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Background: Several indexes have been developed to define the risk attributable to lipid metabolism with a single value. The total cholesterol/high-density lipoprotein (TC/HDL-C) and low-density lipoprotein/high-density lipoprotein (LDL-C/HDL-C) ratios are the most used. The higher the value of these ratios, the greater the probability of cardiovascular events. Objective: To identify whether the TC/HDL-C and LDL-C/HDL-C ratios are early prognostic markers of mortality and major cardiovascular events in patients with ST-elevation acute coronary syndrome. Material and methods: 265 patients with ST-segment elevation acute coronary ischemic syndrome were included, divided into 4 groups according to the values of the atherogenic indices. Mortality and major cardiovascular events at 30-day follow-up were analyzed. Comparison of the groups was performed using the chi-squared test or ANOVA, depending on the case (p < 0.05). Results: The cut-off point for the TC/HDL-C index was 6.9 and for the LDL-C/HDL-C it was 2.7. The comparative analysis of groups showed that cardiovascular death and arrhythmia were higher in group 3 (p = 0.006 and p = 0.003, respectively). Conclusions: TC/HDL-C and LDL-C/HDL-C indexes can be used as prognostic markers of cardiovascular mortality in the first 30 days of follow-up.

Introducción: se han elaborado diferentes índices para definir el riesgo atribuible al metabolismo lipídico con un solo valor. Los coeficientes colesterol total/lipoproteínas de alta densidad (CT/C-HDL) y lipoproteínas de baja densidad/lipoproteínas de alta densidad (C-LDL/C-HDL) son los más utilizados. A mayor valor de estos cocientes, la probabilidad de eventos cardiovasculares es mayor. Objetivo: identificar si los índices CT/C-HDL y C-LDL/C-HDL son marcadores pronósticos tempranos de mortalidad y evento cardiovascular mayor en pacientes con síndrome isquémico coronario agudo con elevación del ST. Material y métodos: se incluyeron 265 pacientes con síndrome isquémico coronario agudo con elevación del segmento ST, divididos en 4 grupos según los valores de los índices aterogénicos. Se analizó la mortalidad y el evento cardiovascular mayor en los 30 días de seguimiento. Se identificó el punto de corte de cada índice mediante un análisis de curva ROC. La comparación de los grupos se hizo con chi cuadrada o ANOVA, según fuera el caso (p < 0.05). Resultados: el punto de corte para el índice CT/C-HDL fue de 6.9 y para el C-LDL/C-HDL de 2.7. El análisis comparativo de los grupos demostró que la muerte cardiovascular y arritmia fue mayor en el grupo 3 (p = 0.006 y p = 0.003, respectivamente). Conclusiones: los índices CT/C-HDL y C-LDL/C-HDL pueden ser utilizados como marcadores pronósticos de mortalidad cardiovascular en los primeros 30 días de seguimiento.

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Introduction: Mexico ranks second in the global prevalence of obesity in the adult population, which increases the probability of developing dyslipidemia. Dyslipidemia is closely related to cardiovascular diseases, which are the leading cause of death in the country. Therefore, developing tools that facilitate the prediction of dyslipidemias is essential for prevention and early treatment. Methods: In this study, we utilized a dataset from a Mexico City cohort consisting of 2,621 participants, men and women aged between 20 and 50 years, with and without some type of dyslipidemia. Our primary objective was to identify potential factors associated with different types of dyslipidemia in both men and women. Machine learning algorithms were employed to achieve this goal. To facilitate feature selection, we applied the Variable Importance Measures (VIM) of Random Forest (RF), XGBoost, and Gradient Boosting Machine (GBM). Additionally, to address class imbalance, we employed Synthetic Minority Over-sampling Technique (SMOTE) for dataset resampling. The dataset encompassed anthropometric measurements, biochemical tests, dietary intake, family health history, and other health parameters, including smoking habits, alcohol consumption, quality of sleep, and physical activity. Results: Our results revealed that the VIM algorithm of RF yielded the most optimal subset of attributes, closely followed by GBM, achieving a balanced accuracy of up to 80%. The selection of the best subset of attributes was based on the comparative performance of classifiers, evaluated through balanced accuracy, sensitivity, and specificity metrics. Discussion: The top five features contributing to an increased risk of various types of dyslipidemia were identified through the machine learning technique. These features include body mass index, elevated uric acid levels, age, sleep disorders, and anxiety. The findings of this study shed light on significant factors that play a role in dyslipidemia development, aiding in the early identification, prevention, and treatment of this condition.

