Instituto Mexicano Del Seguro Social Research Articles

Family medicine and practice in the Mexican Social Security Institute

The central ideas of this research paper are related to the practice of family medicine as a specialty. It focuses in its origins, problems, unique characteristics, limitations, scope, management, and processes within the context of primary care of the Mexican Social Security System. This approach was based on a qualitative, hermeneutical study closely related to the Structural Functionalism Theory. Within this framework, medical practice is seen as an equation: Meaning = action + function/structure. This offers an approach to the understanding of reality through surveys and observations in five categories: identity, activity, purpose, values/norms, and power/relationship. The practice of family medicine is defined as a medical act in the Mexican Social Security Institute. This act is limited to a brief encounter and a prescription, which makes it a short, fleeting, medicalized interaction. The result is a negative social imaginary of the physician, the patient and the whole of society. Thus, individuals and society host a negative social imaginary bestowed on doctors and users of the health system.

AB0084 Serum Levels of Syndecan-1 and Organ Involvement in Systemic Lupus Erythematosus

BackgroundSyndecan-1 is expressed on plasma cells surface and serum levels as reflect an activation of these cells. To date, a significant association between serum levels of syndecan-1with disease activity has...

AB0087 Macrophage Migration Inhibitory Factor, Resistin, Leptin, Adiponectin and Clinical Variables in Systemic Lupus Erythematosus

BackgroundMacrophage migration inhibitory factor (MIF) is a cytokine with proinflammatory properties with potential interest in systemic lupus erythematosus (SLE)1. Also adipokines have interest in this disease. Nevertheless, the relationship between...

PSY22 - The National Cost Of Hemophilia Type A And B In Mexico

PSY22 The NaTioNal CoST of hemoPhilia TYPe a aNd B iN mexiCo Carlos F1, Gasca R1, Mucino E2, Huicochea JL2 1R A C Salud Consultores S.A. de C.V., Mexico City, Mexico, 2Pfizer S.A. de C.V., Mexico City, Mexico Objectives: Hemophilia is a hereditary, lifelong bleeding disorder. Patients are deficient in either coagulation factor VIII (hemophilia A) or IX (hemophilia B). This study is aimed to assess the economic impact of these conditions in Mexico. MethOds: In this cost-of-illness study, both direct medical costs (diagnosis, follow-up, prophylaxis and on-demand coagulation factor replacement therapy, inpatient and outpatient care of hemorrhages and complications) and indirect costs related with loss of productivity in either adult patients or in parents of affected children along one year were assessed. Local demographic and epidemiological data (last update: 2011), as well as annual bleeding rates in both prophylaxis and on-demand approaches were extracted from published sources. Resource use patterns were derived mainly from Mexican Clinical Practice Guidelines co-authors (n= 8) through a survey. Unitary costs of medical resources were gathered mainly from Instituto Mexicano del Seguro Social (IMSS) sources. It is assumed that productivity losses of adult patients/parents of hemophiliac children are proportional to the number of days in hospital; average per hour wage and worked hours per week were extracted from National Statistics Office database. All costs are expressed in 2013 USD. Results: A total of 3906 (87%) type A and 597 (13%) type B patients comprised the 2011 documented prevalence of hemophilia in Mexico. Most (57%) of all patients received medical care at IMSS. Direct medical costs (79.3 USD millions) and indirect costs (370,398 USD) accounted for 99.5% and 0.5% of total costs (79.7 USD millions), respectively. Among direct medical costs, acquisition of coagulation factors represented the most important category (55.1 USD millions, 69.23%), followed by non-pharmacological care of hemorrhages (20 USD million, 25.12%). Average cost per patient was very similar: 18,152 and 14,662 USD for type A and B, respectively. cOnclusiOns: Despite its low prevalence, hemophilia imposes a considerably high economic burden in Mexico s health care system.

Comportamiento del Geriatric/General Oral Health Assessment Index (GOHAI) y Oral Impacts on Daily Performances (OIDP) en una población de adultos mayores de la Ciudad de México

