Mexican Adult Patients Research Articles

Comparative Effects of Gymnema sylvestre and Berberine on Adipokines, Body Composition, and Metabolic Parameters in Obese Patients: A Randomized Study.

We performed a comparative study in 50 adult Mexican patients with obesity treated with GS or BBR for 3 months. The baseline and final biochemical parameters, body composition, blood pressure, gene expression of Res, Ome, Vis, and Ap, and safety parameters were evaluated. BBR significantly decreased (p < 0.05) body weight, blood pressure and Vis and Ap gene expression and increased Ome, while GS decreased fasting glucose and Res gene expression (p < 0.05). A comparative analysis of the final measurements revealed a lower gene expression of Ap and Vis (p < 0.05) in patients treated with BBR than in those treated with GS. The most frequent adverse effects in both groups were gastrointestinal symptoms, which attenuated during the first month of treatment. In patients with obesity, BBR has a better effect on body composition, blood pressure, and the gene expression of adipokines related to metabolic risk, while GS has a better effect on fasting glucose and adipokines related to insulin resistance, with minimal side effects.

Development of dyslipidemias in a cohort of Mexican adult patients with HIV/AIDS under highly active antiretroviral therapy

Dyslipidemias are comorbidities in seropositive patients under highly active antiretroviral therapy (HAART), which increase their risk of complications and reduce their life expectancy. Objective: evaluate the frequency and development of dyslipidemias in seropositive patients with highly active antiretroviral therapy (HAART). Material and method: retrospective cohort study, in recently diagnosed HIV+ patients: 366 men and 59 women. Serum concentrations of total cholesterol (TC), triglycerides (TGC), HDL cholesterol (HDL-c) and LDL cholesterol (LDL-c) were evaluated before starting and at month 6, 24, 36 and 48 with HAART. Results: in both sexes at the beginning of the HAART, 67.1% of low HDL-C levels were obtained. Dyslipidaemia due to TGC and TC increased significantly in all participants after 48 months of HAART (36.9% vs. 52.7% and 7.1% vs. 22.4%, respectively, p&lt;0.05). however, the HDL-C decreased in patients with nucleoside and non-nucleoside reverse transcriptase inhibitor drugs. Discussion: HIV+ patients with HAART have a higher risk of developing dyslipidaemia, an increase in concentrations occurred after 6 months of treatment, a trend that continued positive until 48 months with HAART. Conclusions: dyslipidemias due to TG and TC, as well as low HDL-C are the most frequent in HIV+ patients, which change depending on the time and the type of drug indicated in the HAART.

Low quality of life, increased number of anti-seizure drugs, and the lack of caregiver support are associated with internalized stigma in adult Mexican patients with epilepsy

BackgroundPeople with epilepsy (PWE) have been subject to stigma throughout history, a factor that could compromise their performance in daily life. In Mexico, little is known about the factors that may be affecting internalized stigma. ObjectiveTo evaluate the internalized stigma in adult PWE, its relationship with the quality of life, cognitive and depressive symptomatology, and clinical-demographic characteristics. Material and methodsWe conducted a cross-sectional study with a consecutive sampling approach in patients with epilepsy treated at the National Institute of Neurology and Neurosurgery Manuel Velasco Suárez (NINNMVS). Sociodemographic and clinical data, depressive symptomatology (Beck's depression inventory, DBI), cognition (MoCA test), quality of life (QOLIE-31 scale), and internalized stigma (King's internalized stigma scale, ISS) were evaluated. Correlations were made between the continuous variables and the ISS to select those with statistical significance and include them in a multiple linear regression model, along with the dummy variables, to explain internalized stigma. ResultsOf 128 patients, 74 (58%) were women; 38% of the patients had more than 20 years of epilepsy evolution. In addition, 39% presented depressive symptoms, and around 60% manifested a possible cognitive impairment. The variables that showed statistical significance concerning the ISS were selected along with dummy variables for multiple linear regression analysis. The resultant model considers the QOLIE-31 total score (β = −0.489), the number of anti-seizure drugs (ASD, β = 0.253), and those patients without caregiver support (β = −0.166) with an adjusted R2 value of 0.316. ConclusionsA diminishing quality of life, an increased number of ASD, and patients without caregiver support influence a slight to moderate variation of internalized stigma in Mexican PWE. Therefore, it is necessary to continue studying other possible factors that influence internalized stigma to generate effective strategies to reduce its negative effects on PWE.

