RESUMO
The Gender-Diverse (TGD) population in Mexico faces significant health challenges, such as limited access to healthcare and a prevalence of adverse conditions. Cardiology is crucial for this population due to a high prevalence of risk factors and cardiovascular diseases. Despite a lack of precise data, it is estimated that 0.5-1.5% of the population identifies as TGD. They encounter sociocultural challenges, including discrimination and stigma, contributing to health issues and a lack of treatment access. Cardiovascular risk factors, hormone self-administration, and barriers to healthcare access are prominent concerns. Opportunities for improvement involve strengthening medical education, implementing inclusive policies, and promoting research and data collection. The development of specific clinical guidelines and inclusive health programs is suggested. The theory of minority stress emphasizes addressing chronic psychosocial stressors and recognizing the influence of stress factors on health. Integrating healthcare services for all populations in cardiology and fostering resilience are key strategies. In summary, a comprehensive approach is needed to reduce disparities in cardiac care and enhance the health of all populations in Mexico.
La población de diferentes géneros en México se enfrenta a desafíos significativos en salud, cómo el acceso limitado a la atención médica y la prevalencia de malas condiciones. La cardiología es crucial para esta población debido a la alta prevalencia de factores de riesgo y enfermedades cardiovasculares. A pesar de la falta de datos precisos, se estima que el 0.5-1.5% de la población se identifica como transgénero. Enfrentan desafíos socioculturales, como discriminación y estigmatización que contribuyen a problemas de salud y falta de acceso a tratamientos. Los factores de riesgo cardiovascular, la autoadministración de hormonas, y las barreras en el acceso a la atención médica son preocupaciones destacadas. Las oportunidades para mejorar incluyen fortalecer la educación médica, implementar políticas inclusivas, y promover la investigación y recopilación de datos. Se sugiere el desarrollo de guías clínicas específicas y programas de salud inclusivos. La teoría de la minorización destaca la importancia de abordar tensiones psicosociales crónicas y reconocer la influencia de factores estresantes en la salud. Integrar servicios de salud para todas las poblaciones en cardiología y fomentar la resiliencia son estrategias clave. En resumen, se necesita un enfoque integral para reducir las disparidades en la atención cardíaca y mejorar la salud de todas las poblaciones en México.
Assuntos
Cardiologia , Pessoas Transgênero , Humanos , Pessoas Transgênero/psicologia , Hostilidade , Acessibilidade aos Serviços de Saúde , Estigma SocialRESUMO
Several studies suggest that the central nervous system coordinates muscle activation by modulating neural commands directed to groups of muscles combined to form muscle synergies. Individuals with patellofemoral pain (PFP) move differently from asymptomatic individuals. Understanding the neural strategies involved in the execution of tasks such as walking can help comprehend how the movement is planned and better understand this clinical condition. The objective of this study was to compare muscle synergies between women with and without PFP during walking. Eleven women with PFP and thirteen asymptomatic women were assessed using three-dimensional kinematics and electromyography (EMG) while walking at self-selected speed. Kinematics of the trunk, pelvis and lower limbs were analyzed through the Movement Deviation Profile. Muscle synergies were extracted from the EMG signals of eight lower limb muscles collected throughout the whole gait cycle. Kinematic differences between the two groups (p<0.001, z-score = 3.06) were more evident during loading response, terminal stance, and pre-swing. PFP group presented a lower number of muscle synergies (p = 0.037), and greater variability accounted for (VAFtotal) when using 3 (p = 0.017), 4 (p = 0.004), and 5 (p = 0.012) synergies to reconstruct all EMG signals. The PFP group also presented higher VAFmuscle for rectus femoris (p = 0.048) and gastrocnemius medialis (p = 0.019) when considering 4 synergies. Our results suggest that women with PFP show lower motor complexity and deficit in muscle coordination to execute gait, indicating that gait in PFP is the result of different neural commands compared to asymptomatic women.