ObjectiveTo determine the behavior of the Geriatric/General Oral Health Assessment Index as well as the Oral Impacts on Daily Performances as effective measures in oral-dental health related to quality of life in senior citizens in a given population. MethodsA representative sample of senior citizens entitled to medical services at the Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) located in the southwest region of Mexico City. Home interviews were conducted in order to ascertain the sample’s characteristics as well as the application of the Geriatric/General Oral Health Assessment Index and Oral Impacts on Daily Performances instruments. Clinical evaluation in order to determine experience of crown caries (CPO-D) and root caries CO-R). ResultsA total of 531 subjects aged 60 years and over participated in the study, of which 68.4% were female. Age average (AA) was 71.4 years (7.0). Geriatric/General Oral Health Assessment Index exhibited a mean of 46.8 (6.2) and Oral Impacts on Daily Performances showed 4.1 (12.4). Subjects included in the sample who had attended school for over 6 years, did not present limitations of cognitive deterioration, and were depression-free exhibited a higher mean in Oral Impacts on Daily Performances score than those which did not present those characteristics (p<0.05). Six or more years of schooling with paid work and depression-free subjects presented lesser Oral Impacts on Daily Performances scores when compared to those who did not. (p<0.05) A correlation was found between the Geriatric/General Oral Health Assessment Index and filled components, functional teeth (p>0.05). Filled and lost components and CPO-D index as well as healthy crowns and functional teeth exhibited a correlation with Oral Impacts on Daily Performances (p<0.05). ConclusionGeriatric/General Oral Health Assessment Index exhibited higher discrimination in the population’s characteristics, whereas Oral Impacts on Daily Performances showed higher correlation with the state of the dentition.

Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City

BackgroundMexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics.MethodsWe randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children’s height and weight and parents reported children’s diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values.Results93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program.ConclusionsAlthough satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI.Trial registrationClinicalTrials.gov NCT01539070.Comisión Nacional de Investigación Científica del IMSS: 2009-785-120.

Carbetocin versus oxytocin for prevention of postpartum haemorrhage: a randomised controlled trial

BackgroundPostpartum haemorrhage (PPH) is the leading cause of maternal death worldwide. Prophylactic uterotonics are effective in reducing PPH, and the drug of choice is oxytocin. Carbetocin, a newer analogue of oxytocin, has a greater biological effect and longer half-life. It is also more heat-stable than oxytocin, which is of crucial importance to resource-poor settings. We compared the efficacy of carbetocin with oxytocin. MethodsIn this randomised controlled trial in a tertiary maternity hospital in Mexico, pregnant women with at least one risk factor for PPH were randomly assigned by a central computer-generated list of random numbers in a 1:1 ratio with no masking either to carbetocin 100 μg as a single intravenous bolus or to oxytocin 20 IU as a 6-h infusion, both administered immediately after childbirth. The primary outcome was PPH with blood loss exceeding 500 mL. Secondary outcomes were the volume of blood loss, severe PPH (blood loss >1000 mL), change in haemodynamic and clinical variables within 24 h of childbirth, and the need for additional uterotonic treatment. Comparisons were done by intention-to-treat analysis. This trial is registered with Instituto Mexicano del Seguro Social (IMSS), number R-2011-3606-1. Findings1210 women were included with 602 assigned to carbetocin and 608 assigned to oxytocin. Blood loss exceeding 500mL was lower in women assigned to carbetocin than in women assigned to oxytocin (18·4% [111/602] vs 25·8 [157/208], relative risk [RR] 0·67, 95% CI 0·54–0·83; number needed to treat [NNT] 14, 95% CI 8–37). Mean blood loss was less with carbetocin than with oxytocin (366 mL [SE 7·8] vs 400 [7·6], p<0·001). The frequency of blood transfusion was similar in the two groups (1·7% [10/602] vs 2·6% [16/608]; RR 0·67, 95% CI 0·31–1·38). The frequency of severe PPH did not differ between the two groups (1·3% [8/602] vs 1·6% [7/608]; 1·15, 0·42–3·16). Fewer participants receiving carbetocin than receiving oxytocin required additional uterotonics (1·5% [9/602] vs 5·8% [35/608], adjusted RR 0·3, 95% CI 0·14–0·61), and fluid resuscitation (20·6% [124/602] vs 24·2% [147/608]; 0·77, 0·62–0·95). No significant difference in the haemodynamic variables was found. InterpretationTo our knowledge, this is the largest trial comparing carbetocin with oxytocin. An updated meta-analysis, combining the results from six randomised trials, including this study, found that carbetocin was associated with a reduction of PPH compared with oxytocin. FundingAmmalife Charity, Ferring Pharmaceuticals.

Increased acetylcholine esterase activity produced by the administration of an aqueous extract of the seed kernel of Thevetia peruviana and its role on acute and subchronic intoxication in mice.