Management of hypertension and dyslipidemia in Mexico: Evidence, gaps, and approach.

Hypertension and dyslipidemia are key risk factors for cardiovascular disorders and mortality worldwide. To understand the local health system challenges faced in the management of the two conditions, a semi-systematic approach was adopted for quantifying stages of the journey of care of adult Mexican patients, namely, awareness, screening, diagnosis, treatment, adherence, and control. A structured literature search was conducted for articles published in English from 2010 to 2019 in EMBASE and MEDLINE databases. The articles restricted to patient subgroups, or not having national representativeness, thesis abstracts, letters to the editor, editorials, or case studies were excluded. In addition, an unstructured unrestricted literature search was conducted, on websites of Incidence and Prevalence Database, World Health Organization, Country's Ministry of Health, and Google. Last search was run on 28 August 2020 for Hypertension and 12 November 2019 for Dyslipidemia. Weighted or simple means were calculated for the pooled data. Seven articles of 647 retrievals for hypertension and 11 articles of 1265 retrievals for dyslipidemia were included in the review. The prevalence of hypertension was estimated to be 24.1%, while 59.9% of patients had awareness, 97.5% underwent screening, 18.4% had diagnosis, 50% received treatment, 50% were adherent to treatment, and 49.9% had disease control. Prevalence of dyslipidemia was estimated as 36.7%, while 8.6% of patients had awareness, 48.1% underwent screening, 28% had diagnosis, 68.9% received treatment, 50% were adherent to treatment, and 30% had disease control. The study suggested that addressing the synergistic effect of hypertension and dyslipidemia could reduce cardiovascular risk associated with these conditions.

Over-Expression of CRLF2 By Flow Cytometry (FC) Impacts on Overall Survival (OS) in Mexican Patients with Acute Lymphoblastic Leukemia (ALL)

▪Introduction:“Philadelphia like” ALL has been related to poor prognosis. CRLF2 over-expression (cytokine receptor like factor-2) has been found in up to 50% of patients with Philadelphia-like ALL and its expression can be measured by Flow Cytometry (FC). CRLF2 over-expression is more common in Hispanic population (45-68%) however, there is no current recommendation in using it as a prognostic marker.Objectives:Find the prevalence of CRLF2 overexpression measured by FC, in adult Mexican patients with treatment-naïve ALLDescribe the outcomes of the patients who over-expressed CRLF2 by Complete Response (CR), Minimal Residual Disease (MRD), Leukemia-Free Survivale (LFS) and Overall Survival (OS).Methodology:This is a retrospective cohort study in adults with newly diagnosed ALL from two reference centers in Mexico City. We measured CRLF2 expression by FC in fresh bone marrow samples from treatment-naïve patients at one location; to define over-expression, samples were first analyzed by two different experts who grouped the cases in over-expression or no overexpression using Mean Fluorescence Intensity (MFI) between two populations, blasts and controls (normal B cells). Outcomes were compared using chi-square test for binary variables and log-rank test for time-to-event variables with a p value <0.05 as significant.Results:From April 2018 to January 2020 46 patients with treatment-naïve B-cell ALL were evaluable; the median age was 29.5 years, 38 (82.6%) were Adolescents and Young Adults (AYA), 22 (47.8%) had leukocytosis, 15 (53.5%) of the evaluable karyotypes, were assigned to high-risk group. The median time of follow-up was 24.5 months and 19 (41.3%) patients were positive for CRLF2-overexpression. For the follow-up cohort all of the patients were evaluable for outcomes. CNS disease was detectable in 11(24.5%) patients which was higher in CRLF2-overexpresed patients (15.5% vs 8.9%, p=0.015). We found no difference in Complete Remission (CR) in CRLF2 status but a high tendency for R/R (Relapse/Refractory) disease (83.3% in CRLF2-overexpression vs 60% in CRLF2 negative group; p=0.09) and dead (63.2% in CRLF2-overexpression vs 37% in CRLF2 negative group; p=0.07). MRD1, 2 and 3 (1=after induction, 2= week 16 and 3= before maintenance) was significantly worse in patients with CRLF2 overexpression (1=15.8% vs 58.3%, p<0.01; 2=7.1% vs 52.6%, p<0.01; 3=0% vs 55.6%, p<0.05).Overall Survival was significantly worse in patients with CRLF2 overexpression (Median Not Reached vs 11.05 months; p=0.04) (Figure 1); Disease-Free Survival (DFS) had a tendency towards worse outcome in patients with CRLF2 overexpression (18.48 vs 5.82 months, p=0.07) (Figure 2).Conclusion:Survival in patients who have CRLF2 overexpression is significantly worse when measured by FC, this might be related to early high-risk markers as MRD. CRLF2 overexpression in this hispanic sample was higher (41%) than other reports. CRLF2 measured as a prognostic factor by FC needs to be further considered due to the high availability of this technique across Latin-America. [Display omitted] DisclosuresRangel-Patiño: Abbvie: Speakers Bureau; Bristol: Consultancy. Espinosa: Pfizer: Consultancy; Amgen: Speakers Bureau; Janssen: Consultancy. Demichelis: Novartis: Consultancy, Research Funding, Speakers Bureau; Gilead: Consultancy; Bristol/Celgene: Consultancy, Speakers Bureau; Jazz: Consultancy; ASH: Research Funding; Astellas: Consultancy; AMGEN: Consultancy, Speakers Bureau; Abbvie: Consultancy, Speakers Bureau.

