Jorge Escobedo de la Peña

Association of polymorphisms within the transforming growth factor-β1 gene with diabetic nephropathy and serum cholesterol and triglyceride concentrations.

Aim:  The TGF‐β gene participates in the development of chronic kidney disease. We investigated whether the 869 T > C, 915 G > C and −800 G > A polymorphisms of TGF‐β1 are associated with diabetic nephropathy (DN).

High burden of cardiovascular disease risk factors in Mexico: An epidemic of ischemic heart disease that may be on its way?

BACKGROUND Whereas developed nations have witnessed a drop in the occurrence and mortality of ischemic heart disease, developing nations have recorded a constant rise. The burden of cardiovascular disease risk factors may explain this increase. METHODS We conducted a population-based cross-sectional survey to estimate the prevalence of cardiovascular risk factors in the population protected by the Mexican Social Security Institute. A total of 20,062 Mexicans, aged >or=20 years, 43.5% (8,727) male and 56.5% (11,335) female, randomly selected in a 4-stage stratified population-based sampling process were included. RESULTS The most prevalent cardiovascular risk factor in men was smoking (31.9%), whereas in women, it was obesity (26.6%) and central obesity (49.7%). A similar high age-adjusted prevalence was observed in women and men for hypertension (29.7% and 28.8%), diabetes (12.94% and 12.66%), and hypercholesterolemia (13.81% and 12.36%). There was a clear age effect on the prevalence of diabetes, hypertension, and hypercholesterolemia, with increasing prevalence with aging. Smoking also had an age effect, but its prevalence increases as age diminishes. More than half of the subjects in reproductive age (20-44 years old) have at least 1 cardiovascular risk factor, mainly smoking. CONCLUSIONS Cardiovascular risk factors are highly prevalent in the Mexican population, which seems to be between the second and third stages of the tobacco epidemic. The increased prevalence of risk factors clustering indicates the need for comprehensive integrated management of cardiovascular risk factors in Mexicans, with special emphasis on individuals at younger ages.

Prevalencia de consumo riesgoso y dañino de alcohol en derechohabientes del Instituto Mexicano del Seguro Social

Objetivo. Medir la prevalencia de consumo riesgoso y danino de alcohol en la poblacion amparada por el Instituto Mexicano del Seguro Social (IMSS). Material y metodos. En un estudio transversal se entrevistaron 45 117 derechohabientes del IMSS, en las 36 delegaciones del pais. Se aplico un cuestionario estructurado y autoaplicable a cada sujeto usando el instrumento de tamizaje AUDIT (Alcohol Use Disorder Identification Test), el cual consta de 10 preguntas. Las tres primeras se relacionan con la cantidad y frecuencia del consumo de alcohol, las tres siguientes evaluan la dependencia y las cuatro ultimas se refieren a problemas causados por el alcohol. Cada pregunta consta de tres a cinco opciones, a las que se les asignan valores progresivos de cero a cuatro. Se estimo la prevalencia de consumo, con intervalos de confianza al 95% (IC 95%). Resultados. La prevalencia de consumo problema de alcohol (riesgoso y danino) fue de 12.8% (IC 95% 12.5-13.2). El consumo fue mayor en hombres (22.2%; IC 95% 21.7-22.8) que en mujeres (3.4%; IC 95% 3.1-3.6). En los hombres se observo un efecto de edad, mientras que en las mujeres el consumo por edad fue mas homogeneo. En ambos grupos el consumo fue mas importante en la edad productiva. Conclusiones. La prevalencia de consumo de alcohol que constituye un problema para la salud, es elevada en la poblacion derechohabiente del IMSS. Es necesario desarrollar politicas y programas de salud especificos, para disminuir este grave problema.

Muerte prematura y discapacidad en los derechohabientes del Instituto Mexicano del Seguro Social

Objective: To carry out estimations of the burden of disease for 129 causes in order to identify health priorities in the different geographic regions of the country and to present comparative data between 1995 and 2000. Material and Methods. Indicators such as disability-adjusted life years (DALYs) and disability adjusted life expectancy (DALE) were analyzed for the population covered by IMSS in 1995 and 2000; for both years, the methodology proposed by the Burden of Disease Worldwide Study was applied. Data corresponding to 1995 were analyzed in 1997, while data corresponding to 2000 were analyzed in 2001. The comparative study was carried out in 2006 by IMSS, Mexico. Results. The higher proportion of DALYs was due to chronic diseases, although the 2000 rate is 1.5 times higher than that of 1995. Priorities that were identified were diabetes mellitus, ischemic cardiopathy, and cerebrovascular disease, with a loss that is mainly accounted for by premature death, as well as by diseases related to disability with an important burden of disease, such as AIDS or depression. Epidemiological backlogs can still be observed. Conclusion. The population covered by IMSS is still in a phase of epidemiologic transition, favoring polarization in health conditions. Health policies need to be directed toward bringing about an improved response and reversing the trend in diseases that represent an institutional risk for the financing of health care.