Background:The real mechanism for Thevetia peruviana poisoning remains unclear. Cholinergic activity is important for cardiac function regulation, however, the effect of T. peruviana on cholinergic activity is not well-known.Objective:To study the effect of the acute administration of an aqueous extract of the seed kernel of T. peruviana on the acetylcholine esterase (AChE) activity in CD1 mice as well its implications in the sub-chronic toxicity of the extract.Materials and Methods:A dose of 100 mg/kg of the extract was administered to CD1 mice and after 7 days, serum was obtained for ceruloplasmin (CP) quantitation and liver function tests. Another group of mice received a 50 mg/kg dose of the extract 3 times within 1 h time interval and AChE activity was determined for those animals. Heart tissue histological preparation was obtained from a group of mice that received a daily 50 mg/kg dose of the extract by a 30-days period.Results:CP levels for the treated group were higher than those for the control group (Student's t-test, P ≤ 0.001). AChE activity in the treated group was significantly higher than the control group (Tukey test, control vs. T. peruviana, P ≤ 0.001). Heart tissue histological preparations showed leukocyte infiltrates and necrotic areas, consistent with infarcts.Conclusion:The increased levels of AChE and the hearth tissue infiltrative lesions induced by the aqueous seed kernel extract of T. peruviana explains in part the poisoning caused by this plant, which can be related to an inflammatory process.

Recent advances in gastric cancer.

Recent advances in gastric cancer.

Cytogenetics As a Prognostic Factor Of The Overall Survival (OS) Of Mexican Patients With Myelodysplastic Syndrome (MDS)

IntroductionMDS are a heterogeneous group of acquired clonal diseases, characterized by an increase of the apoptosis and several grades of cytopenias. They originate in hematopoietic stem cells with cytogenetic and molecular abnormalities, having the risk of evolving into an acute myeloid leukemia (AML).There are no clinical data of the characteristics of the patients with MDS in Mexico, thus we consider necessary to know the behavior of this disease in our population, also to evaluate the cytogenetic alterations, and to investigate whether they are associated with the OS. MethodsA longitudinal-observational study was performed at the MDS clinic of the Hematology Department of the Specialties Hospital of the Centro Médico Nacional La Raza of the Instituto Mexicano del Seguro Social (IMSS), from January 25, 2005 to January 25, 2013. The primary objective was to evaluate the epidemiological characteristics and the cytogenetic findings of the patients with MDS in our population, establishing its correlation with the OS. We included patients >16 y.o., male and female, with diagnosis of newly diagnosed MDSs with a cytogenetic testing available (GGT-band analysis performed at Quest Diagnostics and Genetica Pre y Post Natal). SPSS version 20 was used for statistical analysis. Survival was evaluated through KM curve. A Multivariate analysis with logistic regression was performed in order to know the OR and 95% CI and a p<0.05 was accepted as statistically significant. ResultsA total of 92 patients were included, 44 (47.8%) men, and 48 (52.2%) women. The cytogenetic study was normal in 72 (78.3%) of the patients and 20% (21.7%) had an abnormal cytogenetic study. The cytogenetic abnormalities were as follows: 5 (25%) had complex karyotype, 3 (15%) had –Y, 2 (10%) hypodiploidy, 2 (10%) del9, 1 (5%) del7, 1 (5%) +9, 1 (5%) t 1;5, 1 (5%) 17p-, 1 (5%) del21, 1 (5%) +19, 1(5%) del5q y 1(5%) +8.77 patients (83.7%) had favorable cytogenetic risk; 8 (8.7%) intermediate cytogenetic risk; and 7 (7.6%) poor risk.The IPSS risk stratification was: low risk in 33 (35.9%) of the patients, intermediate-1 risk in 39 (53.3%), intermediate 2 risk in 5 (5.4%), and high risk in 5 (5.4%).The median OS was 85 months (figure 1), with a median follow-up of 35 months (2-96 months). The median survival for the favorable cytogenetic risk was 82.7 months 95% CI; 74.7-90.6), for the intermediate cytogenetic risk 73.6 months (95% CI; 49.06-98.1), and for the poor cytogenetic risk, 46.8 months (95% CI; 10.6-18.4). The patients with favorable cytogenetic risk had a better survival than those with intermediate or poor cytogenetic risk (P= .001 Log-rank test). (Figure 2)Of the 92 patients, 10 (10.08%) progressed to acute myeloid leukemia the cytogenetic risk of these patients was as follows: 5 had a favorable risk karyotype and 5 had poor risk karyotype. The patients with favorable cytogenetic risk had a lower risk of progression in comparison with those with poor risk karyotype (P= 0.000). The median PFS to AML was 18.7 months (95 CI 4.1-33.2). Survival per cytogenetic risk group: for the favorable cytogenetic risk the median survival was 22.2 months 95% CI (.76-43), and for the poor cytogenetic risk it was 15.2 months, 95% CI (.0-36.8). (P= .362 Log-rank test). (Figure 3). The performance of the cytogenetic study to classify the patients and to estimate the IPSS is statistically associated with mortality (P 0.006). In the multivariate analysis was found that there is an association, independently of the cytogenetic study with favorable risk according to the IPSS, with the protection against mortality, with an OR=0.141, (95% CI 0.042-0.47). This confered a protection factor of 86% for the survival, independently of the treatment and the MDS type. ConclusionCytogenetic alterations in MDS patients differs importantly from other reports, since only a 21.7% of our patients had an abnormal cytogenetic finding. Nevertheless cytogenetic evaluation was very important for this population since it confirmed its prognostic importance for the OS of the Mexican MDS patients. Disclosures:Nacho-Vargas:Novartis Oncologia Mexico: Employment. Romero-Salas:Novartis Oncologia Mexico: Employment.