Clinical Characteristics and Predictors of Short-Term Outcome in Mexican Adult Patients with Guillain-Barré Syndrome.

Information regarding the clinical presentation and outcome of Guillain-Barré Syndrome (GBS) in adults from Latin America is limited. To identify clinical characteristics and short-term outcome predictors in adult Mexican patients with GBS. We included adult patients with clinical and electrophysiological data with confirmed GBS, admitted to a tertiary hospital in Western Mexico, from January 2002 to February 2011. A good outcome at hospital discharge was considered if patients had a Hughes score of 0-2 and at 3 and 6 months, a Hughes score of 0-1. A total of 115 patients were analyzed (68% men, mean age 44 years old, range 18-84). Previous infection occurred in 63% of cases. Descendent pattern of weakness was observed in 40 (35%) patients. GBS subtypes were: acute motor axonal neuropathy in 31%, acute inflammatory demyelinating polyneuropathy in 29%, sensory axonal neuropathy (AMSAN) in 18%, and equivocal in 22%. A total of 73 (63%) patients received induction therapy: 50 (68%) received plasmapheresis and 13 (18%) received intravenous immunoglobulin (IVIG). In-hospital mortality occurred in 14 (12%) patients. Early gait complaints and emergency room admission with mild Hughes score (0-2) were predictors for a good outcome at hospital discharge (P < 0.05); meanwhile, age >75 years; dysarthria and higher Hughes score were associated with a poor outcome(P < 0.05). Axonal pattern, motor involvement, and the descendent pattern of presentation were the main clinical GBS findings in our cohort. Higher Hughes scale scores at hospital admission were a strong predictor for a bad outcome at hospital discharge and short-term follow-up, independently of treatment type or in-hospital management. GBS in Mexico still carries considerable mortality.

The Neutrophil-to-Monocyte Ratio and Lymphocyte-to-Neutrophil Ratio at Admission Predict In-Hospital Mortality in Mexican Patients with Severe SARS-CoV-2 Infection (Covid-19).