Assuntos
Síndrome da Dor Patelofemoral , Humanos , Feminino , Caminhada/fisiologia , Marcha/fisiologia , Extremidade Inferior/fisiologia , Músculo Esquelético/fisiologia , Eletromiografia , Fenômenos BiomecânicosRESUMO
INTRODUCTION: Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF. OBJECTIVE: To identify cardiometabolic risk factors (CMRF) and antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender. METHODS: CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender. RESULTS: Out of 1,423 patients with NVAF, 336 had HFrEF. On average, females were older than males. There was no difference between genders with regard to the type of NVAF or direct oral anticoagulants use. Hypertension was more common in women. History of transient ischemic attack was reported in 3.6% of the patients and cerebrovascular event in 10%, without differences in terms of gender. The percentage of men with elevated embolic risk was higher, but without antithrombotic treatment, in comparison with women. CONCLUSIONS: Significant differences were found according to gender in patients with NVAF and HFrEF, both in CMRF and some comorbidities, as well as in antithrombotic treatment according to embolic and bleeding risk.
INTRODUCCIÓN: La insuficiencia cardiaca en pacientes con fibrilación auricular no valvular (FANV) es de dos a tres veces más frecuente que en individuos sin FANV. OBJETIVO: Identificar los factores de riesgo cardiometabólico (FRCM) y el tratamiento antitrombótico de pacientes con FANV e insuficiencia cardiaca con fracción de expulsión reducida (IC-FEr), y determinar si existen diferencias conforme al sexo. MÉTODOS: En forma global y de acuerdo con el sexo se analizaron FRCM, riesgo protrombótico, riesgo de sangrado y terapia antitrombótica. RESULTADOS: De 1423 pacientes con FANV, 336 tuvieron IC-FEr. Las mujeres promediaron mayor edad que los hombres. No hubo diferencia entre los sexos respecto al tipo de FANV o uso de anticoagulantes orales directos. La hipertensión arterial sistémica fue más frecuente en mujeres. Un 3.6 % de los pacientes reportó antecedente de ataque isquémico transitorio y 10 % de evento vascular cerebral, sin diferencias en cuanto al sexo. El porcentaje de hombres con riesgo embólico elevado fue mayor, pero sin tratamiento antitrombótico, en comparación con las mujeres. CONCLUSIONES: Se encontraron diferencias significativas de acuerdo con el sexo en pacientes con FANV e IC-FEr, tanto en FRCM y algunas comorbilidades, como en el tratamiento antitrombótico de acuerdo con el riesgo embólico y de sangrado.
Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Acidente Vascular Cerebral , Humanos , Masculino , Feminino , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Anticoagulantes/efeitos adversos , Fibrinolíticos/efeitos adversos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/epidemiologia , Fatores de Risco Cardiometabólico , Volume Sistólico , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
Resumen Introducción: La insuficiencia cardiaca en pacientes con fibrilación auricular no valvular (FANV) es de dos a tres veces más frecuente que en individuos sin FANV. Objetivo: Identificar los factores de riesgo cardiometabólico (FRCM) y el tratamiento antitrombótico de pacientes con FANV e insuficiencia cardiaca con fracción de expulsión reducida (IC-FEr), y determinar si existen diferencias conforme al sexo. Métodos: En forma global y de acuerdo con el sexo se analizaron FRCM, riesgo protrombótico, riesgo de sangrado y terapia antitrombótica. Resultados: De 1423 pacientes con FANV, 336 tuvieron IC-FEr. Las mujeres promediaron mayor edad que los hombres. No hubo diferencia entre los sexos respecto al tipo de FANV o uso de anticoagulantes orales directos. La hipertensión arterial sistémica fue más frecuente en mujeres. Un 3.6 % de los pacientes reportó antecedente de ataque isquémico transitorio y 10 % de evento vascular cerebral, sin diferencias en cuanto al sexo. El porcentaje de hombres con riesgo embólico elevado fue mayor, pero sin tratamiento antitrombótico, en comparación con las mujeres. Conclusiones: Se encontraron diferencias significativas de acuerdo con el sexo en pacientes con FANV e IC-FEr, tanto en FRCM y algunas comorbilidades, como en el tratamiento antitrombótico de acuerdo con el riesgo embólico y de sangrado.
