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Background: Non-pharmacological interventions (NFI) or preventive actions (PA) are the best alternatives to control future pandemics, especially in vulnerable populations, such as semi-urban areas. Objective: To describe the predominant health behavior groups (HBG) and associated factors during the third wave of COVID-19 in a semi-urban area. Material and methods: A survey which included characteristics, factors related to COVID-19, perceptions of health behavior and PA was applied in a probabilistic sample in a first-level hospital in the State of Mexico. People of both sexes over 18 years of age were included. Using a hierarchical cluster analysis, HBGs were obtained and characterized with a descriptive and multivariate statistical analysis. Results: In a probabilistic sample (n = 260), 4 HBGs were identified: 2 of high-risk (HRG) and 2 of low-risk (LRG), and the proportions were 43.5% y 56.5%, respectively. The sociodemographic characteristics of both groups were similar. Perceptions of severity and COVID-19-related barriers significantly influenced health behaviors in LRG. In HRG, low security played a significant role, highlighting the importance of comorbidities as a clinical factor. Conclusions: In a semi-urban area, 2 crucial health behaviors were identified: one associated with low risk and the other with high risk. In the HRG, the perception of insecurity was particularly relevant, emphasizing the importance of comorbidities as a clinical factor.

Introducción: las intervenciones no farmacológicas (INF) o acciones preventivas (AP) contra enfermedades son la mejor alternativa para controlar futuras pandemias, en especial en poblaciones vulnerables, como las zonas semiurbanas. Objetivo: describir los grupos predominantes de conductas de salud (GCS) y los factores asociados durante la tercera ola de la COVID-19 en una zona semiurbana. Material y métodos: se aplicó una encuesta que incluyó las características, los factores relacionados con COVID-19, las percepciones de conductas de salud y las AP, en una muestra probabilística en un hospital de primer nivel del Estado de México. Se incluyeron personas de ambos sexos, mayores de 18 años. Mediante un análisis de conglomerados se caracterizaron los GCS con un análisis estadístico descriptivo y multivariado. Resultados: en una muestra probabilistica (n = 260), se identificaron cuatro GCS: 2 de riesgo alto de contagio por la COVID-19 (GRA) y 2 de riesgo bajo (GRB) y las proporciones fueron 43.5% y 56.5%, respectivamente. Las características sociodemográficas de los grupos fueron similares. Para los GRB los factores significativos fueron las percepciones sobre la severidad y las barreras relacionadas con la COVID-19. En los GRA fue la seguridad baja y destacó la importancia de la comorbilidad como factor clínico. Conclusiones: en una zona semiurbana se identificaron 2 conductas de salud de importancia: una de bajo riesgo y otra de alto riesgo. En el GRA, la percepción de seguridad baja fue especialmente relevante, lo cual resalta la importancia de las comorbilidades como factor clínico.

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Background: Arterial hypertension is highly prevalent in Mexico; nevertheless, there are limited insights regarding its management during the COVID-19 pandemic. Here, we estimate the prevalence of clinical and treatment profiles of arterial hypertension and explore associated factors for undiagnosed and uncontrolled hypertension using a cross-sectional survey endorsed by the Collaborative Group on Arterial Hypertension from the Mexican Institute of Social Security. Methods: Our survey was conducted from May to November 2021 using the May-Measurement Month 2021 protocols of the International Society of Hypertension. Arterial hypertension (defined as: blood pressure [BP] ≥140/90 mmHg, previous diagnosis, or taking antihypertensives) and its clinical and treatment profiles were classified according to the World Hypertension League Expert Committee. Mixed-effects logistic regression models were used to explore associated factors for undiagnosed and uncontrolled hypertension. Results: Among 77,145 screened participants (women: 62.4%; median age: 46 [IQR: 32-59] years), the prevalence of arterial hypertension was 35.7% (95% CI: 35.3-36.0, n = 27,540). Among participants with arterial hypertension, 30.9% (95% CI: 30.4-31.5, n = 8,533) were undiagnosed, 6.6% (95% CI: 6.3%-6.9%, n = 1,806) were diagnosed but untreated, 43.4% (95% CI: 42.9-44.0, n = 11,965) had uncontrolled hypertension, and only 19% (95% CI: 18.6%-19.5%, n = 5,236) achieved hypertension control (BP < 130/80 mmHg). Explored associated factors for undiagnosed and uncontrolled hypertension include being men, living in the central and southern regions, lower educational attainments, higher use of pharmacological agents, and previous COVID-19 infection. Conclusion: Our findings suggest that adverse arterial hypertension profiles, mainly undiagnosed and uncontrolled hypertension, were highly prevalent during the context of the COVID-19 pandemic in Mexico.