There is a deep need for mortality predictors that allow clinicians to quickly triage patients with severe coronavirus disease 2019 (Covid-19) into intensive care units at the time of hospital admission. Thus, we examined the efficacy of the lymphocyte-to-neutrophil ratio (LNR) and neutrophil-to-monocyte ratio (NMR) as predictors of in-hospital death at admission in patients with severe Covid-19. A total of 54 Mexican adult patients with Covid-19 that met hospitalization criteria were retrospectively enrolled, followed-up daily until hospital discharge or death, and then assigned to survival or non-survival groups. Clinical, demographic, and laboratory parameters were recorded at admission. A total of 20 patients with severe Covid-19 died, and 75% of them were men older than 62.90 ± 14.18 years on average. Type 2 diabetes, hypertension, and coronary heart disease were more prevalent in non-survivors. As compared to survivors, LNR was significantly fourfold decreased while NMR was twofold increased. LNR ≤ 0.088 predicted in-hospital mortality with a sensitivity of 85.00% and a specificity of 74.19%. NMR ≥ 17.75 was a better independent risk factor for mortality with a sensitivity of 89.47% and a specificity of 80.00%. This study demonstrates for the first time that NMR and LNR are accurate predictors of in-hospital mortality at admission in patients with severe Covid-19.

Electrophysiological subtypes and associated prognosis factors of Mexican adults diagnosed with Guillain-Barré syndrome, a single center experience

BackgroundThe clinical characteristics of electrophysiological subtypes and prognostic factors of Mexican adults diagnosed with Guillain-Barré Syndrome (GBS) have not been described. Materials and methodsA single center, ambispective, cohort study was performed (2015–2019). GBS was defined following the Asbury and Cornblath criteria. Electrodiagnosis was made according to Hadden criteria. Clinical, biochemical and electrodiagnostic parameters were described, compared and analyzed using a multivariate model. Only patients who completed a 3-month follow-up were included. Results137 GBS patients (92 males; mean age 46.6 ± 16.6).132 (96.3%) underwent an electrodiagnostic assessment.68 (51.5%) were classified as axonal GBS, with further classified into two groups: acute motor axonal neuropathy (AMAN) 45.4%, and acute motor and sensory axonal neuropathy (AMSAN) 8,6%. The following characteristics were lower in the AMAN group: Medical Research Counsel sumscore (MRC) 30.1 ± 16.3 vs 36.4 ± 14.4, unilateral facial palsy 10% vs 25.9% and albuminocytologic dissociation 41.3% vs. 71.7%.Multivariate analysis found AMAN as an independent predictor of an unfavorable outcome OR: 3.34 (p = 0.03) ConclusionsAMAN subtype is the most frequent presentation of GBS in Mexican adult patients and an independent predictor of inability to walk independently at 3 months after discharge.

Landscape of Germline Genetic Variants in AGT, MGMT, and TP53 in Mexican Adult Patients with Astrocytoma.

Astrocytoma is the most common type of primary brain tumor. The risk factors for astrocytoma are poorly understood; however, germline genetic variants account for 25% of the risk of developing gliomas. In this study, we assessed the risk of astrocytoma associated with variants in AGT, known by its role in angiogenesis, TP53, a well-known tumor suppressor and the DNA repair gene MGMT in a Mexican population. A case-control study was performed in 49 adult Mexican patients with grade II-IV astrocytoma. Sequencing of exons and untranslated regions of AGT, MGMT, and TP53 from was carried in an Ion Torrent platform. Individuals with Mexican Ancestry from the 1000 Genomes Project were used as controls. Variants found in our cohort were then assessed in a The Cancer Genome Atlas astrocytoma pan-ethnic validation cohort. Variants rs1926723 located in AGT (OR 2.74, 1.40-5.36 95% CI), rs7896488 in MGMT (OR 3.43, 1.17-10.10 95% CI), and rs4968187 in TP53 (OR 2.48, 1.26-4.88 95% CI) were significantly associated with the risk of astrocytoma after multiple-testing correction. This is the first study where the AGT rs1926723 variant, TP53 rs4968187, and MGMT rs7896488 were found to be associated with the risk of developing an astrocytoma.