PIN8 - Estimation of the Number of Cases of Nosocomial Skin and Soft Tissue Infection in Adults Caused by Gram-Positive Bacteria in Public Hospitals in Mexico

To estimate the number of cases of nosocomial skin and soft tissue infection (SSTIs) in adults caused by Gram-positive bacteria (GPB) in public hospitals in Mexico. The total number of hospital discharges in patients ≥18 years were extracted from databases of the National Health Information System. A rate of 5.97 cases of nosocomial infection (NI) per 100 discharges (issued by Instituto Mexicano del Seguro Social between 2011 and 2012) was applied. Through a systematic literature review and critical reading of studies developed under the Mexican setting (using the Critical Appraisal Skills Programme guidelines), we assessed the type of infection and determined the proportions of: microbiological culture obtained and microbiological culture giving positive isolates. In the last stage, microorganisms were classified according to their Gram staining characteristics. In the year 2011 there were 5,517,139 discharges from public hospital, inferring 329,373 cases of NI rate (16.9% under 18 years and 83.1% in adults). We estimated that SSTIs represents 33.2% of NI (42,430 cases), of these, a microbiological culture was obtained only in 63.0% of the cases (26,731) and pathogen were isolated in 87.0% of microbiological cultures (23,256), among these, GPB was identified in 44.2%. According to our estimates a conservative number of cases of nosocomial SSTis in adults caused by GPB in 2011 was 10,279 and the pathogens reported were Staphylococcus aureus (71.1%), Enterococcus spp (14.2%), and others (14.6%). Although we found high heterogeneity in NI reports which may decrease the quality of the estimates presented in this research, in our opinion these results could help clinicians in the choice of initial antibiotics in order to reduce the probability of failure due emergence of resistant organisms.

PRS13 - Budget Impact Analysis of Step-Down Strategy Versus Conventional Therapy in the Treatment of Nosocomial Pneumonia Caused by Gram Positive Bacteria in Mexico

Previous reports of national literature estimated 15,135 cases of nosocomial pneumonia caused by Gram-positive bacteria (GPB) in Mexico, of which approximately 51% (95%CI 43%-59%) are candidates to use the step-down strategy (SDS) with linezolid. The aim of the study was to estimate the budget impact of SDS vs conventional strategy (CS, only intravenous) with linezolid in Mexico, from the perspective of Instituto Mexicano del Seguro Social (IMSS). Budget impact analysis (BIA) considered direct medical costs of linezolid (intravenous and tablets), length of stay, physician visits, route of administration, laboratory and imaging tests, as well as outpatient control (unit costs extracted from IMSS sources). Costs are expressed in 2013 US$ (1US$:€0.719). The resource use profile was estimated by Delphi method in a panel of 10 experienced infectologists. A BIA considering two scenarios was performed: i) budget impact of use CS in 100% of cases of nosocomial pneumonia caused by GPB (15,135) and ii) budget impact of use of SDS only in candidates (7,718 cases), based on the National budget allocated to health in 2013. The per-patient average treatment cost (ATC) of SDS was $10,116 ($9,345-10,887) whereas the per-patient ATC of CS was $17,251 ($16,379-18,124). The scenario i) represents 2.79% of National budget allocated to health, whereas scenario ii) represents 2.19%. This means potential savings of 0.6% of National budget allocated to health ($55,078,697). With these resources, CS treatment could be provided to 3,192 additional nosocomial pneumonia patients caused by GPB in Mexico. In the Mexican setting, SDS with linezolid in suitable patients is an intervention that could promote significant savings regarding the use of only intravenous form of the drug, which represents an opportunity to allocate scarce resources in a more efficient way.