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May Measurement Month 2021 (MMM21) in Mexico was an opportunistic survey that aimed to improve blood pressure awareness at the individual and population levels and to analyse the impact of the COVID-19 pandemic on the prevalence, knowledge, and rates of hypertension in the country. This survey followed the methodology of MMM, previously published. The total number of participants screened was 77 547, of which 47 793 (61.6%) were female and 29 178 (37.6%) were male. The mean age (SD) was 46.2 (16.6) years. Of all 77 547 participants, 14 939 (19.3%) had hypertension, of which 48% were aware. The frequency and awareness of hypertension in this survey are similar to those reported before the pandemic (MMM19-Mexico and the 2019 National Health Survey), suggesting that the impact of the COVID-19 pandemic in these parameters of arterial hypertension was not as important as expected. These data are concordant with the official reports in Mexico that showed that the pandemic had a severe impact on cardiovascular mortality but did not modify mortality due to hypertension or stroke.

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BACKGROUND: Antimicrobial resistance is a global health problem, due to morbidity, mortality, and healthcare costs. The misuse of antimicrobials is the main cause of antimicrobial resistance. The aim of this study was to report antimicrobial resistance and antibiotic consumption in a secondary care hospital in Mexico. METHODS: Within a cross-sectional study, antimicrobial resistance data on ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) and antibiotic consumption from 2020 to 2022 were collected. Antimicrobial resistance was reported based on percentages of resistance and consumption was analyzed using the defined daily dose (DDD)/100 bed days and the AWaRe (Access, Surveillance, Reservation) antibiotic group. RESULTS: Antibiotic consumption in 2020, 2021 and 2022 was 330, 175 and 175 DDD/100 beds day, respectively. The rate of ceftriaxone resistance in E. coli (n = 526) and K. pneumoniae (n = 80) was 76% and 69%, respectively, the rate of carbapenem resistance in A. baumannii (n = 168) and P. aeruginosa (n = 108) was 92% and 52%, respectively; the rate of oxacillin resistance in S. aureus (n = 208) was 27%; and the rate of vancomycin resistance in E. faecium (n = 68) was 47%. CONCLUSION: The reported results are congruent with global estimates of antibiotic resistance and consumption, providing an overview that could generate actions for antimicrobial optimization at the local and regional levels.

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Risk factors associated with severe-critical COVID-19 (coronavirus disease 2019) are based on findings in the general population. Pregnant women are at increased risk of severe-critical infection, and few reports are based on these women. A multicentric case-control study was conducted at the Mexican Institute of Social Security, State of Mexico, during the COVID-19 pandemic. We included pregnant women who were consecutively admitted to respiratory care units and were followed until 30 days after the resolution of pregnancy. A total of 758 pregnant women with a positive RT-PCR test for SARS-CoV-2 were enrolled from June 2020 to July 2021. We defined groups using the World Health Organization Severity Classification; cases were pregnant women with severe-critical COVID-19 (n = 123), and controls were subjects with non-severe COVID-19 (n = 635). Data was gathered from clinical files. A multivariate logistic regression analysis was used to adjust odds ratios and their 95% confidence intervals of factors associated with severe-critical COVID-19. Risk factors associated with severe-critical COVID-19 in pregnancy were non-vaccination (OR 10.18), blood type other than O (OR 6.29), maternal age > 35 years (OR 5.76), history of chronic hypertension (OR 5.12), gestational age at infection ≥ 31 weeks (OR 3.28), and multiparity (OR 2.80).

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Background: The COVID-19 pandemic represented a challenge in medical care. A tool would be very useful to establish the prognosis of in-hospital death that is reliable and can be applied to the Mexican population entitled to the IMSS. Objective: To propose a prognostic scale to stratify patients with viral pneumonia COVID-19 in the emergency services. Material and methods: A nested case-control study was conducted in a cohort of patients who were consecutively admitted to the emergency department with viral pneumonia COVID-19. The cases were those patients who died, and the controls were those who were discharged due to health improvement. An association analysis was performed between the variables with significant differences between groups. Subsequently, the association was adjusted using a multivariate logistic regression model, from which the prognostic scale was developed. Results: A total of 70 subjects with COVID-19 were included, 34 cases and 36 controls. Chronic diseases, smoking, severe pulmonary involvement diagnosed by tomography, leukocytosis, and pulse oximetry less than 80% with were associated with in-hospital mortality; Odds Ratio (OR) of >1.1. Vaccination was a protective factor (OR = 0.04, CI95%: 0.01-0.16). A score greater than 3 points on the prognostic scale predicts in-hospital mortality with a specificity of 0.86 and a sensitivity of 0.73. Conclusions: The proposed prognostic scale can be a useful tool in the classification of patients with COVID-19 viral pneumonia in the emergency room services of secondary care level Hospitals.