Abstract Introduction: Heart failure in patients with non-valvular atrial fibrillation (NVAF) is two to three times more common than in individuals without NVAF. Objective: To identify cardiometabolic risk factors (CMRF) and antithrombotic treatment in patients with NVAF and heart failure with reduced ejection fraction (HFrEF), and to determine if there were differences according to gender. Methods: CMRF, pro-thrombotic risk, bleeding risk, and antithrombotic therapy were globally analyzed and according to gender. Results: Out of 1,423 patients with NVAF, 336 had HFrEF. On average, females were older than males. There was no difference between genders with regard to the type of NVAF or direct oral anticoagulants use. Hypertension was more common in women. History of transient ischemic attack was reported in 3.6% of the patients and cerebrovascular event in 10%, without differences in terms of gender. The percentage of men with elevated embolic risk was higher, but without antithrombotic treatment, in comparison with women. Conclusions: Significant differences were found according to gender in patients with NVAF and HFrEF, both in CMRF and some comorbidities, as well as in antithrombotic treatment according to embolic and bleeding risk.
RESUMO
Resumen La población de diferentes géneros en México se enfrenta a desafíos significativos en salud, cómo el acceso limitado a la atención médica y la prevalencia de malas condiciones. La cardiología es crucial para esta población debido a la alta prevalencia de factores de riesgo y enfermedades cardiovasculares. A pesar de la falta de datos precisos, se estima que el 0.5-1.5% de la población se identifica como transgénero. Enfrentan desafíos socioculturales, como discriminación y estigmatización que contribuyen a problemas de salud y falta de acceso a tratamientos. Los factores de riesgo cardiovascular, la autoadministración de hormonas, y las barreras en el acceso a la atención médica son preocupaciones destacadas. Las oportunidades para mejorar incluyen fortalecer la educación médica, implementar políticas inclusivas, y promover la investigación y recopilación de datos. Se sugiere el desarrollo de guías clínicas específicas y programas de salud inclusivos. La teoría de la minorización destaca la importancia de abordar tensiones psicosociales crónicas y reconocer la influencia de factores estresantes en la salud. Integrar servicios de salud para todas las poblaciones en cardiología y fomentar la resiliencia son estrategias clave. En resumen, se necesita un enfoque integral para reducir las disparidades en la atención cardíaca y mejorar la salud de todas las poblaciones en México.
Abstract The Gender-Diverse (TGD) population in Mexico faces significant health challenges, such as limited access to healthcare and a prevalence of adverse conditions. Cardiology is crucial for this population due to a high prevalence of risk factors and cardiovascular diseases. Despite a lack of precise data, it is estimated that 0.5-1.5% of the population identifies as TGD. They encounter sociocultural challenges, including discrimination and stigma, contributing to health issues and a lack of treatment access. Cardiovascular risk factors, hormone self-administration, and barriers to healthcare access are prominent concerns. Opportunities for improvement involve strengthening medical education, implementing inclusive policies, and promoting research and data collection. The development of specific clinical guidelines and inclusive health programs is suggested. The theory of minority stress emphasizes addressing chronic psychosocial stressors and recognizing the influence of stress factors on health. Integrating healthcare services for all populations in cardiology and fostering resilience are key strategies. In summary, a comprehensive approach is needed to reduce disparities in cardiac care and enhance the health of all populations in Mexico.
