Mexican Patients Research Articles

Transnational utilization of diagnostic studies across the US-Mexico border.

e18574 Background: Transnational healthcare utilization between US and Mexico border states is well described for specific medical conditions; however, little is known regarding the trans-border use of diagnostic imaging and invasive studies in cancer care in this region. We aimed at identifying patterns of diagnostic testing use among US- and Mexico-based patients. Methods: A cross-sectional online survey was sent to oncologists practicing in Mexican border states (Baja California, Chihuahua, Coahuila, Nuevo León, Sonora, and Tamaulipas), identified from the Mexican Society of Oncology’s member directory. The survey was administered through REDCap between October and November 2022. Responses were analyzed using descriptive statistics. The study was approved by the IRB of Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Results: Sixty-six respondents completed the survey. Respondents were mostly medical oncologists (n = 24) or surgical oncologists (n = 24). Most reported primarily practicing for < 5 years (46.9%) in both public and private practice settings. Approximately 70% (n = 46) of respondents reported interacting with US-based patients traveling to Mexico to undergo diagnostic imaging studies, the most common of which included CT-scan (82.6%). Fifty-six percent (n = 37) of respondents interacted with patients traveling to Mexico for the purpose of undergoing invasive testing, requiring access via percutaneous puncture or incision, where the most frequently sought test included a biopsy (91.9%, n = 34). Forty percent (n = 26) of respondents interacted with patients from Mexico who travelled to the US for diagnostic imaging, who most frequently sought nuclear imaging studies (80.0%). Approximately 33% of respondents (n = 22) interacted with patients who travelled for diagnostic testing, with next generation sequencing (NGS) the most common study requested (90.9%). See Table. Conclusions: Diagnostic studies play an essential role in the management of cancer. A significant proportion of patients travelling to Mexico for diagnostic tests pursued CT imaging scans and biopsies, which may be due to the lower costs of those procedures in Mexico, even for patients who might have insurance. In contrast, most Mexican patients who traveled to the US for testing pursued nuclear imaging and NGS, perhaps reflecting lack of access and availability. Strategies aimed at improving access to evidence-based diagnostic testing are needed to reduce inequities both in high- and middle-income countries. [Table: see text]

Survival outcomes and clinicopathological factors analysis of breast cancer patients. A single-institution cohort from 2012 to 2020 in a Mexican population.

e13104 Background: In Mexico, The Instituto Mexicano del Seguro Social (IMSS) is a tripartite contribution which provides care to more than 74 million beneficiaries, which represents more than 50% of the general population of the country. Although Mexican breast cancer statistics have been reported, it is imperative to know the updated statistics on the epidemiology in our Institution. The aim of this study is to describe the survival outcomes and the clinical-pathological characteristics of patients with breast cancer. Methods: Records of breast cancer patients treated at the Oncology Hospital from Centro Medico Nacional Siglo XXI of IMSS, from January 2012 to December 2020 were included. We analyzed clinical and demographic characteristics of the population, as well as survival outcomes at 5-years. Results: A cohort of 5,264 patients was included. Median follow up was 54.9 months. Forty-three percent (n = 2,274) were diagnosed in early-stage breast cancer (I–IIA), 43.1% (n = 2,269) in stages IIB-III, and 7% (n = 383) in stage IV. The most common immunophenotype was hormone receptor (HR) positive, HER2-negative (70.8%, n = 3,726). HER2-positive represents 19.3% (n = 1011), among HR-positive were 12.4% (n = 650) and HR-negative, 6.9% (n = 361). 527 patients (10.1%) were triple negative. At 5-years, disease-free survival was 74.9% (95% CI, 73.5 to 76.3) and overall survival was 90.4% (95% CI, 89.4 to 91.3). High histologic grade (HR 1.51; 95% CI, 1.33 to 1.7; p < 0.001) and lymphovascular invasion (HR 1.84; 95% CI, 1.62 to 2.1; p < 0.001) were associated with higher risk of recurrence. Adjuvant chemotherapy was significantly associated to a 42% reduction in the risk of recurrence, HR 0.58 (95% CI, 0.49 to 0.69; p < 0.0001), and 54% in the risk of death, HR 0.46 (95% CI, 0.33 to 0.63; p < 0.0001) in stage III. Lobular histology was also associated with worse survival, HR 1.41 (95% CI, 1.069 to 1.859; p = 0.015). Conclusions: An update of breast cancer Mexican patients treated at IMSS is presented. We highlight the impact of adjuvant treatment and pathological risk factors for recurrence and death. This work can contribute to evaluate areas for improvement in management and outcomes in our population.