PIN108 - Comparative Costs Analysis of Conventional Strategy Versus Step-Down Strategy with Linezolid in the Treatment of Nosocomial Pneumonia Caused by Gram Positive Bacteria in Mexico

To estimate the cost difference between use and absence of use of Step-Down Strategy (SDS) with linezolid for treatment of nosocomial pneumonia (NP) caused by Gram Positive Bacteria (GPB) in Mexico, from public health care institution perspective. To evaluate the potential cost savings between the two strategies, a microcosting was made along three phases: (1) characterization of therapeutic protocol, (2) assessment of resources and (3) estimation of the unit costs of medical care. The temporal horizon of the analysis was set to 14 days. Costs were estimated for the year 2013, expressed in US$ and consider the following medical services: days of hospitalization, consultation with specialists, route of administration, laboratory and imaging tests as well as outpatient control, based on unit costs by level of care reported by Instituto Mexicano del Seguro Social. The frequency of use of these resources were determined from Delphi method with a panel of 10 experienced infectologists. We calculated the differences between average total costs (ATC). The stastistical significance difference between strategies was evaluated by Student’s t statistic. The ATC of patients using SDS was $10,116, [95%CI $9,344.6 - $10,887.3] and the ATC of patients not using this strategy was $17,251.6 [$16,379.4 - $18,123.8]. The average potential savings due the use of SDS over conventional therapy (only intravenous) are $ 7,135.6, (p<0.001). The use of step down strategy could significantly reduce the costs of treatment of NP in terms of hospitalization, physician visits, laboratory and imaging tests, and drug administration, not as well the resources used in the outpatient control. In a challenging setting of cost containment policies, the use of step down strategy in suitable patients represents the opportunity to invest health care resources in a more efficient way.

PRS10 - Estimation of the Number of Cases of Nosocomial Pneumonia in Adults Caused by Gram-Positive Bacteria in Public Hospitals in Mexico

To estimate the number of cases of nosocomial pneumonia (NP) in adults caused by Gram-positive bacteria (GPB) in public hospitals in Mexico. To estimate the number of hospital discharges for each public institution in ≥ 18 years, databases from the National Health Information System (SINAIS) were consulted. We apply the nosocomial infection (NI) rate (5.97 cases per 100 discharges) issued by Instituto Mexicano del Seguro Social (IMSS) during the period 2011-2012. Through a systematic literature review and critical reading of studies developed in the Mexican setting (using the Critical Appraisal Skills Programme guidelines) we assessed the type of infection and determined the proportion of cases in which microbiological culture was obtained, as well as the proportion giving positive isolates; subsequently, etiologic agent was disaggregated according to their Gram staining characteristics. In the year 2011 there were 5,517,139 discharges from public hospitals, applying a rate of 5.97 NI cases/100 discharges, resulted in 329,373 NI cases (16.9% under 18 years and 83.1% in adults). The NP represented 33.2% of NI (90,882 cases), of these, only in 63% of cases a microbiological culture was obtained (57,256) and pathogens were isolated in 87.0% of microbiological cultures (49,813), among these, GPB we identified in 30.4% . According to our estimates the number of cases of adult NP caused by GPB is 15,135 and the pathogens reported were Staphylococcus aureus (74.3%), Streptococcus pneumoniae (15.6%), Enterococcus spp. (6.3%) and others (3.8%). In spite of high heterogeneity found in NI reports (which may decrease the quality of the information recorded), the local data reported in this study can help clinicians in the choice of first line antibiotics in order diminish the probability of unsuccessful treatment and additionally to reduce the emergence of resistant organisms, which could cause negative economic impact in the health care institutions.

Surveillance of Methicillin-resistant Staphylococcus aureus Causing Nosocomial Infections in Five Medical Centers of Monterrey, Nuevo León, México from 2005–2009

Staphylococcus aureus is a principal cause of human bacterial infection worldwide. The dissemination of antibiotic resistance among S. aureus strains is very import in the treatment of Staphylococcal infections. We undertook this study to identify methicillin-resistant Staphylococcus aureus (MRSA) clones responsible for nosocomial infection in five medical centers in Monterrey, Nuevo León (N.L.), México from 2005-2009. One hundred ninety MRSA strains collected from 2005-2009 from five hospitals affiliated with the Instituto Mexicano del Seguro Social (IMSS) in Monterrey, N.L., México were characterized by antimicrobial susceptibility, pulsed field gel electrophoresis (PFGE) and Staphylococcal Cassette Chromosome mec (SCCmec) typing. Only one clone was present in the five hospitals (clone C); this clone is strongly associated with the New York-Japan clone (SCCmec II) with a broad resistance profile. This study clearly documented the high ability for dissemination and the persistence of the New York-Japan clone in these centers.