Prevalence of peripheral arterial disease and related risk factors in an urban Mexican population

Peripheral arterial disease (PAD) is a growing and often underdiagnosed health problem that predicts cardiovascular events and mortality. Estimating its prevalence in the general popula tion is a major issue for assessing health needs and planning health services. The aim of this study was to determine the prevalence of PAD and its risk factors in an urban Mexican popu lation. A random sample of 400 adult subjects was selected from a Family Medical Unit of the Mexican Institute of the Social Security. Clinical examination was performed and a question naire was applied to all subjects. After an overnight fast, serum glucose, triglyceride, and cholesterol concentrations were measured. Blood pressure was taken and the ankle-brachial index (ABI) was calculated by Doppler examination in both sides. PAD was diagnosed if one of the ABIs was less than 0.90. Prevalence was estimated with 95% confidence intervals (CI95%), and odds ratios (OR) with CI95% were obtained to assess association with some atherogenic risk factors in a multiple logistic regression analysis. The prevalence of PAD was 10.0% (CI95%, 7.24%-13.37%), and it was higher in men. Most subjects with PAD had no signs or symptoms, although the presence of either signs or symptoms was more frequent in subjects with PAD. The main risk factors related to PAD were serum triglycerides ≥150 mg/dL (OR 2.25; CI95% 1.0-5.1), heavy smoking (OR 2.5; CI95% 0.9-6.7) and a history of diabetes mellitus for longer than 7 years (OR 1.9; CI95% 0.6-5.8). The prevalence of PAD is high in this Mexican urban population. Asymptomatic PAD may be highly frequent, and low-cost, noninvasive Doppler ultrasonography should be considered as an adequate screening procedure in primary care to detect individuals at high risk for major cardiovascular events.

Critical Analysis of Deaths Due to Atypical Pneumonia during the Onset of the Influenza A (H1N1) Virus Epidemic

BACKGROUND The ongoing influenza A (H1N1) pandemic stroked Mexico and posed a huge challenge to the medical care and public health systems. This report analyzes the clinical course and process of care of patients who died due to atypical pneumonia and fulfilled the clinical criteria of suspected case of novel influenza A (H1N1) virus infection. METHODS We conducted a retrospective analysis of a series of 38 patients who died between April 7 and April 28, 2009 at Instituto Mexicano del Seguro Social (IMSS) hospitals due to severe pneumonia and respiratory distress. These cases coincided with the beginning of the outbreak, so patients did not undergo laboratory testing to diagnose influenza. According to IMSS and CDC criteria, post-hoc analysis allowed considering the presumptive diagnosis of S-OIV infection. A multidisciplinary group analyzed the information from the clinical charts, laboratory tests, radiographic studies and death certificates, using descriptive statistics. RESULTS Most cases were middle-aged (mean 33 years, range: 4-62 years) and previously healthy; 18.4% had an underlying chronic disease, 23.7% were obese and 7.9% were current smokers. None had received the seasonal influenza vaccine; they had cough (92%), fever (86.8%), and malaise (73.7%). The median time from disease onset to hospital admission was 6 days (range 0-8 days). All were admitted to the intensive care unit with pneumonia and/or respiratory distress. Average time from disease onset to death was 8 days (range 4-18 days). CONCLUSIONS An increased number of severe cases of atypical pneumonia in previously healthy adults highlight the importance of the availability of a timely surveillance system able to identify sudden increases in the number of cases or presentation of apparently known diseases.

Impacto de la educación nutricional sobre alteraciones metabólicas en niños y adolescentes con obesidad