Crossing the US-Mexico border for cancer care: Which treatments are more sought-after?

e18576 Background: Crossing the US-Mexico border to seek healthcare is common, but limited data is available regarding cross-border cancer care. Since access and availability differs between Mexico and the US, we investigated which therapies were sought by Mexico and US-based patients crossing the border to receive cancer care. Methods: An online survey was sent to oncologists in Mexican border states (Baja California, Chihuahua, Coahuila, Nuevo León, Sonora, and Tamaulipas) using the Mexican Society of Oncology’s member directory. The survey was administered via REDCap in October-November 2022. Responses were analyzed using descriptive statistics. The study was approved by the IRB of Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Results: Sixty-six respondents completed the survey (response rate 29.3%). Most were medical (n = 24, 36.4%) or surgical (n = 24, 36.4%) oncologists practicing in both public and private settings (71.2%), with almost a third practicing in Baja California (31.8%). Sixty respondents (90.9%) reported treating US patients seeking a second opinion in Mexico. Respondents reported patients traveled to receive various treatment modalities with curative surgery (64.4%) being the most common. Seven respondents (11.9%) had interacted with patients who traveled to Mexico seeking non-FDA approved therapies, including homeopathic/alternative treatments. Thirty-one respondents (47.0%) reported treating patients traveling to buy medications with oral chemotherapy (CT) (76.7%) being the most common. Fifty respondents (75.8%) reported treating Mexican patients who traveled to the US seeking a second opinion. Respondents reported patients traveled to receive immunotherapy (59.2%). Five respondents (10.2%) treated patients who traveled to the US to receive CAR-T cell therapy, not currently available in Mexico. Twenty respondents (30.8%) reported treating patients who traveled to buy medications, with oral CT (60%) being the most common. Conclusions: Mexican oncologists often treat patients seeking cross-border cancer care. Therapies sought by patients from both sides of the border differ, mostly due to local availability. Factors associated with these differences require further study to address disparities on health outcomes across the US-Mexico border. [Table: see text]

Low-diversity microbiota and an increased metabolism of arginine and aromatic amino acids: a hallmark of hepatic encephalopathy in western Mexican patients with alcohol-associated cirrhosis.

To evaluate the composition and functions of the gut microbiota in patients with decompensated alcohol-associated cirrhosis, with and without hepatic encephalopathy (HE). Faecal samples from 31 inpatients (20 with HE, 11 without HE), and from 18 age-balanced healthy controls (HC), were included. Microbial composition was determined by 16S rRNA amplicon sequencing and analysed using QIIME2. Metabolic pathways were inferred by PICRUSt2, and short-chain fatty acids (SCFAs) quantification was performed by gas chromatography. The gut microbiota of patients with HE was characterized by a diminished α-diversity, compared to no-HE (P<0.01) and HC (P<0.001) groups; β-diversity also differed between HE vs no-HE patients (P<0.05), and between HE vs HC (P<0.001). In patients with HE, Escherichia/Shigella, Burkholderiales and Lactobacillales taxa predominated. In contrast, patients without HE were characterized by Veillonella and Bacteroides. Reduced levels of faecal SCFAs in both groups correlated with a depletion of beneficial taxa, such as Ruminococcus or Faecalibacterium. PICRUSt2 analysis showed both an enhanced catabolism of arginine through ammonia-producing pathways and chorismate biosynthesis in HE patients, a key precursor of aromatic amino acids. The gut microbiota of HE patients exhibits a proinflammatory dysbiotic profile, plus metabolic pathways that produce potentially neurotoxic byproducts.

Spectrum of germline pathogenic variants among patients with cancer in Mexico.

