Ana Olivia Cortés-Flores

Serum albumin level as a risk factor for mortality in burn patients

OBJECTIVE: Hypoalbuminemia is a common clinical deficiency in burn patients and is associated with complications related to increased extravascular fluid, including edema, abnormal healing, and susceptibility to sepsis. Some prognostic scales do not include biochemical parameters, whereas others consider them together with comorbidities. The purpose of this study was to determine whether serum albumin can predict mortality in burn patients. METHODS: We studied burn patients ≥16 years of age who had complete clinical documentation, including the Abbreviated Burn Severity Index, serum albumin, globulin, and lipids. Sensitivity and specificity analyses were performed to determine the cut-off level of albumin that predicts mortality. RESULTS: In our analysis of 486 patients, we found that mortality was higher for burns caused by flame (p = 0.000), full-thickness burns (p = 0.004), inhalation injuries (p = 0.000), burns affecting >30% of the body surface area (p = 0.001), and burns associated with infection (p = 0.008). Protein and lipid levels were lower in the patients who died (p<0.05). Albumin levels showed the highest sensitivity and specificity (84% and 83%, respectively), and the area under the receiver-operating characteristic curve (0.869) had a cut-off of 1.95 g/dL for mortality. CONCLUSION: Patients with albumin levels <2 g/dL had a mortality risk of >80%, with 84% sensitivity and 83% specificity. At admission, the albumin level could be used as a sensitive and specific marker of burn severity and an indicator of mortality.

Long-term outcome after percutaneous endoscopic gastrostomy in geriatric Mexican patients

To evaluate long‐term survival and prognostic factors in elderly Mexican patients who have undergone percutaneous endoscopic gastrostomy (PEG).

Body weight changes after adjuvant chemotherapy of patients with breast cancer: results of a Mexican cohort study

&NA; Weight gain is observed in breast cancer patients receiving chemotherapy and is a well‐known complication. Several factors that contributing to weight gain have been identified. However, there is a lack of information about factors associated with weight changes following adjuvant chemotherapy. A retrospective cohort of 200 pre‐ and post‐menopausal Mexican patients treated for breast cancer was made. Anthropometric variables were measured before/after treatment. Biomarkers, cellular differentiation and chemotherapy were similar between groups. Weight gain occurred in 85.6% of pre‐menopausal and 72.6% of post‐menopausal women (p = .03). At the end of chemotherapy, weight and body mass index (BMI) did not differ significantly between pre‐menopausal (69.3 ± 12.6 kg; 26.6 ± 4.8 kg/m2) and post‐menopausal women (69.5 ± 10.9 kg; 27.3 ± 4.4 kg/m2) (p = .91 and 0.34). Dexamethasone doses were higher in pre‐menopausal (85.7 ± 39.1 g) than post‐menopausal patients (79.2 ± 22.5 g; p = .13). Weight loss was observed in 9.2% of pre‐menopausal and 20.2% of post‐menopausal patients (p = .04). A multivariate analysis revealed that age (OR = 2.7; 95% CI = 1.26‐5.79; p = .01), menopausal status (OR = 2.29; 95% CI = 1.09‐4.80; p = .03), dexamethasone dosage (OR = 2.1; 95% CI = 1.04‐4.23; p = .03) and daily caloric intake (OR = 2.3; 95% CI = 1.12‐5.10; p = .02) were independent variables that inducted weight gain. Pre‐ and post‐menopausal women gained weight, but more pre‐menopausal patients showed gain. An effort should be made to administer lower steroid doses to reduce weight gain.

Prevalence of the Triple-Negative Phenotype in Mexican Patients with Breast Cancer Treated in Private Practice

Background: Identifying the biological profile of breast cancer is fundamental to predict the response to various treatments and for prognosis. The aim of this study was to determine the triple-negative breast cancer prevalence in patients treated in private practice in Mexico. Methods: The study was performed using Mexican patients older than 18 years and had a histopathological diagnosis of breast adenocarcinoma and immunohistochemical studies for estrogen, progesterone, and HER2/Neu receptors, according to validated standards. Results: A total of 1,989 patients with a mean age of 52.9 ± 13.4 (23–93) years and a tumor size of 2.72 ± 1.12 cm were evaluated. The TNBC biological subtype was observed in 17.3%, HER2/Neu overexpression in 22.6%, and the presence of positive hormonal receptors (estrogen and/or progesterone) in 60.1% of the cases. An association was found between the TNBC type and the degree of differentiation (P<0.01), p53 overexpression (P<0.01, OR=1.84, 95% CI 1.35–2.52), proliferation index (P<0.01, OR=1.83, 95% CI 1.44–2.34), and tumor size (P<0.01). TNBC patients were younger (P<0.01) and lymph node involvement was more common in these patients (P<0.01, OR=4.57, 95% CI 3.53–5.90). Conclusions: TNBC is a highly aggressive tumor with a lower prevalence in women treated in private practice than in patients treated through the Seguro Popular, probably as a consequence of faster detection and opportune treatment.

Antioxidant drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis: What does evidence suggest?

AIM To determine whether or not the use of antioxidant supplementation aids in the prevention of post- endoscopic retrograde cholangiopancreatography pancreatitis. METHODS A systematic review of randomized controlled trials (RCTs) was made to evaluate the preventive effect of prophylactic antioxidant supplementation in post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The inclusion criteria included: acute post-endoscopic retrograde cholangiopancreatography pancreatitis in adults; randomized clinical trials with the use of any antioxidant as an intervention compared with placebo, to reduce PEP. The outcome measure was the incidence and severity of PEP. Twelve RCTs involving 3110 patients since 1999 were included. The antioxidants used were selenite, β-carotene, and pentoxifylline (each one in one trial), N-acetylcysteine (NAC) in three trials, and allopurinol in six trials. The group of patients treated with NAC received different doses; either oral or intravenous, and allopurinol-treated patients received five different oral doses in two different administration periods. The results are expressed with raw numbers, proportions, as well as mean and standard deviations. The incidence of pancreatitis between groups was analyzed with Pearsons χ(2) test or Fishers exact test (F). The main outcome is expressed as relative risks and 95%CI. RESULTS The incidence of pancreatitis in all antioxidant treatment groups was 8.6%, whereas it was 9.7% in the control group. The antioxidants used were selenite, β-carotene, and pentoxifylline (each one in one trial), NAC in three trials, and allopurinol in six trials. In allopurinol trials, three different dosifications were used; two trials reported a low dosage (of less than 400 mg), two trials reported a moderate dose (600 mg) and the remaining two employed higher doses (more than 900 mg). Supplementation was not associated with a significant reduction in the incidence of PEP [relative risk (RR) = 0.93; 95%CI: 0.82-1.06; P = 0.28]. In addition, the incidences of PEP in patients treated with allopurinol and those treated with other antioxidants were similar to that observed in patients who received the placebo (RR for trials with allopurinol, 0.92; 95%CI: 0.78-1.08; P = 0.31) and, with the use of other antioxidants, the incidence of PEP was 8.9%, whereas it was 9.7% in the control group (RR = 0.95; 95%CI: 0.77-1.18; P = 0.19). CONCLUSION Antioxidant supplementation shows no beneficial effect on the incidence of PEP. There is a lack of robust trials to support the use of antioxidants for prevention.