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Introducción. La turbidez por lipemia en las muestras para diagnóstico es una de las principales causas de la aparición de sesgos clínicamente significativos en la medición de magnitudes bioquímicas. Objetivo. Valorar la interferencia por lipemia en la medición de 25 constituyentes bioquímicos en dos analizadores con tecnología de química seca (Vitros 7600®) y química liquida (Atellica® Solution). Métodos. Estudio pre-experimental con pre y posprueba. Se añadieron cantidades crecientes de una emulsión lipídica de nutrición parenteral a siete alícuotas de una mezcla de sueros y se determinó por duplicado la influencia del interferente en 25 constituyentes. Se calculó el porcentaje relativo de desviación de la concentración del constituyente por influencia de la turbidez con respecto a una muestra sin interferente. Se establecieron límites de tolerancia para la interferencia utilizando tres criterios: del distribuidor de reactivos, del error sistemático deseable y del error máximo admisible. Resultados. Los constituyentes que presentaron los mayores sesgos para el analizador de química liquida fueron: fósforo (-84,72%), ALT (+81,25%) y AST (-75,76%), mientras que para la plataforma de química seca los constituyentes: ALT (-79,41%), CK (-28,92%) y lipasa (+24,85%). Se detectó interferencia significativa en diferente número de los constituyentes de acuerdo con el criterio de límite tolerable utilizado. Conclusiones. Los distintos resultados encontrados según la metodología y el analizador utilizado, además de la falta de replicabilidad de los ensayos para la valoración de interferencia por lipemia, origina la necesidad de armonizar los procesos e instaurar límites idénticos de interferencia tolerables entre los laboratorios y proveedores de insumos.

Introduction. Turbidity due to lipemia in diagnostic samples is one of the main causes of the appearance of clinically significant biases in the measurement of biochemical magnitudes. Objective. To assess the interference by lipemia in the measurement of 25 biochemical constituents in two analyzers with dry chemistry technology (Vitros 7600®) and liquid chemistry (Atellica® Solution). Methods. Pre-experimental study with pre and post test. Increasing amounts of a parenteral nutrition lipid emulsion were added to seven aliquots of pooled sera and the influence of the interferent on 25 constituents was determined in duplicate. The relative percentage deviation of the concentration of the constituent due to the influence of turbidity with respect to a sample without interference, was calculated. Tolerance limits for interference were established using three criteria: reagent distributor, desirable systematic error, and maximum permissible error. Results. The constituents that presented the greatest biases for the liquid chemistry analyzer were: Phosphorus (-84.72%), ALT (+81.25%) and AST (-75.76%), while for the dry chemistry platform the constituents, ALT (-79.41%), CK (-28.92%) and lipase (+24.85%). Significant interference was detected in a different number of constituents according to the tolerable limit criteria used. Conclusions. The different results found according to the methodology and the analyzer used, in addition to the lack of replicability of the tests for the evaluation of interference by lipemia, originates the need to harmonize the processes and establish identical limits of tolerable interference between the laboratories and suppliers of inputs.

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Objetivo: en pacientes con diabetes mellitus el genotipo de haptoglobina es considerado un factor de riesgo para la aparición de una cardiopatía, se ha reportado que en diabéticos el genotipo Hp 2-2 genera un riesgo cinco veces mayor de presentar una enfermedad cardiovascular comparado con pacientes diabéticos con otro genotipo. Este estudio tiene como objetivo la determinación del genotipo de haptoglobina en pacientes diabéticos que acuden al laboratorio el Hospital Clínico Viedma de noviembre de 2018 a enero de 2019. Métodos: se analizaron 76 sueros de pacientes diabéticos en ayunas y que contaban con una solicitud de perfil lipídico. Para la determinación de los tres genotipos de haptoglobina se usó un kit comercial de enzimoinmunoanalisis (ELISA Hp-Epitope); para la determinación de la glicemia y el perfil lipídico se usó el método enzimático. Resultados: del total de la población estudiada de pacientes diabéticos un 12 % presenta el genotipo Hp 2-2 en aquellos pacientes no controlados, los valores de glicemia (201 mg/dl) son estadísticamente significativas en relación con los otros dos genotipos. También estos pacientes diabéticos no controlados con genotipo Hp 2-2 presentan niveles de colesterol, LDL, VLDL y triglicéridos significativamente elevados en relación con los otros dos genotipos. Conclusiones: nuestros resultados coinciden con estudios previos el cual señalan que pacientes diabéticos que poseen el genotipo Hp 2-2 tiene mayor riesgo a sufrir una enfermedad cardiovascular en comparación con los otros 2 genotipos.