10620 Background: Up to 10% of patients with cancer harbor pathogenic germline variants (PVs) in one or more cancer susceptibility genes. Genetic cancer risk assessment (GCRA) is an important tool for the management of patients with cancer. It allows the identification of candidates for structured screening protocols, risk reduction strategies, targeted therapies and cascade testing. Knowledge about the prevalence and spectrum of PVs is limited among underrepresented populations. We studied the prevalence of germline PVs in a cohort of Mexican patients with cancer. Methods: Between April 2017 and September 2022, patients with diagnosis of cancer who met clinical criteria for GCRA according to international guidelines (NCCN) and were enrolled in the international Clinical Cancer Genomics Community Research Network (CCGCRN) registry at Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran were included. Cancer risk counseling and germline multi-gene panel testing were performed. Post-test counseling and cascade testing with known PV analysis was offered. Results: 1322 patients met inclusion criteria (probands n = 1027, relatives n = 295). Among the probands, 72.4% (744/1027) were women, median age at cancer diagnosis was 48.2 years (range 1-88) and 9.8% (n = 101) had more than one primary tumor. 14.5% (149/1027) of probands had a positive result in which 152 PV were identified ( BRCA1 n = 39, BRCA2 n = 33, ATM n = 11, CHEK2 n = 11, MLH1 n = 11, TP53 n = 7, PALB2 n = 7, NF1 n = 6, MSH2 n = 5, MSH6 n = 3, PTEN n = 3, APC n = 2, BRIP1 n = 2, CDH1 n = 2, RB1 n = 2 and 1 PV in the genes: CDKN2A, MAX, MUTYH, NBN, PTCH1, RAD50, SDHA and SDHB). The frequency of PV according to cancer diagnosis was: breast 15.5% (82/527), prostate 2% (4/198), ovarian 15.6% (12/77), colorectal 26.6% (16/60) and pancreatic 11.9% (5/42). The frequency of recurrent, potentially founder PVs in their respective genes was as follows: BRCA1 del(exons9-12) 30.7% (12/39) and CHEK2 c.707T &gt; C 81.8% (9/11). Among the relatives referred for cascade testing the frequency of PV was 40% (118/295), 18.6% (55/295) had personal history of cancer with a median age at diagnosis of 47 years. Conclusions: Our results show a wide spectrum and a variable frequency of PVs among one of the largest examined cohorts of Mexican patients with cancer, with a high frequency of PVs among cases of breast, ovarian, and colorectal cancer. In contrast to reports from other populations, there was very low frequency of PVs among patients with prostate cancer. The outcomes of this study add to our understanding of the genetic epidemiology of cancer in the Mexican population, and support creating GCRA programs to improve access to multi-gene panel testing among underrepresented patients in limited resource settings.

Prevalence of Latent Tuberculosis Infection (LTBI) in Mexican Patients With Rheumatoid Arthritis (RA).

Patients with rheumatoid arthritis (RA) are at increased risk of developing tuberculosis, and even more so if they receive biological agents. In Mexico, the prevalence of latent tuberculosis infection (LTBI) in RA diagnosed by interferon-gamma release assay (IGRA) is largely unknown. The objective was to determine LTBI prevalence and the associated risk factors in rheumatoid arthritis patients. A cross-sectional study was performed comprising 82 patients with RA who attended the rheumatology service at a second-level hospital. Demographic characteristics, comorbidity, Bacillus Calmette-Guerin (BCG) vaccination and smoking history, type of treatment, disease activity and functional capacity were investigated. The Disease Activity Score 28 and the Health Assessment Questionnaire-Disability Index were applied for the estimate of RA activity and functional capacity. Further information was compiled from the electronic medical records and personal interviews. LTBI was determined by QuantiFERON TB Gold Plus (QIAGEN, Germantown, USA). Prevalence of LTBI was 14% (95% confidence interval (CI): 8.6% to 23.9%). Factors associated with LTBI were history of smoking (odds ratio (OR) = 6.63 95% CI 1.01 to 43.3) and disability score (OR = 7.19 95%CI 1.41 to 36.6). The prevalence of LTBI in Mexican patients with RA was 14%. Our results suggest prevention of smoking and functional incapacity could reduce the risk of LTBI. Further research could endorse our results.