Introducción: la pandemia por COVID-19 representó un reto en la atención médica. Sería de gran utilidad una herramienta para establecer el pronóstico de muerte intrahospitalaria que sea confiable y pueda aplicarse a la población mexicana derechohabiente del Instituto Mexicano del Seguro Social. Objetivo: proponer una escala pronóstica para estratificar a los pacientes con neumonía viral por COVID-19 en los servicios de urgencias de los hospitales de segundo nivel. Material y métodos: se realizó un estudio de casos y controles anidado en una cohorte de pacientes adultos que fueron admitidos consecutivamente en el servicio de Urgencias con diagnóstico de neumonía viral por COVID-19. Los casos fueron aquellos pacientes que fallecieron y los controles aquellos que fueron egresados de la unidad por mejoría. Se realizó un análisis de asociación ente las variables con diferencias significativas entre ambos grupos, se ajustó la asociación mediante un modelo de regresión logística multivariada a partir del cual se elaboró la escala pronóstica. Resultados: se incluyeron en total 70 personas con COVID-19, 34 casos y 36 controles. Se asociaron a la mortalidad intrahospitalaria: las enfermedades crónicas, el tabaquismo, la afectación pulmonar severa diagnosticada por tomografía, la leucocitosis y la oximetría de pulso menor a 80% con una razón de Momios (RM) de > 1.1. La vacunación fue un factor protector (RM: 0.29, IC95%: 0.11-0.80). Un puntaje mayor a 3 puntos en la escala pronóstica predice la mortalidad intrahospitalaria (sensibilidad: 0.73, especificidad: 0.86). Conclusiones: la escala pronóstica propuesta puede ser una herramienta útil en la clasificación de los pacientes con neumonía viral por COVID-19 en los servicios de urgencias de los hospitales de segundo nivel de atención.

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Background: COVID-19 in pregnancy can increase the risk of complications due to the cardiorespiratory and immunological changes typical of pregnancy. Objective: To report the epidemiological characterization of COVID-19 in Mexican pregnant women. Material and methods: Cohort study on pregnant women with a positive COVID-19 test, which were followed until delivery and one month later. Results: 758 pregnant women were included in the analysis. Mothers' mean age was 28.8 ± 6.1 years; the majority were workers 497 (65.6%) and with an urban origin (482, 63.6%); the most common blood group was O with 458 (63.0%); 478 (63.0%) were nulliparous women and more than 25% had some comorbidities; the average gestation weeks at infection were 34.4 ± 5.1 weeks; only 170 pregnant women (22.4%) received vaccination; the most frequent vaccine was BioNTech Pfizer (96, 60%); there were no serious adverse events attributed to vaccination. The mean gestational age at delivery was 35.4 ± 5.2 weeks; 85% of pregnancies were cesarean section; the most frequent complication was prematurity (406, 53.5%), followed by preeclampsia (199, 26.2%); there were 5 cases of maternal death and 39 cases of perinatal death. Conclusions: COVID-19 in pregnancy increases the risk of preterm birth, preeclampsia, and maternal death. Vaccination against COVID-19 in this series showed no risk for pregnant women and their newborns.