Dosing Recommendations Based on Population Pharmacokinetics of Lamotrigine in Mexican Adult Patients With Epilepsy

Dose individualization is essential in epilepsy treatment, especially in antiepileptic drugs that present high interindividual variability such as lamotrigine. We aimed an observational study to develop a population pharmacokinetic model for quantitative evaluation of the factors that influence lamotrigine pharmacokinetics in Mexican adults with epilepsy. Patients on stable treatment with lamotrigine therapy were included, plasma concentrations were analyzed by a high-performance liquid chromatography method and UGT2B7–161C > T polymorphism was determined. The data were analyzed by NONMEM® 7.3, model validation was performed using bootstrap approach and visual predictive check. Finally, stochastic simulations were carried out to propose dosage regimens. A total of 73 lamotrigine plasma concentrations from 2 h after last dose and up to 0.5 h prior to next administration were fitted to a one-compartment open model. The final population pharmacokinetic model for lamotrigine indicates that concomitant treatment with valproic acid and carbamazepine should be considered to individualize epilepsy treatment with this drug. Based on this model, we proposed dosage regimens to achieve trough lamotrigine concentrations within reference interval (2.5–15 mg/L). These results provide clinical useful data to give more rational anticonvulsant therapy in our population.

Changing the game: New data on axonal Guillain-Barré syndrome in Mexican adult patients (1048)

Changing the game: New data on axonal Guillain-Barré syndrome in Mexican adult patients (1048)

Hyperglycemia: the metabolic syndrome component that aggravates erectile dysfunction in Mexican patients

&#x0D; Objectives: To analyze the relationship between erectile dysfunction and metabolic syndrome in a group of Mexican patients, study the influence of other morbidity factors on erectile dysfunction, and define the specific metabolic syndrome components most associated with erectile dysfunction severity.&#x0D; Materials and methods: A descriptive, cross-sectional study was conducted on a group of 86 adult Mexican patients previously diagnosed with erectile dysfunction. Participants were classified as presenting with or not presenting with metabolic syndrome. Anthropometric, biochemical, and clinical parameters were determined and erectile dysfunction severity, alcohol or tobacco consumption, and depressive behavior were identified through validated questionnaires. The results were compared between the two groups.&#x0D; Results: The anthropometric measures, laboratory values, and clinical characteristics were significantly different between the two groups. More patients with severe and moderate erectile dysfunction were identified in the group with metabolic syndrome. Of the metabolic syndrome components, glycated hemoglobin &gt;5.7% and fasting glucose &gt;110 mg/dl were significantly associated with the development of erectile dysfunction.&#x0D; Limitations: The size of our study sample was a limitation, as was the observational and cross-sectional study design.&#x0D; Originality: Our study results suggest that metabolic syndrome contributed to the progression of erectile dysfunction in the Mexican sample analyzed, with hyperglycemia being the most strongly associated factor.&#x0D; Conclusions: Metabolic syndrome components were shown to aggravate erectile dysfunction, particularly the lack of glycemic control. The inclusion of fasting glucose and glycated hemoglobin as complementary biochemical screening in patients with erectile dysfunction should be assessed.

Hyperglycemia: the metabolic syndrome component that aggravates erectile dysfunction in Mexican patients

&#x0D; Objectives: To analyze the relationship between erectile dysfunction and metabolic syndrome in a group of Mexican patients, study the influence of other morbidity factors on erectile dysfunction, and define the specific metabolic syndrome components most associated with erectile dysfunction severity.&#x0D; Materials and methods: A descriptive, cross-sectional study was conducted on a group of 86 adult Mexican patients previously diagnosed with erectile dysfunction. Participants were classified as presenting with or not presenting with metabolic syndrome. Anthropometric, biochemical, and clinical parameters were determined and erectile dysfunction severity, alcohol or tobacco consumption, and depressive behavior were identified through validated questionnaires. The results were compared between the two groups.&#x0D; Results: The anthropometric measures, laboratory values, and clinical characteristics were significantly different between the two groups. More patients with severe and moderate erectile dysfunction were identified in the group with metabolic syndrome. Of the metabolic syndrome components, glycated hemoglobin &gt;5.7% and fasting glucose &gt;110 mg/dl were significantly associated with the development of erectile dysfunction.&#x0D; Limitations: The size of our study sample was a limitation, as was the observational and cross-sectional study design.&#x0D; Originality: Our study results suggest that metabolic syndrome contributed to the progression of erectile dysfunction in the Mexican sample analyzed, with hyperglycemia being the most strongly associated factor.&#x0D; Conclusions: Metabolic syndrome components were shown to aggravate erectile dysfunction, particularly the lack of glycemic control. The inclusion of fasting glucose and glycated hemoglobin as complementary biochemical screening in patients with erectile dysfunction should be assessed.