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.

Risk factors associated with diabetic neuropathy in Mexican patients

Risk factors associated with diabetic neuropathy in Mexican patients

Psychometric properties of the Functional Assessment of Cancer Therapy, prostate version (FACT-P), in Mexican patients

Psychometric properties of the Functional Assessment of Cancer Therapy, prostate version (FACT-P), in Mexican patients

Post-COVID-19 syndrome and quality of life impairment in severe COVID-19 Mexican patients.

Post-COVID-19 syndrome (PCS) usually occurs 3 months after the onset of COVID-19 with a symptom duration of at least 2 months without an alternative diagnosis. This study aimed to describe the prevalence, characteristics, and impact on the quality of life (QoL) of post-COVID-19 syndrome in patients with a history of hospitalization for COVID-19. We conducted a cross-sectional study. Patients who required hospitalization due to COVID-19 between March 2020 and October 2021 were invited to answer a PCS questionnaire and the EQ-5D instrument. A total of 246 patients were included: 187 (76%) met the definition of PCS and 54% were men, with a median age of 50 years (IQR 41-63). From 187 patients with PCS, the median time to symptom onset after hospital discharge was 1 day (IQR 1-20), and the median symptom duration was 150 days (IQR 90-225). A total of 27 different symptoms were reported; the most frequent were difficulty concentrating (81%), dyspnea (75%), arthralgia (71%), fatigue (68%), and hair loss (60%). Some symptoms, such as difficulty concentrating, arthralgia/myalgia, and hair loss, were more prevalent in women with PCS. Patients with PCS had a higher frequency of tobacco smoking (37 vs. 4%, p = 0.02) and increased severity of lung involvement in the initial chest tomography (75 vs. 58%, p = 0.01) than those without PCS. Patients with PCS were less likely to receive antivirals (15.5 vs. 27%, p = 0.04). No difference between ICU admission, mechanical ventilation, and length of hospital stay was found. Patients with PCS had a lower visual analog scale result for EQ-5D vs. those without (80 [IQR 70-90] vs. 89.5 [IQR 75-90], p = 0.05). All five QoL dimensions were affected in PCS patients, showing increased pain/discomfort (67 vs. 39%, p = < 0.001), difficulties in performing usual activities (39.2 vs. 20.3%, p = 0.03), and anxiety/depression (57.5 vs. 37%, p = 0.02). PCS occurred in 76% of hospitalized patients with prolonged duration and QoL impairment. Neurological symptoms such as difficulty concentrating were the most frequent symptoms. Timely diagnostic and therapeutic interventions are required.

Clinical Characteristics and Outcomes of Mexican Patients With Behçet's Syndrome.

The aim of this study was to describe the clinical characteristics and outcomes of Mexican patients with Behçet syndrome (BS) from a single center. This medical records review study included patients with established BS diagnosis, followed up in a tertiary care center in Mexico City from 2000 to 2020. Demographics, clinical characteristics, laboratory and imaging studies, disease activity, damage, treatment, and outcomes were assessed and compared according to sex and with other international cohorts. Descriptive statistics were used, and differences between groups were evaluated using the χ2 or Mann-Whitney U tests. Thirty-eight patients were included, 23 (60%) women and 15 (40%) men; the median age at BS diagnosis was 33 years (range, 24-39 years). The most frequent manifestations at diagnosis were recurrent oral and genital ulcers in 34 (89%) and 29 (76%), respectively, musculoskeletal in 21 (55%), and cutaneous in 15 (39%). The most frequent phenotype was the joint involvement. Treatment comprised prednisone in all, colchicine (24 [63%]), pentoxifylline (12 [32%]), and thalidomide (10 [26%]). During a median follow-up time of 12.5 years (range, 7-23 years), relapses were frequent (97%), severe infections were present in 5 patients (13%), and 2 patients (5%) died due to sepsis and pneumonia. Men showed a higher frequency of arterial hypertension (47% vs. 13%, p = 0.03) and thrombosis (20% vs. 0, p = 0.05), and a lower frequency of genital ulcers (40% vs. 78%, p = 0.03) than women. This cohort of Mexican patients with BS showed a predominance of female sex, joint involvement phenotype, frequent relapses, and favorable outcomes. Differences in comorbidities and clinical manifestations were identified according to sex.

