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Perez-Alba E, Iquize-Condori RC, Cantú-Hernández JA, Álvarez-Villalobos NA, Salinas-García LA, Camacho-Ortiz A. PrEP for Transgender People: A Systematic review. Clin Infect Dis 2024:ciae226. [PMID: 38657085 DOI: 10.1093/cid/ciae226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Eduardo Perez-Alba
- Servicio de Infectología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey Mexico
| | - Roxana Claudia Iquize-Condori
- Servicio de Infectología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey Mexico
| | - Jorge Alberto Cantú-Hernández
- Centro de Análisis Avanzado de Información 360, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey Mexico
| | - Neri Alejandro Álvarez-Villalobos
- Centro de Análisis Avanzado de Información 360, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey Mexico
| | - Luis Adrián Salinas-García
- Servicio de Infectología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey Mexico
| | - Adrián Camacho-Ortiz
- Servicio de Infectología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey Mexico
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Torres-Reyes ED, Carranza-Guzmán FJ, Tamez-Rodríguez AR, Álvarez-Villalobos NA. [Correlation between consultation time and patient´s satisfaction in primary care]. Rev Med Inst Mex Seguro Soc 2023; 61:759-766. [PMID: 37995316 DOI: 10.5281/zenodo.10064307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/26/2023] [Indexed: 11/25/2023]
Abstract
Background It is important to understand how consultation time relates to patient satisfaction, as these two variables have not been extensively studied together. Objective To determine the correlation between consultation time and patient satisfaction in primary care settings in Mexico. Materials and methods Cross-sectional, observational, and analytical study that included patients over 18 years old. Time was measured using a stopwatch, and satisfaction was assessed using the Patient Doctor Relationship Questionnaire (PDRQ-9). The correlation between both variables was analyzed using the Spearman test, and multiple linear regression was employed to associate satisfaction with the consultation. Results A total of 115 participants were included. The average consultation duration was 12.1 minutes, and 74% of patients reported that the consultation time was adequate. A weak positive correlation (p < 0.001, r = 0.38) was found between actual consultation time and satisfaction. Multiple linear regression demonstrated that for every minute increase in consultation time, level of satisfaction increased in 0.04 units (p = 0.001, CI95%: 0.016-0.063). Conclusion Most patients reported satisfaction with the duration of their medical consultation, and longer consultation times were associated with higher satisfaction levels.
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Affiliation(s)
- Erik David Torres-Reyes
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar Plus/UMAA No. 7, Departamento de Enseñanza. San Pedro Garza García, Nuevo León, México
| | - Francisco Javier Carranza-Guzmán
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar Plus/UMAA No. 7, Departamento de Enseñanza. San Pedro Garza García, Nuevo León, México
| | - Abraham Rubén Tamez-Rodríguez
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar Plus/UMAA No. 7, Departamento de Enseñanza. San Pedro Garza García, Nuevo León, México
| | - Neri Alejandro Álvarez-Villalobos
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar Plus/UMAA No. 7, Departamento de Enseñanza. San Pedro Garza García, Nuevo León, México
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3
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Contreras-Silva MY, Álvarez-Villalobos NA, de León-Gutiérrez H, Elizondo-Omaña GG, Navarrete-Floriano G, Romo-Salazar JC. [Impact of electronic devices used at an early age on language]. Rev Med Inst Mex Seguro Soc 2023; 61:427-432. [PMID: 37535982 PMCID: PMC10484535 DOI: 10.5281/zenodo.8200118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/17/2023] [Indexed: 08/05/2023]
Abstract
Background The acquisition of language in infants is largely the result of the process of brain maturation, as well as environmental stimulation. Currently, society is in an era of technology and use of electronic devices from an early age. Objective The aim of this study was to demonstrate if the amount of time of use of electronic devices in children under 5 years of age affects language development. Methods An observational, comparative, survey-type study was carried out in 269 infants of both sexes, with an age range of 6 to <60 months. The language development section of the Child Development Scale (EDI) was used. A logistic regression was performed to determine the strength of association between the factors to be studied. Results 269 participants were included, of which 224 (83.2%) presented their level of neurological maturation, 44 infants (16.4%) presented laged development and one (0.4%) was classified as having developmental delay. It was found that the number of daily hours that an electronic device is used behaved as a risk factor by increasing the risk of delayed language development by 1.37 times for each hour of exposure (OR: 1.37, CI95%: 1.15-1.62). Conclusions It was shown that a greater number of hours of use of electronic devices is a risk factor for delayed language development in children under 5 years of age. Therefore, it is vital to limit its use in this population.