RESUMO
Resumen Objetivo: Conocer el comportamiento epidemiológico y asociaciones de la FA en población mexicana. Material y métodos: Analizamos 8,686 pacientes de 38 cardiólogos inscritos en REMECAR, divididos por edad y sexo. Comorbilidades estudiadas: obesidad, ERC, HTA, DM, dislipidemia, EVC, EPOC, hipotiroidismo, IC y CI. Programa: IBM SPSS. Resultados: FA en 498 pacientes (5.7%), mayor prevalencia en hombres (6.1 vs. 5.3%), mayor edad en mujeres (74.3 ± 12.1 vs. 70.5 ± 12.3 años, p < 0.0001). En mujeres menores de 60 años la FA se asoció con IC (p = 0.041), en hombres con ERC (p = 0.43), DM (p = 0.009), EVC (p = 0.001), hipotiroidismo (p = 0.001) e IC (p = 0.001). En mujeres mayores de 60 años se asoció con ERC (p = 0.001), dislipidemia (p = 0.001), EVC (p = 0.001), EPOC (p = 0.001) e IC (p = 0.001), en hombres con ERC (p = 0.002), EVC (p = 0.001), EPOC (p = 0.002), hipotiroidismo (p = 0.002), IC (p = 0.001) y CI (p = 0.033). En mujeres la FA se asoció con 1.13 veces mayor probabilidad de obesidad, 1.13 de HTA, 2.8 de ERC, 2.9 de EPOC, 4.3 de EVC y 6.5 de IC, en hombres la FA se asoció con 1.05 veces mas probabilidad de HTA, 1.4 de DM, 2.1 de ERC, 2.4 de EPOC, 3 de hipotiroidismo, 4.7 de EVC y 6 de IC. Conclusiones: La FA es una arritmia muy frecuente, con mayor prevalencia en pacientes que acuden a consulta de cardiología, en hombres y mayor edad de presentación en las mujeres. A mayor edad, mayor prevalencia de FA y de comorbilidades, la IC es la condición más frecuente con la que se asoció la FA.
Abstract Objective: To know the epidemiological behavior and associations of AF in Mexican population. Material and methods: 8,686 patients from 38 cardiologists participating in REMECAR were analyzed. They were divided by gender and age, the comorbidities studied were obesity, chronic kidney disease (CKD), high blood pressure (HBP), diabetes mellitus (DM), dyslipidemia, stroke, chronic obstructive pulmonary disease (COPD), hypothyroidism, heart failure (HF) and ischemic heart disease (IHD). Program used: IBM SPSS Statistic. Results: AF was diagnosed in 498 patients (5.7%), with higher prevalence in men (6.1% vs. 5.3%) and older age in women (74.3 ± 12.1 vs. 70.5 + -12.3 years, p<0.0001). In those under 60 years, AF was associated in women with HF, in men with CKD, DM, stroke, hypothyroidism and HF. In women older than 60 years, AF was associated with CKD, dyslipidemia, stroke, chronic COPD and HF, in men with CKD, stroke, COPD, hypothyroidism, HF and IHD. AF in women increase the probability 1.13 for obesity, 1.13 for HBP, 2.8 for CKD, 2.9 for COPD, 4.3 for stroke and 6.5 for HF, in men increase the probability 1.05 for HBP, 1.4 for DM, 2.1 for CKD, 2.4 for COPD, 3.0 for hypothyroidism, 4.7 for stroke and 6.0 for HF. Conclusions: AF is a very common arrhythmia, with a higher prevalence in patients attending the cardiology consultation, in men and with an older age of presentation in women. The older the age, the higher the prevalence of AF and comorbidities, HF is the most frequent condition associated with AF.