Suicidal Thoughts and Behaviors in Anti-NMDA Receptor Encephalitis: Psychopathological Features and Clinical Outcomes.

A wide variety of neuropsychiatric symptoms are described during the acute phase of anti-N-methyl-d-aspartate receptor encephalitis (ANMDARE), including psychosis, mania, depression, and catatonia, but there are few reports on suicidal thought and behaviors in ANMDARE. To address this gap in the literature, the authors measured the presence of suicidal thoughts and behaviors among a large cohort of Mexican patients diagnosed with definite ANMDARE. This observational and longitudinal study included patients with definite ANMDARE hospitalized at the National Institute of Neurology and Neurosurgery of Mexico between 2014 and 2021. Suicidal thoughts and behaviors were assessed before and after treatment by means of a clinical interview with relatives and a direct clinical assessment with each patient. Thoughts of engaging in suicide-related behavior and acts of suicidal and nonsuicidal self-directed violence before and during hospitalization were recorded. From a total sample of 120 patients who fulfilled the diagnostic criteria for definite ANMDARE, 15 patients (13%) had suicidal thoughts and behaviors during the acute phase of the disease. All 15 of these patients experienced psychosis and had suicidal ideation with intention. Three patients engaged in preparatory behaviors and seven carried out suicidal self-directed violence. Psychotic depression and impulsivity were more frequent among those patients with suicidal thoughts and behaviors than among those without any form of suicidality. Four patients engaged in self-directed violence during hospitalization. Remission was sustained in 14 of 15 patients, with suicidal ideation and self-directed violence persisting during follow-up in only one patient. Suicidal thoughts and behaviors are not uncommon during the acute phase of ANMDARE. On the basis of our sample, the persistence of these features after immunotherapy is rare but may be observed. A targeted assessment of suicidal risk should be strongly considered in this population.

Clinical and Biochemical Profile Associated with Renal Recovery after Acute Kidney Injury in A Mexican Population: Retrospective Cohort Study.

Background and Objectives: Our primary objective was to study the clinical and biochemical characteristics associated with acute kidney injury (AKI) remission in a group of Mexican patients. Materials and methods: We retrospectively enrolled 75 patients who were diagnosed with AKI and separated the sample into two groups: nonremitting patients (n = 27, 36%) vs. remitting patients (n = 48, 64%). Results: We found significant relationships between nonremitting AKI and previous diagnosis of chronic kidney disease (p = 0.009), higher serum creatinine (Cr) at admission (p < 0.0001), lower estimated glomerular filtration rate (eGFR) (p < 0.0001), maximum serum creatinine during hospitalization (p < 0.0001), higher fractional excretion of sodium (FENa) (p < 0.0003) and 24-h urine protein (p = 0.005), higher serum potassium on admission (p = 0.025), abnormal levels of procalcitonin (p = 0.006), and increased risk of death (p = 0.015). Conclusion: Chronic kidney disease (CKD), lower eGFR, higher levels of serum creatinine during hospitalization, higher FENa and 24-h urine protein, abnormal levels of procalcitonin, and higher serum potassium on admission were associated with nonremitting AKI. These findings may facilitate the rapid identification of patients at risk for nonremitting AKI based on clinical and biochemical characteristics. Furthermore, these findings may inform the design of timely strategies for the vigilance, prevention, and treatment of AKI.

Atención plena compasiva para dejar de fumar en México: un ensayo clínico aleatorizado

Introduction: Compassionate Mindfulness (APC, according to the term in Spanish) is defined as the awareness that arises through paying attention to the present moment, without judging experiences and generating actions motivated by the aspiration to free oneself and others from suffering. Currently the effectiveness of this type of treatment has gained relevance in the context of nicotine addiction treatment. Objective: to evaluate the efficacy of an intervention based on APC as a treatment for smoking cessation in the Mexican population. Method: a randomized clinical trial was implemented involving 62 people recruited from a specialized smoking cessation clinic in Mexico City. These people were randomly assigned to one of two treatment conditions: the control group received the treatment provided regularly at the clinic, while the experimental group received an APC-based treatment. Results: at the end of the treatment, participants who received the APC-based treatment were more likely to quit smoking (OR = 4.33, p .025, IC 95% 1.2-15) and they also displayed greater benefits to their mental health in some of the variables evaluated. Discussion and conclusion: APC is an effective intervention for smoking cessation in Mexican patients, since it has important benefits to the patient’s general mental health, and it is important to continue exploring its effects on both the maintenance of abstinence and relapse of tobacco consumption.