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Affiliation(s)
- María Yvette Contreras-Silva
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 64, Servicio de Medicina Familiar. Santa Catarina, Nuevo León, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Neri Alejandro Álvarez-Villalobos
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 7, Servicio de Medicina Familiar. San Pedro Garza García, Nuevo León, MéxicoInstituto Mexicano del Seguro SocialMéxico
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México). Monterrey, Nuevo León, MéxicoUniversidad Autónoma de Nuevo LeónMéxico
| | - Humberto de León-Gutiérrez
- Universidad de Monterrey, Departamento de Posgrados, Medicina Familiar. Monterrey, Nuevo León, MéxicoUniversidad de MonterreyMéxico
| | - Gabriela Guadalupe Elizondo-Omaña
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 64, Servicio de Medicina Familiar. Santa Catarina, Nuevo León, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Gloria Navarrete-Floriano
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 64, Servicio de Medicina Familiar. Santa Catarina, Nuevo León, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Juan Carlos Romo-Salazar
- Instituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 64, Servicio de Medicina Familiar. Santa Catarina, Nuevo León, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Espinosa-Uribe A, Arrambide-Garza FJ, De León-Gutiérrez H, Ortiz-Garza J, Álvarez-Villalobos NA, Gutiérrez-de la O J, Quiroga-Garza A, Elizondo-Omaña RE, Guzmán-López S. Screws versus plate with screws for osteosynthesis of the posterior malleolus: a systematic review and meta-analysis. Acta Ortop Mex 2023; 37:183-190. [PMID: 38052441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
INTRODUCTION fractures involving the posterior malleolus (PM) of the ankle can have significant functional and clinical implications if not properly treated. The optimal treatment approach for these fractures remains uncertain. This review aims to compare the use of cannulated screws versus plate with screw fixation in terms of their impact on the development of postoperative ankle osteoarthritis and functional outcomes in patients with PM fractures. MATERIAL AND METHODS a comprehensive search was conducted in PubMed, EMBASE, and Cochrane Library databases to identify studies directly comparing cannulated screws versus plate with screw fixation for PM fractures and their association with the development of postoperative osteoarthritis and functional outcomes. The quality of the included studies was assessed using appropriate assessment tools. The data on osteoarthritis development and functional outcomes were extracted and analyzed. RESULTS a total of 691 articles were screened, and several studies were included for analysis. The findings revealed no statistically significant difference in the development of postoperative ankle osteoarthritis between the cannulated screws and plate with screw fixation groups. Similarly, there was no significant difference in functional outcomes between the two treatment approaches. CONCLUSION based on the available evidence, there is no significant difference in the development of postoperative ankle osteoarthritis or functional outcomes between cannulated screws and plate with screw fixation for PM fractures. However, further research is needed to strengthen these findings and provide more conclusive evidence.
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Affiliation(s)
- A Espinosa-Uribe
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, México
- Hospital Christus Muguerza, Alta Especialidad, Departamento de Ortopedia y Traumatología
| | - F J Arrambide-Garza
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, México
| | - H De León-Gutiérrez
- Universidad Autónoma de Nuevo León, School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), México
| | - J Ortiz-Garza
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, México
- Hospital Christus Muguerza, Alta Especialidad, Departamento de Ortopedia y Traumatología
| | - N A Álvarez-Villalobos
- Universidad Autónoma de Nuevo León, School of Medicine, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), México
- Knowledge and Evaluation Research Unit, Mayo Clinic
| | - J Gutiérrez-de la O
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, México
- Hospital Christus Muguerza, Alta Especialidad, Departamento de Ortopedia y Traumatología
| | - A Quiroga-Garza
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, México
- Instituto Mexicano del Seguro Social, Delegación Nuevo León, Monterrey, México
| | - R E Elizondo-Omaña
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, México
| | - S Guzmán-López
- Universidad Autónoma de Nuevo León, School of Medicine, Human Anatomy Department, México
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De la Cruz-de la Cruz C, De León-Gutiérrez H, Millán-Alanís JM, Bautista-Gómez AJ, Velasco-Sepúlveda BH, González-Martínez A, Álvarez-Villalobos NA. Acquiring Medical Statistical Competencies in a Demanding Evidence-Based World: Thoughts and Experience from a Student Statistical Team in a Mexican Academic Center. Int J Med Stud 2022. [DOI: 10.5195/ijms.2022.1614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Training and encouraging students to critically review the evidence and make evidence-based decisions should be one of the goals of medical education. We report our experience developing an extracurricular university student statistical team that offer statistical aid to other students and faculty. This includes supervised training sessions and mentoring in diverse scientific research fields performed in our university.