RESUMO
OBJECTIVE: To know the epidemiological behavior and associations of AF in Mexican population. MATERIAL AND METHODS: 8,686 patients from 38 cardiologists participating in REMECAR were analyzed. They were divided by gender and age, the comorbidities studied were obesity, chronic kidney disease (CKD), high blood pressure (HBP), diabetes mellitus (DM), dyslipidemia,stroke, chronic obstructive pulmonary disease (COPD), hypothyroidism, heart failure (HF) and ischemicheart disease (IHD). Program used: IBM SPSS Statistic. RESULTS: AF was diagnosed in 498 patients (5.7%), with higher prevalence in men (6.1% vs. 5.3%) and older age in women (74.3 ± 12.1 vs. 70.5 + -12.3 years, p<0.0001). In those under 60 years, AF was associated in women with HF, in men with CKD, DM, stroke, hypothyroidism and HF. In women older than 60 years, AF was associated with CKD, dyslipidemia, stroke, chronic COPD and HF, in men with CKD, stroke, COPD, hypothyroidism, HF and IHD. AF in women increase the probability 1.13 for obesity, 1.13 for HBP, 2.8 for CKD, 2.9 for COPD, 4.3 for stroke and 6.5 for HF, in men increase the probability 1.05 for HBP, 1.4 for DM, 2.1 for CKD, 2.4 for COPD, 3.0 for hypothyroidism, 4.7 for stroke and 6.0 for HF. CONCLUSIONS: AF is a very common arrhythmia, with a higher prevalence in patients attending the cardiology consultation, in men and with an older age of presentation in women. The older the age, the higher the prevalence of AF and comorbidities, HF is the most frequent condition associated with AF.
OBJETIVO: Conocer el comportamiento epidemiológico y asociaciones de la FA en población mexicana. MATERIAL Y MÉTODOS: Analizamos 8,686 pacientes de 38 cardiólogos inscritos en REMECAR, divididos por edad y sexo. Comorbilidades estudiadas: obesidad, ERC, HTA, DM, dislipidemia, EVC, EPOC, hipotiroidismo, IC y CI. Programa: IBM SPSS. RESULTADOS: FA en 498 pacientes (5.7%), mayor prevalencia en hombres (6.1 vs. 5.3%), mayor edad en mujeres (74.3 ± 12.1 vs. 70.5 ± 12.3 años,p < 0.0001). En mujeres menores de 60 años la FA se asoció con IC (p = 0.041), en hombres con ERC (p = 0.43), DM(p = 0.009), EVC (p = 0.001), hipotiroidismo (p = 0.001) e IC (p = 0.001). En mujeres mayores de 60 años se asoció conERC (p = 0.001), dislipidemia (p = 0.001), EVC (p = 0.001), EPOC (p = 0.001) e IC (p = 0.001), en hombres con ERC(p = 0.002), EVC (p = 0.001), EPOC (p = 0.002), hipotiroidismo (p = 0.002), IC (p = 0.001) y CI (p = 0.033). En mujeres la FA se asoció con 1.13 veces mayor probabilidad de obesidad, 1.13 de HTA, 2.8 de ERC, 2.9 de EPOC, 4.3de EVC y 6.5de IC, en hombres la FA se asoció con 1.05 veces mas probabilidad de HTA, 1.4 de DM, 2.1 de ERC, 2.4 de EPOC, 3 dehipotiroidismo, 4.7 de EVC y 6 de IC. CONCLUSIONES: La FA es una arritmia muy frecuente, con mayor prevalencia en pacientes que acuden a consulta de cardiología, en hombres y mayor edad de presentación en las mujeres. A mayor edad, mayor prevalencia de FA y de comorbilidades, la IC es la condición más frecuente con la que se asoció la FA.