Objective: in patients with diabetes mellitus, the haptoglobin genotype is considered a risk factor for the onset of heart disease. It has been reported that in diabetics, the Hp 2-2 genotype generates a five-fold greater risk of developing cardiovascular disease compared to diabetic patients with another genotype. This study aims to determine the haptoglobin genotype in diabetic patients who come to the Viedma Clinical Hospital laboratory from November 2018 to January 2019. Methods: 76 sera from fasting diabetic patients with a lipid profile request were analyzed. For the determination of the three haptoglobin genotypes, a commercial enzyme immunoassay kit (Hp-Epitope ELISA) was used; The enzymatic method was used to determine glycemia and lipid profile. Results: of the total studied population of diabetic patients, 12% have the Hp 2-2 genotype. In those uncontrolled patients, the glycemia values (201 mg/dl) are statistically significant in relation to the other two genotypes. These uncontrolled diabetic patients with the Hp 2-2 genotype also have significantly elevated levels of cholesterol, LDL, VLDL and triglycerides in relation to the other two genotypes. Conclusions: our results coincide with previous studies which indicate that diabetic patients who have the Hp 2-2 genotype have a greater risk of suffering from cardiovascular disease compared to the other 2 genotypes.

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Abstract Background: Obesity is a public health problem and has been associated with the development of metabolic disorders that have a strong relationship with the onset of cardiovascular diseases (CVD). Objective: The objective was to analyze the influence of abdominal obesity (AO) on systemic arterial hypertension (SAH) and on the lipid profile in cardiovascular risk stratification in adult women. Methods: Altogether, 91 women participated in the research. Lifestyle information was collected, in addition to the analysis of clinical measures of cardiovascular risk and biochemical parameters. Unpaired Student's t-test, logistic regression, and Pearson's correlation were performed for data analysis, with a value of p <0.05 considered significant. Results: The prevalence of AO was 62.6%. Logistic regression showed that AO increased the chance of developing SAH by 2.9-fold. The same behavior was observed in the TG/HDL-c lipid ratio (3.93 ± 0.3 vs. 2.16 ± 0.2), representing an 82% increase in obese women. The present study also demonstrated that the best anthropometric parameter to analyze cardiovascular risk in the studied population was the waist/height ratio (AUC = 0.707). Conclusions: It can therefore be concluded that AO plays a significant role in the development of SAH and changes in lipid values that predict increased cardiovascular risk, configuring a strong influence factor for CVD.

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RESUMEN Introducción: Las alteraciones del metabolismo lipídico constituyen un problema de salud muy frecuente, que se incrementan con la edad del individuo. Objetivo: Determinar la asociación entre factores de riesgo de enfermedad aterogénica en pacientes geriátricos atendidos en consulta del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro¼. Métodos: Se realizó un estudio observacional, descriptivo, transversal, durante el período de septiembre de 2018 a septiembre de 2019. La muestra quedó conformada por 198 pacientes geriátricos, elegidos por muestreo probabilístico sistemático. Resultados: Predominó el sexo masculino; la edad de 60 a 69 años para ambos sexos, y el color de la piel blanca. Los factores clínicos de riesgo aterogénico más frecuentes fueron la hipertensión arterial y la diabetes mellitus. El perfil lipídico se caracterizó por valores elevados de colesterol total, VLDLc, LDLc, triglicéridos, apolipoproteína B, ambos índices lipídicos, y bajos de HDLc y apolipoproteínas A1. Conclusiones: Todas las determinaciones lipídicas mostraron significación estadística al relacionarlas con la edad, no siendo así con el sexo. La hipertensión arterial y la cardiopatía isquémica se asociaron de forma significativa con valores no deseables de colesterol total, VLDLc, LDLc, triglicéridos, apoproteína B y ambos índices lipídicos. La diabetes mellitus y el alcoholismo se asociaron con alteraciones de todas las fracciones lipídicas, excepto HDLc y apoproteína A1, respectivamente. Los pacientes fumadores presentaron valores no deseados de VLDLc, LDLc, e índice aterogénico, y los obesos de colesterol total, LDLc, triglicéridos y apoproteína B.