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Herz-Ruelas ME, Álvarez-Villalobos NA, Millán-Alanís JM, de León-Gutiérrez H, Ocampo-Garza SS, Gómez-Flores M, Grimalt R. Efficacy of Intralesional and Oral Dutasteride in the Treatment of Androgenetic Alopecia: A Systematic Review. Skin Appendage Disord 2020; 6:338-345. [PMID: 33313048 DOI: 10.1159/000510697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022] Open
Abstract
Androgenetic alopecia is the most common cause of hair loss [Br J Dermatol. 2011 Jan;164(1):5-15]. Finasteride and minoxidil are the only approved treatments [J Am Acad Dermatol. 2008 Oct;59(4):547-8 and J Eur Acad Dermatology Venereol. 2018 Jan;32(1):11-22]. Dutasteride is more potent than finasteride due to its ability to inhibit both 5-α-reductase type I and II [Our Dermatol Online. 2017 Sep;9(1):75-9] though its adverse effects and long half-life contribute to the reluctance on its oral use. Mesotherapy could be a feasible alternative to avoid systemic exposure and side effects [J Pan-Arab League Dermatologist. 2009 Feb;20(1):137-45]. We aim to perform a systematic review to analyze scientific literature with the purpose of comparing efficacy and adverse effects of both administration routes. Five clinical trials using oral route and 3 intralesional in comparison with placebo met criteria for inclusion. Regarding intralesional dutasteride, only one study [Clin Dermatol. 2001 Mar;19(2):149-54] reported the mean change in hair count. Although both interventions favor over placebo, there are not enough data to reliably compare outcomes obtained between both routes. Mean increase in hair count observed with oral dutasteride was higher (MD: 15.92 hairs [95% CI: 9.87-21.96]; p = <0.00001; I 2 = 90%) compared to intralesional dutasteride in Abdallah's study (MD: 7.90 hairs [95% CI: 7.14-8.66]; p = <0.00001). Future studies are required to assess the therapeutic efficacy of both treatment routes, including head-to-head treatments before well-supported conclusions can be established.
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Affiliation(s)
| | | | - Juan Manuel Millán-Alanís
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Sonia Sofía Ocampo-Garza
- Servicio de Dermatología, Hospital Universitario "Dr. José Eleuterio González", U.A.N.L, Monterrey, Mexico
| | - Minerva Gómez-Flores
- Servicio de Dermatología, Hospital Universitario "Dr. José Eleuterio González", U.A.N.L, Monterrey, Mexico
| | - Ramón Grimalt
- Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain
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Ramírez-Galván YA, Cardona-Huerta S, Elizondo-Riojas G, Álvarez-Villalobos NA, Campos-Coy MA, Ferrara-Chapa CM. Does axillary lymph node size predict better metastatic involvement than apparent diffusion coefficient (ADC) value in women with newly diagnosed breast cancer? Acta Radiol 2020; 61:1494-1504. [PMID: 32064890 DOI: 10.1177/0284185120903449] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND It has been demonstrated that the number of metastatic axillary lymph nodes (mALNs) influence disease-free and overall survival in patients with breast cancer. PURPOSE To determine if the ALN size is more accurate than the ALN apparent diffusion coefficient (ADC) value to predict metastatic involvement in newly diagnosed breast cancer. MATERIAL AND METHODS A total of 44 patients with breast cancer were included. Magnetic resonance imaging (MRI) examinations were performed on a 1.5-T system with sagittal T1-weighted fast spin-echo non-fat saturated, sagittal T2-weighted fast spin-echo non-fat saturated, axial diffusion-weighted imaging echo-planar (b values of 0 and 700 s/mm2), and non-contrast axial VIBRANT sequences. The size and the ADC value were obtained for ALN ipsilateral and contralateral to breast cancer. The reference standard was the histopathologic lymph node status. RESULTS mALN had a greater cortical thickness compared to contralateral non-mALN (10.3 ± 5.32 mm vs. 4 ± 1.17 mm, P ≤ 0.001). The threshold of ≥6.7 mm for predicting axillary metastatic involvement had a sensitivity and a specificity of 80.0% and 97.7%, respectively. The ADC value of mALN was significantly higher than the contralateral non-mALN (0.90 ± 0.12 × 10-3mm2/s vs. 0.78 ± 0.12 × 10-3mm2/s; P = 0.001). The threshold of ≥0.86 × 10-3mm2/s had a sensitivity and a specificity of 66.7% and 76.7%, respectively. CONCLUSION Our results indicate that the cortical thickness has a better diagnostic performance in the differentiation of metastatic and non-metastatic lymph nodes than the lymph node ADC.