Assuntos
Fibrilação Atrial , Diabetes Mellitus , Insuficiência Cardíaca , Hipertensão , Hipotireoidismo , Doença Pulmonar Obstrutiva Crônica , Insuficiência Renal Crônica , Acidente Vascular Cerebral , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Hipotireoidismo/complicações , Hipotireoidismo/epidemiologia , Masculino , Obesidade/complicações , Obesidade/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/epidemiologiaRESUMO
Patients with patellofemoral pain (PFP) present altered activation of the hip and knee muscles. Electromyography (EMG) analyses in PFP patients are usually performed individually for each muscle. However, several studies suggest that the central nervous system may modulate neural commands directed to groups of co-activated muscles, called muscle synergies. Investigating the synergistic organization in PFP will advance our knowledge of the influence of pain on muscle coordination. This study aimed to compare the motor coordination between women with and without PFP during the lateral step down (LSD). 15 women with PFP and 14 asymptomatic women underwent three-dimensional kinematics and EMG assessment during LSD. The Movement Deviation Profile (MDP) was calculated from kinematic data. Muscle synergies were extracted from EMG data of eight lower limb muscles using a non-negative factorization algorithm. Results revealed differences in MDP and an altered synergistic control between women with PFP and asymptomatic while performing the same motor gesture. Particularly, the variability accounted for (VAF) when using 3 synergies to reconstruct EMGs of the PFP group was higher than in the control group, suggesting reduced complexity of motor control in PFP. Detailed synergy analyses highlighted specific differences between groups in vastii and rectus femoris, which are muscles with a crucial role during the squat phase and the transition to rise phase of the LSD. This study shows the ability of muscle synergies analysis to reveal impaired motor coordination in PFP patients, and has the potential to be explored as a complementary tool to current clinical assessment techniques.
Assuntos
Síndrome da Dor Patelofemoral , Fenômenos Biomecânicos , Eletromiografia , Feminino , Humanos , Articulação do Joelho , Extremidade Inferior , Músculo EsqueléticoAssuntos
Cateterismo Cardíaco/métodos , Infecções por Coronavirus/epidemiologia , Assistência ao Paciente/métodos , Pneumonia Viral/epidemiologia , COVID-19 , Cateterismo Cardíaco/normas , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Surtos de Doenças , Humanos , Pandemias/prevenção & controle , Assistência ao Paciente/normas , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Fatores de RiscoRESUMO
The recommendations in which the Mexican Society of Cardiology (SMC) in conjunction with the National Association of Cardiologists of Mexico (ANCAM) as well as different Mexican medical associations linked to cardiology are presented, after a comprehensive and consensual review and analysis of the topics related to cardiovascular diseases in the COVID-19 pandemic. Scientific positions are analyzed and responsible recommendations on general measures are given to patients, with personal care, healthy eating, regular physical activity, actions in case of cardio-respiratory arrest, protection of the patient and health personnel as well as precise indications in the use of non-invasive cardiovascular imaging, prescription of medications, care in specific topics such as systemic arterial hypertension, heart failure, arrhythmias and acute coronary syndromes, in addition to emphasizing electrophysiology, interventionism, cardiac surgery and in cardiac rehabilitation. The main interest is to provide the medical community with a general orientation on what to do in daily practice and patients with cardiovascular diseases in the setting of this unprecedented epidemiological crisis of COVID-19.
Se presentan las recomendaciones en las cuales la Sociedad Mexicana de Cardiología (SMC) en conjunto con la Asociación Nacional de Cardiólogos de México (ANCAM), así como diferentes asociaciones médicas mexicanas vinculadas con la cardiología, después de una revisión y análisis exhaustivo y consensuado sobre los tópicos relacionados con las enfermedades cardiovasculares en la pandemia de COVID-19, se analizan posturas científicas y se dan recomendaciones responsables sobre medidas generales a los pacientes, con cuidados personales, alimentación saludable, actividad física regular, acciones en caso de paro cardiorrespiratorio, la protección del paciente y del personal de salud así como las indicaciones precisas en el uso de la imagen cardiovascular no invasiva, la prescripción de medicamentos, cuidados en tópicos específicos como en la hipertensión arterial sistémica, insuficiencia cardiaca, arritmias y síndromes coronarios agudos, además de hacer énfasis en los procedimientos de electrofisiología, intervencionismo, cirugía cardiaca y en la rehabilitación cardiaca. El interés principal es brindar a la comunidad médica una orientación general sobre el quehacer en la práctica cotidiana y pacientes con enfermedades cardiovasculares en el escenario esta crisis epidemiológica sin precedentes de COVID-19.