INTRODUCTION Childhood obesity has become a serious public health problem. Nutritional therapy plays an important role in its prevention and treatment. PATIENTS AND METHODS A nonrandomized clinical trial was conducted in 40 obese children and adolescents who underwent a complete medical history and assessment of eating habits through 24-hour food recall and a frequency of food consumption questionnaire. In all patients, body weight, height, skinfold thickness, waist and hip circumferences and fasting glucose, total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, and triglyceride levels were measured. The nutritional intervention consisted of identifying the calorie consumption and nutrient intake, and participants were given advice aimed at changing eating habits with a healthy normocaloric diet. After 4 months, biochemical, anthropometric and dietary indicators were measured again. RESULTS Significant reductions were observed in body weight (56.0 +/- 16.5 to 54.4 +/- 16.1 kg), body mass index (26.5 +/- 3.7 to 25.1 +/- 3.1), waist circumference (86.4 +/- 11.6 to 81.4 +/- 11.4 cm) and mid-arm circumference (29.0 +/- 5.0 to 26.0 +/- 4.2 mm). Significant reductions were also observed in total cholesterol (167.1 +/- 30.0 to 156.0 +/- 26.5 mg/dl) and LDL-cholesterol (103.0 +/- 21.4 to 84.6 +/- 26.0 mg/dl). A significant increase was found in HDL values (38.0 +/- 7.8 to 43.4 +/- 9.3 mg/dl). In all comparisons, the p-value was < 0.05. CONCLUSIONS Counseling aimed at changing eating habits is effective in reducing body weight and improves lipid profile in children and adolescents with obesity.Introduccion La obesidad infantil se ha convertido en un grave problema de salud publica, en cuyos prevencion y tratamiento la terapia nutricional tiene un papel importante. Pacientes y metodo Ensayo clinico no aleatorizado realizado en 40 ninos y adolescentes con obesidad, a quienes se realizo una historia clinica completa, evaluacion de habitos de alimentacion a traves de encuesta de recordatorio de alimentos de 24 h y frecuencia de consumo de alimentos. Se determino en todos peso corporal, estatura, pliegues cutaneos, circunferencia de cintura y cadera y concentraciones sericas en ayunas de glucosa, colesterol total y sus fracciones de lipoproteinas de alta densidad (cHDL) y de baja densidad (cLDL) y trigliceridos. La intervencion nutricional consistio en identificar el consumo calorico y la cantidad de nutrientes consumidos, y se otorgo asesoria dirigida a modificar los habitos de alimentacion con una dieta normocalorica saludable. Despues de 4 meses se midieron nuevamente indicadores bioquimicos, antropometricos y dieteticos. Resultados Se observo una reduccion significativa en el peso corporal (de 56 ± 16,5 a 54,4 ± 16,1 kg), el indice de masa corporal (de 26,5 ± 3,7 a 25,1 ± 3,1), la circunferencia de cintura (de 86,4 ± 11,6 a 81,4 ± 11,4 cm) y la circunferencia media del brazo (de 29 ± 5 a 26 ± 4,2 mm). Se observo tambien una disminucion significativa del colesterol total (de 167,1 ± 30 a 156 ± 26,5 mg/dl) y el cLDL (de 103 ± 21,4 a 84,6 ± 26 mg/dl) y un incremento del cHDL (de 38 ± 7,8 a 43,4 ± 9,3 mg/dl). En todas las comparaciones se obtuvo p Conclusiones La asesoria dirigida a la modificacion de habitos de alimentacion es eficaz en la disminucion del peso corporal y la mejora del perfil de lipidos de ninos y adolescentes con obesidad.INTRODUCTION Childhood obesity has become a serious public health problem. Nutritional therapy plays an important role in its prevention and treatment. PATIENTS AND METHODS A nonrandomized clinical trial was conducted in 40 obese children and adolescents who underwent a complete medical history and assessment of eating habits through 24-hour food recall and a frequency of food consumption questionnaire. In all patients, body weight, height, skinfold thickness, waist and hip circumferences and fasting glucose, total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, and triglyceride levels were measured. The nutritional intervention consisted of identifying the calorie consumption and nutrient intake, and participants were given advice aimed at changing eating habits with a healthy normocaloric diet. After 4 months, biochemical, anthropometric and dietary indicators were measured again. RESULTS Significant reductions were observed in body weight (56.0 +/- 16.5 to 54.4 +/- 16.1 kg), body mass index (26.5 +/- 3.7 to 25.1 +/- 3.1), waist circumference (86.4 +/- 11.6 to 81.4 +/- 11.4 cm) and mid-arm circumference (29.0 +/- 5.0 to 26.0 +/- 4.2 mm). Significant reductions were also observed in total cholesterol (167.1 +/- 30.0 to 156.0 +/- 26.5 mg/dl) and LDL-cholesterol (103.0 +/- 21.4 to 84.6 +/- 26.0 mg/dl). A significant increase was found in HDL values (38.0 +/- 7.8 to 43.4 +/- 9.3 mg/dl). In all comparisons, the p-value was < 0.05. CONCLUSIONS Counseling aimed at changing eating habits is effective in reducing body weight and improves lipid profile in children and adolescents with obesity.