Clinical, Imaging, and Laboratory Characteristics of Adult Mexican Patients with Tuberculous Meningitis: A Retrospective Cohort Study

Tuberculous Meningitis (TBM) is the most common form of central nervous system Tuberculosis (TB), accounting for 5–6% of extrapulmonary TB cases. Nowadays, TBM continues to be a major topic in public health because of its high prevalence worldwide. This retrospective study aimed to describe the clinical, laboratory, and imaging characteristics at admission; and in-hospital outcome of adult Mexican patients with TBM. We collected data from medical records of patients aged ≥18 years diagnosed with TBM according to the uniform case definition for clinical research who were treated at Tijuana General Hospital between January 2015 and March 2018 and compared them according to the subtype of diagnosis. We included 41 cases (26 males, median age 28 years, range 18–57 years), 13 (31.7%) patients were HIV positive, and 21 (51.2%) were illicit drug users. At admission, 7 (17.1%) patients were in stage I, 22 (53.6%) in stage II, and 12 (29.3%) in stage III. A definitive diagnosis was established in 23 (56.1%) patients, probable in 14 (34.1%), and possible in four (9.8%). Molecular testing was positive in 83% of the cases, yielding significantly higher positive results than other microbiological studies. There were eight (19.5%) deaths, without statistical difference between mortality and not having a definitive diagnosis (p = 0.109). We found that the baseline characteristics of our population were similar to those described by other authors worldwide. In this series, molecular testing showed to be very useful when used in the early stages, particularly in subjects with subacute onset of headache, fever, weight loss, and altered mental status.

PB1739 SURVIVAL ANALYSIS OF ADULT PATIENTS WITH ACUTE MYELOID LEUKEMIA (AML) TREATED WITH INTENSIVE CHEMOTHERAPY: RESULTS OF A MEXICAN NATIONAL AML REGISTRY.