Disability-adjusted life-years (DALYs) for diabetes in Mexico in 2005: a cross-sectional burden of disease analysis

BackgroundDiabetes is one of the leading causes of morbidity and mortality in Mexico and its prevalence has been rising since the end of the last century. The aim of this study was to estimate, for 2005, the share of burden due to this disease in the Instituto Mexicano del Seguro Social—the major social security institution in Mexico, which covers nearly half of Mexico's population. MethodsDisability-adjusted life-years (DALYs) were calculated by the sum of the estimated years of life lost (YLLs) and years lived with disability (YLDs) due to diabetes. The International Statistical Classification of Disease and Related Health Problems 10th Revision was used, and we included the E10–E14 codes related to diabetes mellitus. YLLs were calculated from age–sex–time-specific estimates of mortality by diabetes. YLDs were calculated by age and sex, and prevalence of diabetes and its disabling sequelae such as retinopathy, amputation, diabetic foot, and neuropathy. FindingsIn 2005, diabetes contributed 787 397 DALYs, 9·21% (95% CI 9·19–9·23) of total DALYs in Mexico, an increase from 7·31% (7·28–7·33) estimated in 1995. 5·83% (95% CI 5·79–5·89) of DALYs due to diabetes were attributed to retinopathy, 2·62% (2·58–2·65) to amputation, and 0·94% (0·92–0·96) to diabetic foot and neuropathy. While in adults aged between 25 and 44 years of age 64·29% (95% CI 64·00–64·60) of DALYs were due to YLDs, this proportion was 18·70% (18·50–18·90) in adults aged 45–59 years and only 6·47% (6·39–6·54) in those aged 60 years and older. 55·52% (95% CI 55·40–55·60) of the population affected with DALYs due to diabetes were female. InterpretationIn recent years, diabetes has been challenging the Mexican health-care system due to its high mortality rate and its high costs of care. In spite of the burden due to mortality, there is also a high burden due to YLDs, mainly among the younger age groups. Some neglected microvascular complications of diabetes, such as retinopathy, neuropathy, and diabetic foot, have contributed considerably to DALYs in Mexico. FundingMexican Social Security Institute (Grant No. 2005-785-154).

Coste-efectividad del tratamiento de síntomas vasomotores en cáncer de mama con desvenlafaxina en México

ObjectiveEstimate the cost-effectiveness of vaso-motor symptoms (VMS) management with hormone replacement therapy (HRT) and non-hormonal alternatives in patients with breast cancer (BC), regarding the Mexican institutional perspective.MethodsA Markov model was developed to estimate health and economic consequences until five years (quarterly cycles). Effectiveness measures were: reduction in hot flashes and quality-adjusted life years gained (QALY’s). Alternatives compared were: conjugated estrogens + medroxyprogesterone (2.5 mg/0.625 mg/day), tibolone (2.5 mg/day), conjugated estrogens (CE, 0.625 mg/day) and no treatment. Desvenlafaxine (100 mg/day) was the non-hormonal reference. The effectiveness of the therapies was extracted from published literature. The resource use profile was obtained from retrospective review of clinical files (n=140) of patients attending Instituto Mexicano del Seguro Social. Costs were extracted from official sources. Acceptability curves were constructed.ResultsIn patients with no contraindication to HRT, desvenlafaxine had the lowest cost (between US$3.011,46 and US$3.169,29) and higher levels of effectiveness and utility (at least 441 fewer hot flashes and 0.16 QALY’s more than CE). In patients with HRT contraindicated, desvenlafaxine is more expensive than no treatment (US$1.186), but prevented 2.754 hot flashes and gained 0.75 QALY’s. Acceptability curves show that desvenlafaxine is the non-hormonal therapy most likely to be cost effective.ConclusionsDesvenlafaxine is a cost-saving and cost effective non-hormonal alternative in the management of VMS in both, BC patients without and with contraindication to HRT use, respectively.