Introducción: la COVID-19 en el embarazo puede incrementar el riesgo de complicaciones debido a los cambios cardiorrespiratorios e inmunológicos propios de la gestación. Objetivo: reportar la caracterización epidemiológica de la COVID-19 en población obstétrica mexicana. Material y métodos: estudio de cohorte en embarazadas con prueba positiva para COVID-19 que fueron seguidas hasta la resolución del embarazo y un mes después. Resultados: 758 mujeres embarazadas fueron incluidas en el análisis. La media de edad en las madres fue 28.8 ± 6.1 años; la mayoría trabajadoras 497 (65.6%) y de origen urbano (482, 63.6%); el grupo sanguíneo más común fue O 458 (63.0%); 478 (63.0%) fueron primigestas, y más del 25% padecía comorbilidades; las semanas de gestación promedio al contagio fueron 34.4 ± 5.1 semanas; solo 170 gestantes (22.4%) recibieron vacunación; la vacuna más frecuente fue BioNTech Pfizer (96, 60%); no hubo eventos adversos graves atribuibles a la vacunación. La edad gestacional media al nacer fue de 35.4 ± 5.2 semanas; el 85% de los embarazos se interrumpieron por cesárea; la complicación más frecuente fue la prematurez con 406 (53.5%), seguida de preeclampsia con 199 (26.2%); hubo 5 casos de muerte materna y 39 casos de muerte perinatal. Conclusiones: la COVID-19 en el embarazo aumenta el riesgo de parto prematuro, preeclampsia y muerte materna. Al menos en esta serie la vacunación contra COVID-19 no mostró riesgo para las mujeres embarazadas y sus recién nacidos.

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Contexto: la nefropatía diabética es la primera causa de enfermedad renal crónica en el mundo, sin embargo, no existe información de la prevalencia de Enfermedad Renal Crónica (ERC) en estadios tempranos en México. Una tarea fundamental del primer nivel de atención es la detección oportuna de enfermedades y la ERC en pacientes diabéticos es subdiagnosticada en estadios tempranos al ser asintomática. Objetivo: determinar la frecuencia y la estadificación de ERC en pacientes con diabetes mellitus tipo 2 de larga evolución en una unidad de primer nivel de atención, en el estado de México. Metodología: estudio transversal descriptivo. Se incluyeron 263 pacientes calculados por fórmula de población finita y selección aleatoria simple. Se incluyeron pacientes con diabetes tipo 2, ≥ 5 años de evolución, sin encontrarse en terapia sustitutiva de la función renal que cumplieran los criterios de inclusión. Las variables de estudio: características sociodemográficas y la estimación de la tasa de filtración glomerular por la ecuación CKD-EPI fueron descritas en frecuencias y porcentajes para variables categóricas y las variables continuas se reportaron medias y de desviación estándar, la diferencia entre grupos fue establecida por medio de prueba de Chi cuadrado o prueba exacta de Fisher y distribución t de student, de acuerdo con el tipo de variable. Un valor de p ˂ 0,05 fue considerado estadísticamente significativo. Resultados: la clasificación Kdigo presenta seis estadios y los resultados con respecto al grado de filtrado glomerular fueron: estadio 1 con 39,5 % (IC 95 %, 34,2-45,6), estadio 2 con 38,8 % (IC 95 %, 32,7-44,5), estadio 3a con 8 % (IC 95 %, 4,9-11,4), estadio 3b con 5,7 % (IC 95 %, 3,4-8,7), estadio 4 con 6,8 % (IC 95 %, 3,8-9,9) y el estadio 5 con 1,1 % (IC 95 % 0,0-2,7). El promedio de edad fue 69,26 ±11,01 en el grupo con ERC, en la segmentación por género estuvo: masculino en el grupo con ERC con 59,6 % y femenino con 40,3 %. Con respecto a comorbilidades, hipertensión arterial y tratamiento al analizarlas en grupos con ausencia de ERC y presencia de ERC fueron estadísticamente significativas, lo mismo en los resultados de laboratorio. Conclusiones: la prevalencia de sospecha de ERC en nuestra población es de 21 %, al menos 1 de cada 5 pacientes diabéticos con ≥ 5 años de evolución padecen una disminución del FG, sin embargo, no podemos considerarla ERC hasta que se valore la presencia de daño renal y corroborarlo a los tres meses.