Background:In the last decades, the outcome of patients with AML treated with intensive chemotherapy have improved, reaching long‐term overall survival (OS) &gt;40%. This has been due to better supportive care and risk stratification with cytogenetic/molecular tests, increasingly access to transplant (HSCT) programs and more recently, new drugs. This improvement has not been equivalent in developing countries were the OS is lower. There are no multicentric studies with survival analysis in Mexico.Aims:To analyze the outcome of Mexican adult patients with AML treated with intensive chemotherapy.Methods:Multicentric and retrospective study, including patients with AML diagnosed between January 2013 and December 2017 in 13 centers in Mexico.Results:The information of 525 patients with AML with a median age of 47 years was recorded. Cytogenetics were available in 363/525 patients (69.1%). The patients were classified according to cytogenetic risk: favorable 16.0%, intermediate 55.6% and unfavorable 28.4%. FLT3 mutations were analyzed in 64 cases and positive in 22% and NPM1 mutations in 43 cases and positive in 12%. Other mutations were analyzed less frequently. The majority of the patients (80.2%) were treated with intensive chemotherapy. When comparing them with those receiving non‐intensive regimens, they were younger (43 vs. 70 years, p &lt; 0.001), with less comorbidity (HCT‐CI≥ 3 11.2% vs. 32.7%, p &lt; 0.001) and fewer secondary AML (10.5% vs. 26.9%, p &lt; 0.001). The most common induction regimen was 7+3 in 74.1%. The complete remission (CR) rate was 71.3%. Induction related mortality occurred in 17.8% and we identify as independent risk factors: &gt;60 years (OR=2.088), ECOG&gt;2 (OR=4.820), prior solid tumor (OR=3.795) and active infection (OR=1.817). Some patients (28.9%) received maintenance therapy after consolidation: methotrexate and 6‐mercaptopurine (66.3%), cytarabine‐based (27.7%) or hypometilating agents (6%). Allogeneic HSCT was performed in 33 patients (8.2%) in first CR.The 3‐year overall survival (OS) was 34.8% (median OS of 13.9 months). Cytogenetic risk was significantly associated with survival, with median OS of 45.2, 20.5 and 12 months for favorable, intermediate and unfavorable cytogenetics (p = 0.001). Survival increased in patients with less comorbidities (16.6 vs. 8 months, p = 0.001) and in those who received allogenic HSCT in first remission (median NR vs. 10.6 months, p &lt; 0.01). Interestingly, during remission, any maintenance therapy had a positive trend in survival compared to those with no maintenance: median NR vs. 27.1 months, p = 0.011; nevertheless, this advantage was only significant for patients receiving cytarabine‐based maintenance (p = 0.021) and for intermediate cytogenetic risk (p = 0.017). In a multivariate analysis, prognostic factors related to worse OS were secondary AML (HR=2.029) and high cytogenetic risk (HR=1.874), whereas maintenance therapy (HR=0.547) and allogeneic HSCT (HR=0.034) were associated with better OS.Summary/Conclusion:This is the first large multicentric report that analyses the outcome of adult AML patients in Mexico. The impact of cytogenetic risk on survival was like previous reports. The use of a cytarabine‐based maintenance is associated with better survival only in intermediate‐risk patients. We identified some short‐term challenges: to standardize supportive care in order to reduce induction‐related mortality and to expand access to cytogenetic/molecular testing and HSCT programs. This will be addressed in a prospective multicentric trial.image

The role of free immunoglobulin light chains in serum from SLE patients with or without renal involvement

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease. Lupus nephritis (LN) affects 30% to 60% of adult Mexican patients. This study aimed to determine whether immunoglobulin free light chains (FLCs) constitute a biological marker for LN. FLCs have been previously studied as disease activity biomarkers, but patients with kidney damage are frequently excluded. A total of 75 consecutive SLE patients were recruited from a third-level hospital in Mexico City. Thirty-eight patients were diagnosed with LN, and the remaining 37 patients without kidney failure were included as a control group. FLCs concentration was measured by nephelometry. The results showed that SLE patients with high FLCs concentration had a higher rate of kidney failure and that the probability of renal failure increased by 2.4% for each mg/dL of κ FLCs, and 1.7% for each mg/dL of λ FLCs. This study suggests that high FLCs concentration is associated with LN, and therefore may be considered as a possible biomarker for SLE activity.

Dosing recommendations based on population pharmacokinetics of tacrolimus in Mexican adult patients with kidney transplant.

The aim of this study was to perform a population pharmacokinetic analysis of tacrolimus in Mexican adult kidney transplant patients to analyse the influence of clinical and genetic covariates to propose a dosage regimen. Kidney transplant patients (>18 years old) receiving oral tacrolimus treatment were included in the current study. The population pharmacokinetic model was built using a one-compartment model and the First Order Conditional Estimation method with Interaction (FOCEI via NONMEM v.7.3.). A total of 600 tacrolimus trough blood concentrations from 52 kidney transplant patients were analysed. Tacrolimus clearances were 26, 18.8 and 12.3 L/h, for patients with genetic polymorphisms CYP3A5*1*1, *1*3 and *3*3, respectively. The influence of haematocrit was inversely related to tacrolimus clearance, following an allometric power function. Total volume of distribution was 604 L. Interindividual variability associated with tacrolimus clearance and distribution volume for the final model was 33 and 63%, respectively, with a residual error of 2.5 ng/mL. Relative bioavailability was calculated between generic formulations A (0.53) and B (1) of tacrolimus. Internal validation was performed through bootstrap analysis to evaluate the stability of the final model; external validation was performed in a new group of patients (n = 13) to estimate residual errors on basic (57.8%) and final (34.8%) models. Finally, stochastic simulations were performed to propose a dosage regimen based on haematocrit, CYP3A5 genotype and generic formulation of tacrolimus. A stable and predictive population pharmacokinetic model of tacrolimus was developed for Mexican adult kidney transplant patients; additionally, the proposed dosage regimen of tacrolimus should be prospectively validated.