Blood pulmonary tuberculosis biomarkers on diabetic individuals

Event Abstract Back to Event Blood pulmonary tuberculosis biomarkers on diabetic individuals Carmen J. Serrano-Escobedo1, Rosa A. Gonzalez-Curiel1, Leonor Enciso-Moreno1, Noe Macias-Segura1 and Jose A. Enciso-Moreno1* 1 INSTITUTO MEXICANO DEL SEGURO SOCIAL, UNIDAD DE INVESTIGACION MEDICA ZACATECAS, Mexico SETTING. Tuberculosis (TB) associated to chronic health conditions such as non-insulin-dependent diabetes mellitus (NIDDM) could represent nowadays a worldwide Public Health threat. The relative odds of developing tuberculosis in diabetic patients ranges from 3 to 8 compared with non-diabetic patients. No molecular diagnostic or prognostic test to distinguish latent (LTB) from active TB (ATB) exists, neither biomarkers to follow TB pharmacology interventions. Given exacerbated inflammation by TB leads to pulmonary damage; key molecules on the inflammation process could be useful as diagnosis biomarkers for TB states, even in individuals with NIDDM. METHODS. Previous microarrays analysis at our laboratory identified a group of overexpressed genes on mice lungs infected with a Mycobacterium tuberculosis virulent strain that were not induced by a persistent strain that induces no inflammation. Based on the hypothesis that PBMCs from individuals with different TB infectious status could exhibit distinct transcription profiles, the present study evaluated the gene expression capability of 7 mice overexpressed genes on human whole blood, to discriminate subjects with pulmonary TB (PTB) (with or without NIDDM) from non infected or LTB subjects. RESULTS. In the no NIDDM group, CXCR5 presented lower expression on PTB compared to LTB, while PSTP1 expression was higher. On the other hand, NIDDM-PTB individuals showed higher expression for GBP2, ARHGAP30, NCF1, and FPR2 compared to the LTB individuals, while CXCR5 expression was lower. CONCLUSIONS. Gene expression profile of four overexpressed genes on TBA were found with potential utility to discriminate on NIDDM, LTB persons from those with activated pulmonary TB. Acknowledgements This study was supported by the Mexican Council for Science and Technology (grant CONACYT-SALUD-2011-1-161677) Keywords: Tuberculosis, diabetes, biomarkers, Inflammation, Blood Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Host-pathogen interactions Citation: Serrano-Escobedo CJ, Gonzalez-Curiel RA, Enciso-Moreno L, Macias-Segura N and Enciso-Moreno JA (2013). Blood pulmonary tuberculosis biomarkers on diabetic individuals. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00056 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 08 Mar 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Jose A Enciso-Moreno, INSTITUTO MEXICANO DEL SEGURO SOCIAL, UNIDAD DE INVESTIGACION MEDICA ZACATECAS, ZACATECAS, ZACATECAS, 98000, Mexico, enciso_2000@yahoo.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Carmen J Serrano-Escobedo Rosa A Gonzalez-Curiel Leonor Enciso-Moreno Noe Macias-Segura Jose A Enciso-Moreno Google Carmen J Serrano-Escobedo Rosa A Gonzalez-Curiel Leonor Enciso-Moreno Noe Macias-Segura Jose A Enciso-Moreno Google Scholar Carmen J Serrano-Escobedo Rosa A Gonzalez-Curiel Leonor Enciso-Moreno Noe Macias-Segura Jose A Enciso-Moreno PubMed Carmen J Serrano-Escobedo Rosa A Gonzalez-Curiel Leonor Enciso-Moreno Noe Macias-Segura Jose A Enciso-Moreno Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

TNF-alpha, IL-4 and IL-10 cytokines induces changes in HO-1 and HDC expression in cervical cancer cells