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Affiliation(s)
- Yazmín Aseret Ramírez-Galván
- Department of Radiology and Imaging, Faculty of Medicine, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Servando Cardona-Huerta
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnológico de Monterrey, San Pedro Garza García, Nuevo León, México
| | - Guillermo Elizondo-Riojas
- Department of Radiology and Imaging, Faculty of Medicine, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Neri Alejandro Álvarez-Villalobos
- Clinical Research Unit, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Mario Alberto Campos-Coy
- Department of Radiology and Imaging, Faculty of Medicine, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Carla Melissa Ferrara-Chapa
- Department of Radiology and Imaging, Faculty of Medicine, Hospital Universitario “Dr. José Eleuterio González,” Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo León, México
- Department of Radiology and Imaging, Hospital General de Zona #33, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México
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Meléndez-Flores JD, Millán-Alanís JM, González-Martínez A, Álvarez-Villalobos NA, Estrada-Bellmann I. Does glitazone treatment have a role on the prevention of Parkinson's disease in adult diabetic population? A systematic review. Metab Brain Dis 2020; 35:1067-1075. [PMID: 32363472 DOI: 10.1007/s11011-020-00568-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/19/2020] [Indexed: 12/13/2022]
Abstract
Lately, focus on the relation between Parkinson's disease (PD) and Diabetes has risen greatly, as neuroprotective properties have been attributed to insulin use. Several studies have assessed the effect of glitazones, an insulin-sensitizing agent, in diabetic population on PD future risk. However, reports on the effect of their use have been heterogeneous. We aimed to synthesize the available scientific evidence which assesses the effect of glitazone use in type 2 diabetes patients on PD incidence. A systematic review was performed on multiple electronic databases. Considered for inclusion were studies that assessed the incidence of PD in type 2 diabetes glitazone users. Two reviewers worked independently and in duplicate to assess all studies, extract information and assess the methodological quality in each included study. Four high quality retrospective cohorts fulfilled inclusion criteria. Comparison groups varied across studies. In each study, incidence of PD was lower in glitazone-exposed patients compared to their respective comparison group. Pooled analysis showed lesser risk of PD in ever versus never glitazone users (RR 0.75 [95% C.I. 0.67-0.85; p < .0001; I2 = 0]). Our pooled analysis showed lesser risk of PD in glitazone versus non glitazone users, however, we advise to take results with caution since results are non-adjusted to possible confounding variables, furthermore, different glitazone-exposure time, follow up and comparison groups are aspects that also need to be pointed out. More clinical research focused on glitazone use and its relation with PD is needed, as this could result in new potential treatment modalities.
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Affiliation(s)
- Jesús D Meléndez-Flores
- Faculty of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico
- Neurology Division, Internal Medicine Department, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Juan Manuel Millán-Alanís
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | | | - Ingrid Estrada-Bellmann
- Neurology Division, Internal Medicine Department, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico.
- Movement Disorders Clinic, Neurology Division, Internal Medicine Department, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Mexico.
- Servicio de Neurología, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, 64700, Monterrey, NL, Mexico.
