance (IGT) and glycemic variability may be associated with increased risk of micro- and macrovascular complications. The aim of this study was to assess the effect of linagliptin versus metformin on glycemic variability in patients with IGT. MATERIAL AND METHODS: A randomized, double-blind clinical trial with parallel groups was carried out in 16 adult patients with IGT, overweight or obesity. All patients signed an informed consent. The therapies were randomly assigned: (a) metformin 500 mg bid (n = 8) or (b) linagliptin 5 mg a.m. and placebo p.m. (n = 8), both for 90 days. At the beginning of the trial and 3 months later, fasting glucose, glycated hemoglobin A1c, oral glucose tolerance test (OGTT), and glycemic variability [area under the curve (AUC) of glucose, mean amplitude of glycemic excursion (MAGE), standard deviation (SD) of glucose, coefficient of variation (CV) of glucose, and mean blood glucose (MBG)] were measured. Mann-Whitney U, Wilcoxon, and Fisher exact tests were used for statistical analyses. RESULTS: Both groups were similar in basal characteristics. After linagliptin administration, a significant decrease in glucose levels at 120 min of OGTT (9.0 ± 0.9 vs. 6.9 ± 2.2 mmol/L, P = 0.012) was observed. Glycemic variability showed a similar behavior and there were no significant differences in the AUC, MAGE, SD of glucose, CV of glucose, and MBG between groups. CONCLUSION: Linagliptin administration resulted in better glycemic control according to the decrease of glucose levels by the OGTT at 120 min in patients with IGT. Meanwhile, glycemic variability was not modified in any of the study groups.

Cerebrospinal Fluid Biomarkers in Highly Exposed PM2.5 Urbanites: The Risk of Alzheimer's and Parkinson's Diseases in Young Mexico City Residents.

Exposure to fine particulate matter (PM2.5) and ozone (O3) above US EPA standards is associated with Alzheimer's disease (AD) risk, while Mn toxicity induces parkinsonism. Mexico City Metropolitan Area (MCMA) children have pre- and postnatal sustained and high exposures to PM2.5, O3, polycyclic aromatic hydrocarbons, and metals. Young MCMA residents exhibit frontal tau hyperphosphorylation and amyloid-ß (Aß)1 - 42 diffuse plaques, and aggregated and hyperphosphorylated α-synuclein in olfactory nerves and key brainstem nuclei. We measured total prion protein (TPrP), total tau (T-tau), tau phosphorylated at threonine 181 (P-Tau), Aß1-42, α-synuclein (t-α-syn and d-α-synuclein), BDNF, insulin, leptin, and/or inflammatory mediators, in 129 normal CSF samples from MCMA and clean air controls. Aß1-42 and BDNF concentrations were significantly lower in MCMA children versus controls (p = 0.005 and 0.02, respectively). TPrP increased with cumulative PM2.5 up to 5 µg/m3 and then decreased, regardless of cumulative value or age (R2 = 0.56). TPrP strongly correlated with T-Tau and P-Tau, while d-α-synuclein showed a significant correlation with TNFα, IL10, and IL6 in MCMA children. Total synuclein showed an increment in childhood years related to cumulated PM2.5, followed by a decrease after age 12 years (R2 = 0.47), while d-α-synuclein exhibited a tendency to increase with cumulated PM2.5 (R2 = 0.30). CSF Aß1-42, BDNF, α-synuclein, and TPrP changes are evolving in young MCMA urbanites historically showing underperformance in cognitive processes, odor identification deficits, downregulation of frontal cellular PrP, and neuropathological AD and PD hallmarks. Neuroprotection of young MCMA residents ought to be a public health priority.