[Sustained virologic response in patients with hepatitis C and chronic kidney disease]. / Respuesta viral sostenida en pacientes con hepatitis C y enfermedad renal crónica.

Background: Patients with chronic kidney disease (CKD) have a higher prevalence of hepatitis C virus (HCV) infection compared to the general population, and they also present higher morbidity and mortality if they are not treated. Current treatment is based on different direct-acting antiviral (DAA) schemes, which are available in the Mexican health system. However, the efficacy and safety of DAA treatment in patients with CKD on hemodialysis and HCV infection are unknown in Mexican population. Objective: To determine the efficacy through sustained viral response (SVR) and the safety of DAAs in patients with CKD on hemodialysis and chronic HCV infection in the Mexican population. Material and methods: Real-life cohort study. Patients with CKD on hemodialysis and HCV infection treated with DAAs from a third level hospital were included. Descriptive statistics of the clinical characteristics were performed, efficacy was determined by SVR and safety with the global frequency of adverse effects associated with treatment. Results: 25 patients were included. All of them received treatment with glecaprebir/pibrentasvir for 8 weeks. The mean age was 57.8 years and the median time of CKD on hemodialysis was 5 years. 96% of patients had HCV genotype 1B. 100% of the patients presented SVR and the most frequent adverse effects were headache, nausea and fatigue. Conclusions: In the Mexican population studied, patients with HCV and CKD on hemodialysis presented a sustained viral response of 100% with glecaprevir/pibrentasvir with mild adverse effects.

Introducción: los pacientes con enfermedad renal crónica (ERC) tienen una mayor prevalencia de infección por virus de hepatitis C (VHC) en comparación con la población general y presentan mayor morbimortalidad si no se tratan. El tratamiento actual se basa en diferentes esquemas de antivirales de acción directa (ADD), disponibles en el sistema de salud mexicano; sin embargo, se desconoce su eficacia y seguridad en pacientes con ERC en hemodiálisis e infección por VHC en población mexicana. Objetivo: determinar la eficacia mediante respuesta viral sostenida (RVS) y la seguridad de los AAD en pacientes con ERC en hemodiálisis e infección crónica por VHC en población mexicana. Material y métodos: estudio de cohorte de vida real. Se incluyeron pacientes con ERC en hemodiálisis e infección por VHC tratados con AAD en un hospital de tercer nivel. Se usó estadística descriptiva de las características clínicas, se determinó eficacia mediante RVS y seguridad con la frecuencia global de efectos adversos asociados al tratamiento. Resultados: se incluyeron 25 pacientes. Todos recibieron tratamiento con glecaprebir/pibrentasvir durante ocho semanas. La media de edad fue 57.8 años y la mediana de tiempo de ERC en hemodiálisis fue de 5 años. El 96% de los pacientes presentó genotipo 1B de VHC. El 100% de los pacientes presentaron RVS y los efectos adversos más frecuentes fueron cefalea, náuseas y fatiga. Conclusiones: en la población mexicana estudiada, los pacientes con VHC y ERC en hemodiálisis presentaron respuesta viral sostenida del 100% con glecaprevir/pibrentasvir con efectos adversos leves.

Risk Factors and Clinical Phenotypes Associated with Severity in Patients with COVID-19 in Northeast Mexico.

Objective: The aim of this study is to describe the main clinical phenotypes, laboratory findings, and severity of coronavirus disease 2019 (COVID-19) in patients hospitalized at the High Specialty Medical Unit # 71 of the Mexican Social Security Institute. Methods: Prospective observational cohort study with a total of 105 patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at the High Specialty Medical Unit # 71 (Torreón, Coahuila, Mexico), from May 15th to August 15th, 2020. The cases were confirmed to be COVID-19 positive through an RT-qPCR test. Clinical phenotypes and laboratory tests were evaluated to determine the degree of severity of the disease and the most frequent comorbidities. Results: The clinical characteristics of a total of 105 hospitalized patients (47 females and 58 males; median age being 52 years) with confirmed COVID-19 diagnoses were studied. The severity of the disease was classified as moderate grade (62.7%), severe grade (21.5%), and critical grade (15.6%). Among the most frequent underlying pathologies coexisted overweight (n = 75, 78.12%), obesity (n = 21, 21.87%), diabetes (n = 10, 9.52%), and hypertension (n = 6, 5.71%), some of these patients present more than one pathology. This association was found with diabetes (odds ratio [OR]: 1.42; 95% confidence interval [CI]: 1.23-1.97; p = 0.021) and high levels of D-dimer (OR: 1.01; 95% CI: 1.00-1.08; p = 0.001). Conclusion: In this retrospective cohort study of patients with COVID-19 from a specialty hospital in the northeast region of Mexico, it was observed that clinical phenotypes and D-dimer elevation were compatible with an inflammatory state by degree of severity; it was found that the hospitalized patients with underlying chronic medical conditions such as diabetes and elevated D-dimer levels were significantly associated with increased mortality from COVID-19. Age and sex (males) were two factors highly associated with mortality.

Factor de riesgo para asma / Factor of risk for asthma

Objetivo: estudiar la magnitud de los factores de riesgo conocidos para asma en niños de 6 a 10 años de edad. Material y método: estudio de casos y controles con niños de 6 a 10 años de edad; 58 asmáticos y 117 controles, con una relación de 2:1. Los pacientes asmáticos se captaron de la consulta del departamento de inmunoalergias y los controles de la consulta de medicina familiar del Hospital de Especialidades núm. 71, IMSS. Se realizaron encuestas indirectas (madre) y dirigidas, de opción múltiple para explorar los factores de riesgo más conocidos en la literatura. El manejo estadístico se realizó por razón de momios con intervalos de confianza al 95 por ciento. Resultados: se comportaron como factores de riesgo las siguientes variables: ingestión de colorantes artificiales antes del año (OR = 13.2), residencia en un área urbana (OR = 7.74), tabaquismo materno durante el embarazo (OR = 2.4), contacto con lana antes del año (OR = 2.11), fumadores en la familia durante el embarazo (OR = 1.486) y alimentación con leche industrializada (OR = I.2). Conclusiones: los factores de riesgo ambiental son muy importantes en nuestra población al igual que la ablactación temprana; sin embargo, la ingestión antes del año con alergénicos como el huevo, el chocolate, la naranja y el mango no se comportaron como factores de riesgo.