ABSTRACT Introduction: alterations in lipid metabolism are a very frequent health problem, which increase with the age of the individual. Objective: to determine the association among risk factors for atherogenic disease in geriatric patients treated in the consultation from "Arnaldo Milián Castro" Clinical and Surgical University Hospital. Methods: an observational, descriptive and cross-sectional study was carried out from September 2018 to September 2019. The sample was made up of 198 geriatric patients, chosen by systematic probabilistic sampling. Results: male gender, age from 60 to 69 years for both genders and white skin color predominated. The most frequent clinical atherogenic risk factors were arterial hypertension and diabetes mellitus. The lipid profile was characterized by high values of total cholesterol, VLDLc, LDLc, triglycerides, apolipoprotein B, both lipid indices, and low levels of HDLc and apolipoproteins A1. Conclusions: all lipid determinations showed statistical significance when relating them to age, but not to gender. Arterial hypertension and ischemic heart disease were significantly associated with undesirable values ​​of total cholesterol, VLDLc, LDLc, triglycerides, apoprotein B and both lipid indices. Diabetes mellitus and alcoholism were associated with alterations in all lipid fractions, except HDLc and apoprotein A1, respectively. Smokers had undesirable values ​​of VLDLc, LDLc, and atherogenic index, and obese patients of total cholesterol, LDLc, triglycerides, and apoprotein B.

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Background: Clozapine (CZP) is an antipsychotic used in resistant psychosis, but has adverse metabolic effects and is associated with new onset or worsening of epileptic seizures (ES). There is not enough information available regarding its effect on metabolic variables and on ES in patients with epilepsy. Objective: To describe the effect of CZP on the metabolic and hematologic profiles, and on ES in patients with epilepsy and with psychosis and/or aggressive behavior. Methods: A case series of patients with epilepsy and psychosis and/or aggressive behavior that received CZP with an 18-week follow-up. Clinical records were assessed from 2008-2018. 30 patients with epilepsy that received CZP were included. A paired analysis (Student's t-test or Wilcoxon signed rank test) was performed with metabolic variables (glucose, cholesterol, and triglycerides), hematologic variables, weight, body mass index (BMI), and monthly ES before and after CZP administration. Results: The median age to CZP initiation was 31.9 ± 16.07 years. Median CZP dosage was 193 mg/day. There were changes on BMI (p = 0.001; 3.2 kg/m2 increase, median = 3.08), triglycerides (p = 0.002) and glucose (p = 0.030). Weight increase was 7 kg (p = 0.292; median = 4 kg). Monthly ES mean was decreased from 4.9 (median = 2) to 2.04 (median = 1; p = 0.001). Conclusions: This study provide information regarding the security profile of CZP in patients with epilepsy with psychosis and/or aggressive behavior. A decrease on monthly ES was observed, as well as moderate increases in triglycerides, glucose and BMI, which coincide with that described by other authors.

Introducción: La clozapina (CZP) es un antipsicótico efectivo en la psicosis que no responde a otros antipsicóticos, pero tiene efectos metabólicos adversos y se relaciona con la generación de crisis epilépticas (CE). Existe poca información sobre su efecto en variables metabólicas y sobre las CE en pacientes con epilepsia. Objetivo: Describir el efecto de la CZP en el perfil metabólico, el perfil hematológico y la frecuencia de CE en pacientes con epilepsia y con psicosis o agresividad. Método: Serie de casos de pacientes con epilepsia y psicosis o agresividad que recibieron CZP con un seguimiento de 18 semanas. Se revisaron los expedientes clínicos de 2008-2018. Se incluyeron 30 pacientes con epilepsia que recibieron CZP. Se hizo una comparación pareada (prueba t de Student o de signo y rango de Wilcoxon), antes y después del inicio de la CZP, de las variables metabólicas (glucosa, colesterol y triglicéridos) y hematológicas, el peso, el índice de masa corporal (IMC) y las CE mensuales. Resultados: La edad media al iniciar la CZP fue de 31.9 ± 16.07 años. La dosis media fue 193 mg/día. Hubo incremento en el IMC (p = 0.001; aumento de 3.2 kg/m2; mediana = 3.08), los triglicéridos (p = 0.002) y la glucosa (p = 0.030). La ganancia de peso fue de 7 ± 10.4 kg (p = 0.292; mediana = 4 kg). El promedio de CE mensuales se redujo de 4.9 (mediana = 2) a 2.04 (p = 0.001; mediana = 1). Conclusiones: Este estudio aporta información del perfil de seguridad del uso de CZP en pacientes con epilepsia y psicosis o agresividad. Se observó una disminución en la frecuencia mensual de CE, así como aumentos moderados de los triglicéridos, la glucosa y el IMC, que coinciden con lo descrito por otros autores.

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