Event Abstract Back to Event TNF-alpha, IL-4 and IL-10 cytokines induces changes in HO-1 and HDC expression in cervical cancer cells Paulina Gomez-Lomeli1, Pablo C. Ortiz-Lazareno1*, Alejandro Bravo-Cuellar1, Georgina Hernandez-Flores1, Jorge R. Dominguez-Rodriguez1, Luis F. Jave-Suarez1 and Adriana Aguilar-Lemarroy1 1 Instituto Mexicano del Seguro Social, Mexico Background Chronic infection with human papilloma virus (HPV) has been associated as an important factor in generating cancer. E6 and E7 viral proteins are involved in cell transformation. Likewise tumor cells generate escape mechanisms as the expression of molecules that regulate the immune response. HDC and HO-1 exert anti-apoptotic functions. These enzymes may represent another mechanism of resistance in cervical cancer cells. Objectives. We analyzed the gene and protein expression of heme oxygenase (HO-1) and histidine decarboxylase (HDC) enzymes in HPV+ HeLa and SiHa cervical cancer cell lines and HPV- C33A cancer cells treated with TNF-α, I-4 and IL-10 cytokines. Methods HeLa, SiHa and C33A cervical cancer cells were treated with pro and anti-inflammatory cytokines; mRNA was extracted and analyzed expression of HO1 and HDC by real-time PCR. Protein expression was assessed by flow cytometry. Results Cytokines treatment induces a downregulation in HDC gene expression in HPV+ cancer cells in comparison with untreated tumor cells. In HeLa and SiHa cells this gene is downregulated whereas in C33A cancer cells we observed upregulation of HDC gene. In general HDC and HO-1 protein expression was reduced in cancer cells treated with pro and anti-inflammatory cytokines. Conclusions HDC and HO-1 protein expression is modified when the cells were treated with cytokines. In HeLa, SiHa and C33 cancer cells the expression of these enzymes is similar, however at the gene level the behavior is different between cancer cell lines, and this could be due to the presence of HPV infection in some cancer cells. References Moody, C. A. and L. A. Laimins (2010). "Human papillomavirus oncoproteins: pathways to transformation." Nat Rev Cancer 10(8): 550-560. Kareva, I. and P. Hahnfeldt (2013). "The Emerging "Hallmarks" of Metabolic Reprogramming and Immune Evasion: Distinct or Linked?" Cancer Res Gozzelino, R., et al. (2010). "Mechanisms of Cell Protection by Heme Oxygenase-1." Annual Review of Pharmacology and Toxicology 50(1): 323-354. Ichikawa, A., et al. (2010). "Molecular biology of histidine decarboxylase and prostaglandin receptors." Proceedings of the Japan Academy, Series B 86(8): 848-866. Keywords: Heme-oxynenase 1, Histidine Decarboxylase, Cervical cancer cells, tNF-alpha, Anti-inflammatory cytokines Conference: 15th International Congress of Immunology (ICI), Milan, Italy, 22 Aug - 27 Aug, 2013. Presentation Type: Abstract Topic: Adaptive Immunity Citation: Gomez-Lomeli P, Ortiz-Lazareno PC, Bravo-Cuellar A, Hernandez-Flores G, Dominguez-Rodriguez JR, Jave-Suarez LF and Aguilar-Lemarroy A (2013). TNF-alpha, IL-4 and IL-10 cytokines induces changes in HO-1 and HDC expression in cervical cancer cells. Front. Immunol. Conference Abstract: 15th International Congress of Immunology (ICI). doi: 10.3389/conf.fimmu.2013.02.00634 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 11 Jun 2013; Published Online: 22 Aug 2013. * Correspondence: Dr. Pablo C Ortiz-Lazareno, Instituto Mexicano del Seguro Social, Guadalajara, Mexico, pablolazareno@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Paulina Gomez-Lomeli Pablo C Ortiz-Lazareno Alejandro Bravo-Cuellar Georgina Hernandez-Flores Jorge R Dominguez-Rodriguez Luis F Jave-Suarez Adriana Aguilar-Lemarroy Google Paulina Gomez-Lomeli Pablo C Ortiz-Lazareno Alejandro Bravo-Cuellar Georgina Hernandez-Flores Jorge R Dominguez-Rodriguez Luis F Jave-Suarez Adriana Aguilar-Lemarroy Google Scholar Paulina Gomez-Lomeli Pablo C Ortiz-Lazareno Alejandro Bravo-Cuellar Georgina Hernandez-Flores Jorge R Dominguez-Rodriguez Luis F Jave-Suarez Adriana Aguilar-Lemarroy PubMed Paulina Gomez-Lomeli Pablo C Ortiz-Lazareno Alejandro Bravo-Cuellar Georgina Hernandez-Flores Jorge R Dominguez-Rodriguez Luis F Jave-Suarez Adriana Aguilar-Lemarroy Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

A novel HPV-16 L1 based chimeric virus-like particle containing HPV 16 E6 and E7 epitopes elicits a persistent specific antibody immune response and tumor regression.

Event Abstract Back to Event A novel HPV-16 L1 based chimeric virus-like particle containing HPV 16 E6 and E7 epitopes elicits a persistent specific antibody immune response and tumor regression. ALBERTO MONROY-GARCIA1, 2*, MIGUEL A GOMEZ-LIM3, JORGE HERNÁNDEZ-MONTES2, BENNY WEISS-STEIDER2, ROSARIO GARCIA-ROCHA1 and MARÍA DE LOURDES MORA-GARCÍA2 1 INSTITUTO MEXICANO DEL SEGURO SOCIAL, UIMEO, Mexico 2 FES-ZARAGOZA UNAM, UMIEZ-UIDCC, Mexico 3 CINVESTAV, Mexico HPV L1-based virus like particles vaccines (VLPs) are efficient to induce temporary prophylactic activity through the induction of neutralizing antibodies (1). However VLPs that can provide prophylactic as well as therapeutic properties for a long time are necessary. We generated a novel HPV 16 L1-based chimeric virus like particle (cVLP) that was produced in plants and that contains a string of T-cell epitopes from HPV 16 E6 and E7 fused to its C-terminus (2-4). In the present study we analyzed the persistence of specific IgG antibodies with neutralizing activity induced by the immunization with cVLPs, as well as their therapeutic potential in a tumor model of C57BL/6 mice strain. Interestingly, we obtained that these cVLPs induced persistent IgG antibodies for over 12 months, with cross-reactivity and cross-neutralizing activity for VLPs composed of HPV-16 L1 protein. Efficient prevention and rejection of tumors induced by TC-1 tumor cells expressing HPV-16 E6/E7 oncoproteins was observed in mice immunized with these cVLPs. In addition, in mice bearing tumors, important tumor regression (57%) was observed after immunization with cVLPs. The chimeric particles of the type described in this work may potentially be the basis for developing HPV prophylactic and therapeutic vaccines with high efficacy. Acknowledgements Support: CONACYT (82827 and 8373); FIS-IMSS/PROT (60 and 617 and 876) grants.