Sociocultural and moral narratives influencing the decision to vaccinate among rheumatic disease patients: a qualitative study.

Vaccination is a process that involves individual, social, and ethical aspects, beyond public governance of vaccines or vaccination as a public health concern. The aim of this study is to describe the sociocultural and moral narratives that influence the decision to vaccinate in general and to vaccinate against COVID-19 specifically, among patients at the rheumatology units of two hospitals. Qualitative study involving individual semi-structured interviews following an interview guide. We conducted a thematic analysis using the ATLAS.ti software, with further triangulation to verify concordance and aid in the interpretation of the data from a medical anthropology framework and using a narrative ethics approach to gain insight into the participants' underlying moral values. We interviewed 37 patients in total, along with 3 rheumatologists. Five core themes emerged from the analysis to understand the decision to vaccinate: (1) information about vaccines and disease, (2) perceived risk-benefit of vaccination, (3) the physician-patient relationship, (4) governance of vaccination programs, (5) attitudes towards vaccines. Individual and family experiences with vaccination are diverse depending on the type of vaccine. The COVID-19 vaccine, as a new medical technology, is met with more controversy leading to hesitancy. The decision to vaccinate among Mexican rheumatic disease patients can sometimes involve doubt and distrust, especially for those with a lupus diagnosis, but ultimately there is acceptance in most cases. Though patients make and value autonomous decisions, there is a collective process involving sociocultural and ethical aspects. Key points • The complexity of vaccine decision-making is better identified through a narrative, qualitative approach like the one used in this study, as opposed to solely quantitative approaches • Sociocultural and moral perspectives of vaccination shape decision-making and, therefore, highlight the importance of including patients in the development of effective clinical practice guidelines as well as ethically justified public policy • Sociohistorical context and personal experiences of immunization influence vaccine decision-making much more than access to biomedical information about vaccines, showing that approaches based on the information deficit model are inadequate to fight vaccine hesitancy.

The COVID-19 epidemic curve and vaccine acceptance among patients with rheumatic diseases: an ecological study.

The attitudes toward emerging COVID-19 vaccines have been of great interest worldwide, especially among vulnerable populations such as patients with rheumatic and musculoskeletal diseases (RMDs). The aim of this study was to analyze the relationship between the nationwide number of COVID-19 cases and deaths, and vaccine acceptance or hesitancy of patients with RMDs from four patient care centers in Mexico. Furthermore, we explored differences in acceptance according to specific diagnoses: rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). This ecological study was a secondary analysis of a cross-sectional study using a validated questionnaire to measure vaccine acceptance. We generated a global Likert scale to evaluate overall attitudes toward the COVID-19 vaccine. We analyzed data from 1336 patients from March to September 2021: 85.13% (1169) were women, with a mean age of 47.87 (SD 14.14) years. The most frequent diagnoses were RA (42.85%, 559) and SLE (27.08%, 393). 635(47.52%) patients were unvaccinated, 253(18.93%) had one dose and 478(35.77%) had two doses. Of all participating patients, 94% were accepting toward the COVID-19 vaccine. Vaccine acceptance remained consistently high throughout the study. However, differences in vaccine acceptance are identified when comparing diagnoses. The peak of the national epidemic curve coincided with an increase in hesitancy among patients with RA. Contrastingly, patients with SLE became more accepting as the epidemic curve peaked. Mexican patients show high acceptance of the COVID-19 vaccine, influenced in part by a patient's specific diagnosis. Furthermore, vaccine acceptance increased mirroring the curve of COVID-19 cases and deaths in the country. This should be taken into consideration when updating recommendations for clinical practice.