Evaluation of the imputation performance of the program IMPUTE in an admixed sample from Mexico City using several model designs

BackgroundWe explored the imputation performance of the program IMPUTE in an admixed sample from Mexico City. The following issues were evaluated: (a) the impact of different reference panels (HapMap vs. 1000 Genomes) on imputation; (b) potential differences in imputation performance between single-step vs. two-step (phasing and imputation) approaches; (c) the effect of different posterior genotype probability thresholds on imputation performance and (d) imputation performance in common vs. rare markers.MethodsThe sample from Mexico City comprised 1,310 individuals genotyped with the Affymetrix 5.0 array. We randomly masked 5% of the markers directly genotyped on chromosome 12 (n = 1,046) and compared the imputed genotypes with the microarray genotype calls. Imputation was carried out with the program IMPUTE. The concordance rates between the imputed and observed genotypes were used as a measure of imputation accuracy and the proportion of non-missing genotypes as a measure of imputation efficacy.ResultsThe single-step imputation approach produced slightly higher concordance rates than the two-step strategy (99.1% vs. 98.4% when using the HapMap phase II combined panel), but at the expense of a lower proportion of non-missing genotypes (85.5% vs. 90.1%). The 1,000 Genomes reference sample produced similar concordance rates to the HapMap phase II panel (98.4% for both datasets, using the two-step strategy). However, the 1000 Genomes reference sample increased substantially the proportion of non-missing genotypes (94.7% vs. 90.1%). Rare variants (<1%) had lower imputation accuracy and efficacy than common markers.ConclusionsThe program IMPUTE had an excellent imputation performance for common alleles in an admixed sample from Mexico City, which has primarily Native American (62%) and European (33%) contributions. Genotype concordances were higher than 98.4% using all the imputation strategies, in spite of the fact that no Native American samples are present in the HapMap and 1000 Genomes reference panels. The best balance of imputation accuracy and efficiency was obtained with the 1,000 Genomes panel. Rare variants were not captured effectively by any of the available panels, emphasizing the need to be cautious in the interpretation of association results for imputed rare variants.

Consumo de tabaco en la población derechohabiente del Instituto Mexicano del Seguro Social

Objective. To determine the prevalence of tobacco consumption among the active insured population of the Mexican Social Security Institute. Material and methods. A cross-sectional study in which the active insured population from the 36 political delegations was interviewed by means of a structured and self-applicable questionnaire on tobacco consumption, age of initiation, amount of cigarettes consumed and suspension. Results. The sample consisted of 45 117 subjects, of which approximately half were men and half women. Smoking prevalence in men was 40% and in women, 17.6%. Prevalence was highest in the north of the country. There is an effect of age on tobacco consumption and more than half started smoking during adolescence. Conclusions. Smoking prevalence was found to be high, however, the average number of cigarettes is low. Suspension index is low. Public health measures are necessary to diminish this addiction.

Factores de riesgo relacionados con lupus eritematoso sistémico en población mexicana

Objetivo. Evaluar los factores de riesgo asociados con el desarrollo de lupus eritematoso sistemico en poblacion mexicana. Material y metodos. Estudio de casos y controles, efectuado en junio de 1996 en el Departamento de Reumatologia del Hospital de Especialidades del Centro Medico Nacional Siglo XXI (HE CMN), del Instituto Mexicano del Seguro Social, de la Ciudad de Mexico. Se estudiaron 130 pacientes (casos) que presentaban cuatro o mas criterios de clasificacion de lupus eritematoso sistemico (LES) y con una evolucion de la enfermedad menor de cinco anos. Los controles fueron pacientes hospitalizados por enfermedades agudas no autoinmunes. Fueron pareados 1:1 por edad y sexo; ambos grupos se evaluaron a traves de una entrevista directa y la aplicacion de un cuestionario estructurado. Se estudiaron los siguientes factores de riesgo: geneticos (historia familiar de LES o enfermedad de tejido conjuntivo), sociodemograficos (raza, lugar de residencia, educacion, ingreso mensual); hormonales (anticonceptivos orales, terapia hormonal de remplazo y ginecobstetricos); ambientales (productos para el cabello, cohabitacion con perros, infecciones, alergias). El analisis estadistico fue hecho con razon de momios (RM) IC 95% y regresion logistica. Resultados. El analisis estadistico multivariado mostro asociacion con el antecedente familiar de LES (RM 4.2, IC 95% 1.17-15.2) u otra ETC (RM 2.6, IC 95% 1.15-4.5), uso de anticonceptivos orales por mas de un ano (RM 2.1, IC 95% 1.13-4.3), faringoamigdalitis de repeticion (RM 2.1, IC 95% 1.18 - 3.6) y farmacos (RM 5.0, IC 95% 1.62 - 21.6). No hubo relacion con factores socieconomicos, el uso de productos para el cabello, con asma o con antecedentes alergicos. Conclusiones. Factores geneticos como el antecedente heredo-familiar de LES o enfermedad de tejido conjuntivo en familiares de primer grado continuan siendo factores importantes en el desarrollo de LES. Otros factores de riesgo como el uso de farmacos, uso de anticonceptivos orales, faringitis de repeticion, posiblemente interactuan en un huesped geneticamente susceptible para el desarrollo de la enfermedad.