Indices of anti-dengue immunoglobulin G subclasses in adult Mexican patients with febrile and hemorrhagic dengue in the acute phase.

Heterologous secondary infections are at increased risk of developing dengue hemorrhagic fever (DHF) because of antibody-dependent enhancement (ADE). IgG subclasses can fix and activate complement and bind to Fcɣ receptors. These factors may also play an important role in the development of ADE and thus in the pathogenesis of DHF. The aim of this study was to analyze the indices of anti-dengue IgG subclasses in adult patients with febrile and hemorrhagic dengue in the acute phase. In 2013, 129 patients with dengue fever (DF) and 57 with DHF in Veracruz, Mexico were recruited for this study and anti-dengue IgM and IgG determined by capture ELISA. Anti-dengue IgG subclasses were detected by indirect ELISA. Anti-dengue IgG2 and IgG3 subclasses were detected in patients with dengue. IgG1 increased significantly in the sera of patients with both primary and secondary infections and DHF, but was higher in patients with secondary infections. The IgG4 subclass index was significantly higher in the sera of patients with DHF than in that of those with DF, who were in the early and late acute phase of both primary and secondary infection. In conclusion, indices of subclasses IgG1 and IgG4 were higher in patients with DHF.

Search of the p.M918T Mutation in the RET Oncogene in Mexican Adult Patients with Medullary Thyroid Carcinoma.

Inherited mutations in the RET proto-oncogene, which encodes a receptor tyrosine kinase, predispose individuals to the multiple endocrine neoplasia type 2 (MEN 2) cancer syndromes. The major component tumor of these syndromes is medullary thyroid carcinoma (MTC). To date, somatic mutations in RET have been identified in tumors from individuals with MEN 2 finding. RET M918T mutation is present in 95% of the MEN2B cases, and approximately 50% of sporadic MTCs harbor this mutation. We performed a mutational analysis in 17 cases of Medullary thyroid carcinoma, the somatic missense mutation at codon 918 of RET was found in 2 of the 17 MTCs, and one case presented MEN2 phenotype including MTC. The percentage of RET M918T mutation is similar in Mexican MTC patients to other series, although other mutations could be implicated in our population.

Automated Telephone Calls in the Follow-Up of Self-Care in Outpatients with Type 2 Diabetes: A Feasibility Study

Aims and objectives: To test an automated telephone service as a follow-up and support strategy for self-care in a population of adult Mexican patients with type 2 diabetes. Methods: The design was a two-group comparative design, with pre and post-intervention measurements. Patients were assigned into intervention (n = 31), or comparison (n = 33) groups. Over 12 weeks, each participant in the intervention group received automated phone calls with instructions to facilitate accomplishment of the treatment, and self-care activities. Two focus groups helped to appreciate patients’ follow-up experience. Randomized grouping was performed by selecting numbers from an urn; the final sample comprised 31 (48%) patients in the intervention group, and 33 (52%) in the comparison group; these procedures were performed by the case nurse management. The study was approved by the Ethics Committee of the Autonomous University of Nuevo Leon and the University of Michigan; all of the participants signed informed consent. Results: Of the 372 programmed phone calls made to the participants, 234 were completed, representing a 62.9% response rate. Phone calls may be associated to a 0.82% decrease in the HbA1c values and to lower depression scores. HbA1c measurements decreased 0.82% (M = 7.41 - 6.69; t = 25; 4.11; p = ?0.001) from the baseline values over the 12-week study in the intervention group and 0.49% (M = 7.24 - 6.75; t = 26; 2.11; p = 0.044) in the comparison group. Variables related to medication intake did not exhibit differences between the baseline and second measurements, except with respect to the scale of depression.