Patient Experience and Quality of Life in Mexican Patients with Neuromyelitis Optica Spectrum Disorder: A Sub-analysis of an International Multicenter Cross-sectional Survey in Latin America (P13-5.007)

<h3>Objective:</h3> To describe and assess patient experiences and quality of life (QoL) in Mexican patients diagnosed with neuromyelitis optica spectrum disorder (NMOSD). <h3>Background:</h3> The perceived impact of NMOSD on daily living has been described in North America, Europe, and Asia. However, little is known about how patients experience their disease in Latin America. <h3>Design/Methods:</h3> This study employed a comprehensive disease burden and QoL assessment implementing validated instruments previously used by The Guthy-Jackson Charitable Foundation in North America and Asia. <h3>Results:</h3> In Mexico, 66 patients were included (55 women; median age: 46.5, IQR: 31–52.2 years; median disease duration: 6, IQR: 4–10 years; 87.8% of them seropositive for anti-AQP4 antibodies). Almost three-quarters of participants (74.2%) reported an initial diagnosis of a disease other than NMOSD. NMOSD imposed a significant negative effect on the QoL (median: 4.0, IQR: 3–6; 6-point Likert-type scale [1 = least impact, 6 = greatest impact]); more than one-quarter of participants (25.7%) reported QoL to be greatly affected by NMOSD. Most participants (69.6%) agreed that the NMOSD diagnosis made them uncertain about their future (median: 4, IQR: 3–5; 5-point Likert-type scale [1 = strongly disagree, 5 = strongly agree]). The impact of NMOSD on QoL and future uncertainty due to NMOSD were positively correlated (Spearman’s rho: 0.39). Financially, more than one-third of participants (39.3%) believe their monthly expenses due to NMOSD were a significant burden. The impact of NMOSD on QoL and perceived financial burden were also positively correlated (Spearman’s rho: 0.33). No correlation was demonstrated between the impact of NMOSD on QoL and disease duration. <h3>Conclusions:</h3> Mexican patients reported their QoL is negatively affected by NMOSD. Uncertainty about the future as well as NMOSD-related clinical and financial burden are associated with this negative impact. These findings suggest that non-medical factors are also relevant in the psychosocial management of people with NMOSD. <b>Disclosure:</b> Dr. Delgado-Garcia has received research support from Consejo Nacional de Ciencia y Tecnologia (Mexico). Dr. Delgado-Garcia has received research support from Consejo Nacional de Ciencia y Tecnologia (Mexico). Dr. Delgado-Garcia has a non-compensated relationship as a Editorial Team Member with Neurology Resident &amp; Fellow Section that is relevant to AAN interests or activities. Dr. Delgado-Garcia has a non-compensated relationship as a Editorial Board Member with Brain and Life en Espanol that is relevant to AAN interests or activities. Dr. Delgado-Garcia has a non-compensated relationship as a Editorial Board Member with Neurology Clinical Practice that is relevant to AAN interests or activities. Dr. Garcia Sarreon has nothing to disclose. Dr. GOMEZ FIGUEROA has nothing to disclose. Veronica Rivas has nothing to disclose. Ms. Behne has nothing to disclose. Ms. Behne has received personal compensation for serving as an employee of The Guthy-Jackson Charitable Foundation. Ms. Behne has received personal compensation in the range of $50,000-$99,999 for serving as a Independent Contractor with The Guthy-Jackson Charitable Foundation. Dr. Yeaman has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Yeaman has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech-Roche. Dr. Yeaman has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. The institution of Dr. Yeaman has received research support from National Institutes of Health. The institution of Dr. Yeaman has received research support from U.S. Department of Defense. Dr. Yeaman has received intellectual property interests from a discovery or technology relating to health care. Dr. Yeaman has received intellectual property interests from a discovery or technology relating to health care. Dr. Corona Vazquez has received research support from Consejo Nacional de Ciencia y Tecnologia.