Background: Diabetic nephropathy is the main cause of chronic kidney disease (CKD), however, there are no data available about the prevalence of chronic kidney disease in the early stages in Mexico. A key role in first level attention consists in performing timely screenings for diseases such as CKD. In most cases CKD is underdiagnosed in early stages, because it is asymptomatic. Purpose: To determine the frequency of CKD in long-standing diabetes type 2 Methods: This was a cross-sectional descriptive study. We included 263 patients with diabetes type 2 with at least 5 years of evolution, not undergoing renal function replacement therapy. The variables of this study were: sociodemographic characteristics and estimation of the glomerular filtration rate through the CKD-EPI equation. Categorical variables were summarized as frequencies and percentages. For continuous variables, mean and standard deviation were reported. The significance of differences between groups was assessed by Student's t-test or square chi or Fisher's exact test, and p-value ≤ 0.05 was considered statistically significant. Results: the KDIGO classification has 5 stages. The results regarding the degree of glomerular filtration: stage 1 with 39.5% (95% CI, 34.2-45.6) , stage 2 with 38.8% ( 95% CI, 32.77-44.5),stage 3a with 8% ( 95% CI, 4.9-11.4), stage 3b with 5.7% (95% CI, 3.4-8.7), grade 4 with 6.8% (95% CI, 3.8-9.9) and stage 5 with 1.1% (95% CI 0.0-2.7). The average age was 69.26 ± 11.01 in the group with CKD. Male gender predominated in the group CKD with 34 (59.6%) and 23 (40.3%), for female. Regarding comorbidities, hypertension arterial and treatment when analyzed for either absence or presence of CKD were statistically significant. The same findings can be obtained in laboratory results. Conclusion: The prevalence of suspected CKD in our population is 21%, at least 1 in 5 diabetic patients with ≥5 years of evolution suffer a decrease in GFR; however, we cannot consider it to be CKD until the presence of kidney damage is assessed and confirmed at 3 months.

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INTRODUCTION: Gestational hypertension (GH) pregnancies are at a high risk of developing adverse outcomes, including progression to preeclampsia. Prediction of GH-related adverse outcomes is challenging because there are no available clinical tests that may predict their occurrence. OBJECTIVE: The aim of the study was to determine the clinical usefulness of the soluble endoglin (sEng) and parameters of uterine artery flow (UtAF) measured by Doppler ultrasonography as markers of progression to preeclampsia in women with GH. SETTING: Mexico City, Mexico. MATERIAL AND METHODS: We included 77 singleton pregnant women with GH in a nested case-control study. Cases were women who progressed to preeclampsia (n = 36), and controls were those who did not (n = 41). Serum sEng and UtAF measurements were performed at enrollment. The main outcomes measured were progression to preeclampsia and occurrence of preterm delivery (PD) <37 and <34 weeks of gestation, small for gestational age infant (SGA), and fetal growth restriction (FGR). RESULTS: Women with sEng values in the highest tertile had higher risk of progression to preeclampsia, preterm delivery <34 weeks of gestation, and fetal growth restriction, odds ratios (ORs) ≥3.7. Patients with abnormal UtAF Dopp-ler-pulsatility index had higher risk of progression to preeclampsia, preterm delivery <34 weeks of gestation, small for gestational age infant, and fetal growth restriction (ORs ≥3.3). The presence of notch was associated with higher risk of progression to preeclampsia, preterm delivery <37 and <34 weeks of gestation, SGA infant, and fetal growth restriction (ORs ≥2.9). However, logistic regression analysis revealed that only serum sEng was a significant and independent risk factor for progression of GH to preeclampsia, preterm delivery <34 weeks of gestation, and fetal growth restriction (ORs ≥3.1). CONCLUSIONS: In GH pregnancies, UtAF Doppler ultrasonography is associated with increased risk of adverse outcomes and progression to preeclampsia. However, serum sEng concentration appears to be a better predictor to assess the risk of adverse maternal and perinatal outcomes and progression to preeclampsia.

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BACKGROUND: Breast cancer (BC) is the first cause of cancer morbidity and mortality in women. This disease has been linked to obesity; however, it is not clear how fat accumulation affects women who survive breast cancer. Although the visceral adiposity index (VAI) is a marker of cardiometabolic risk and adipose tissue dysfunction, it is not clear how it changes in breast cancer survivors. The aim of this investigation was to compare VAI in women with and without breast cancer. METHODS: A case-control cross-sectional study was conducted on women who were BC survivors and women without the history of BC (control group). Body composition was assessed using electrical bioimpedance while VAI by means of waist circumference (WC), body mass index (BMI), triacylglycerols (TG), and high-density lipoprotein cholesterol (HDL-C). RESULTS: 49 women in the BC survivor group and 50 in the control group. WC was wider in the survivor group as regards control (93.65 ± 10.48 vs. 88.52 ± 9.61 cm) (p=0.025); at once, TG and VAI were significantly higher for the survivor group (243.55 ± 199.84 vs. 159.84 ± 75.77) (p=0.007) and (11.03 ± 11.15 vs. 6.41 ± 3.66) (p < 0.005), respectively. Body composition parameters were similar in both groups. CONCLUSIONS: VAI is higher in women who are BC survivors in comparison with controls matched by age and bodyweight.