Autologous hematopoietic stem cell transplantation in multiple sclerosis: A 20-year single center’s experience in Mexico. (P14-3.015)

<h3>Objective:</h3> To describe the clinical characteristics and clinical outcomes of AHSCT in Mexican patients. <h3>Background:</h3> Autologous Hematopoietic Stem Cell treatment (AHSCT) is an immune reconstitution treatment option for Multiple Sclerosis (MS) that has grown in clinical evidence over the last decades; detailed efficacy and safety data is still lacking, especially outcomes data from low-income countries. <h3>Design/Methods:</h3> Retrospective single-center observational study of all MS patients that underwent AHSCT in a single reference center in Mexico City from January 2000 to January 2020. <h3>Results:</h3> We identified 24 patients, of which 22 had at least one year of follow-up after AHSCT and underwent analysis for clinical outcome. The median follow-up time was 85 months (range: 12–267); with a median age of 44.0 years (IR 38–52); 62.8% (n=15) were men and 31.8% (n=7) women; 50% were secondary progressive forms of MS (SPMS), and 27.3% were relapsing-remitting MS (RRMS); 59% (n=13) met the criteria for highly active MS (HAMS). The composite score of no evidence of disease activity 3 or NEDA3 (no relapses, no new MRI lesions, and no EDSS progression) was achieved in all the patients at a 24-month follow-up and in 72.1% (n=16) of the patients at the time of the last follow up visit. Relapse-free survival at the last follow-up visit was achieved at 77.3%; MRI event-free survival at 90.9%; Expanded disability status scale score progression-free survival in 95.4%. Only one patient required the re-initiation of disease-modifying therapy. There was no treatment-related mortality. One patient was diagnosed with premature ovarian failure. <h3>Conclusions:</h3> AHSCT in Mexican MS patients is an effective and relatively safe treatment option with no mortality and can be performed with a reasonable degree of safety at experienced centers. <b>Disclosure:</b> Dr. Rodriguez Estrada has nothing to disclose. Dr. Molina Carrion has nothing to disclose.

Association between the Polymorphisms rs2070744, 4b/a and rs1799983 of the NOS3 Gene with Chronic Kidney Disease of Uncertain or Non-Traditional Etiology in Mexican Patients.

Background and Objectives: Chronic Kidney Disease of uncertain or non-traditional etiology (CKDnT) is a form of chronic kidney disease of undetermined etiology (CKDu) and is not associated with traditional risk factors. The aim of this study was to investigate the association of polymorphisms rs2070744, 4b/a and rs1799983 of the NOS3 gene with CKDnT in Mexican patients. Materials and Methods: We included 105 patients with CKDnT and 90 controls. Genotyping was performed by PCR-RFLP's, genotypic and allelic frequencies were determined and compared between the two groups using χ2 analysis, and differences were expressed as odd ratios with 95% confidence intervals (CI). Values of p < 0.05 were considered statistically significant. Results: Overall, 80% of patients were male. The rs1799983 polymorphism in NOS3 was found to be associated with CKDnT in the Mexican population (p = 0.006) (OR = 0.397; 95% CI, 0.192-0.817) under a dominant model. The genotype frequency was significantly different between the CKDnT and control groups (χ2 = 8.298, p = 0.016). Conclusions: The results of this study indicate that there is an association between the rs2070744 polymorphism and CKDnT in the Mexican population. This polymorphism can play an important role in the pathophysiology of CKDnT whenever there is previous endothelial dysfunction.

Mpox in the Mexican population: Case Report and review of the literature

Mpox is a disease caused by an Orthopoxvirus, first discovered in Denmark in 1958 and presenting its first epidemic outbreaks in 1970. Currently, as of May 2022, numerous cases have been reported in non-endemic countries, generating worldwide concern given the current pandemic disease caused by SARS-CoV-2. To date, more than 85,142 cases have been reported worldwide and more than 3,768 in Mexico, predominantly in the male population, specifically in men who have sex with men and those with a history of HIV as major comorbidity. We present the case of a Mexican patient with a clinical diagnosis of Mpox with evidence of dermatologic lesions and emphasize the clinical context of his infection mechanism. This case report aims to highlight the importance of the underdiagnosis of the disease at the nationwide level and the need for a real epidemiological paradigm in Mexico. Likewise, the objective is to destigmatize the antecedents that lead to a risk of Mpox infection, as well as a review of the literature and correlation of the same with the clinical case in question.