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Álvarez-Villalobos NA, Rodríguez-Gutiérrez R, González-Saldivar G, Sánchez-García A, Gómez-Flores M, Quintanilla-Sánchez C, Treviño-Álvarez AM, Mancillas-Adame LG, González-González JG. Acanthosis nigricans in middle-age adults: A highly prevalent and specific clinical sign of insulin resistance. Int J Clin Pract 2020; 74:e13453. [PMID: 31769902 DOI: 10.1111/ijcp.13453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/12/2019] [Accepted: 11/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Insulin resistance (IR) precedes the diagnosis of many metabolic and non-metabolic illnesses, including type 2 diabetes mellitus (T2DM). Acanthosis nigricans (AN) is a clinical sign associated with IR. However, AN prevalence and diagnostic accuracy in middle-age adults before or at the time of prediabetes/diabetes diagnosis remain uncertain. METHODS With the aim to define AN prevalence and diagnostic accuracy, adults between 40 and 60 years of age were consecutively invited to participate in the study. Participants were categorised into one of two main groups: individuals with normoglycaemia (group 1) and hyperglycaemia (group 2 [ie, prediabetes/diabetes]). Demographic, clinical, anthropometric characteristics, homeostasis model assessment of IR, homeostatic model assessment of β-cell function, as well as the presence of AN on the neck, axillae, elbows and knuckles were assessed. RESULTS A total of 320 consecutive participants with a mean age of 49.3 years (59.4% women) were included. Overall, AN prevalence was 46.3%, while AN in group 1 and group 2 was 36.3% and 49.6%, respectively (P = .04). The most common affected sites in group 1 (n = 80) were the knuckles (21.2%) and the neck (17.5%), while in group 2 (n = 240), the neck (29.6%) followed by the knuckles (26.7%). The specificity and positive predictive value of AN for IR were 0.85 and 0.86 in group 1 and 0.90 and 0.96 in group 2, respectively. CONCLUSIONS In middle-age adults, within the entire spectrum of carbohydrate tolerance, AN is highly prevalent and specific. This finding supports its assessment as a reliable and convenient clinical sign of IR. The understanding of AN behaviour through different carbohydrate tolerance strata, and its different locations, could lead to early detection of individuals at high metabolic risk or help direct a more pathophysiological treatment approach in patients with T2DM.
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Affiliation(s)
- Neri Alejandro Álvarez-Villalobos
- Research Unit, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - René Rodríguez-Gutiérrez
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Gloria González-Saldivar
- Dermatology Division, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Adriana Sánchez-García
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Minerva Gómez-Flores
- Dermatology Division, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Carolina Quintanilla-Sánchez
- Research Unit, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Andrés Marcelo Treviño-Álvarez
- Research Unit, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Leonardo Guadalupe Mancillas-Adame
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - José Gerardo González-González
- Research Unit, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
- Endocrinology Division, Facultad de Medicina y Hospital Universitario "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
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Sánchez-García A, Rodríguez-Gutiérrez R, Mancillas-Adame L, González-Nava V, Díaz González-Colmenero A, Solis RC, Álvarez-Villalobos NA, González-González JG. Diagnostic Accuracy of the Triglyceride and Glucose Index for Insulin Resistance: A Systematic Review. Int J Endocrinol 2020; 2020:4678526. [PMID: 32256572 PMCID: PMC7085845 DOI: 10.1155/2020/4678526] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/07/2020] [Accepted: 02/17/2020] [Indexed: 02/01/2023] Open
Abstract
UNLABELLED Introduction. The triglyceride and glucose (TyG) index has been described as a biochemical marker of insulin resistance (IR); however, its diagnostic accuracy remains uncertain. OBJECTIVE To summarize the evidence assessing the diagnostic accuracy of the TyG index regarding IR. METHODS A comprehensive search in MEDLINE, EMBASE, Web of Science, and Scopus was performed without any language restriction. Studies assessing the diagnostic accuracy of the TyG index against the hyperinsulinemic-euglycemic clamp (HIEC) or any other IR biochemical were assessed independently and in duplicate. Diagnostic accuracy measures (sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios) were extracted independently and in duplicate. The QUADAS-2 tool was used to assess the risk of bias of independent studies. RESULTS We identified 15 eligible studies with 69,922 participants and an overall quality of low to moderate. The TyG index was evaluated by HIEC and HOMA as reference tests. The highest achieved sensitivity was 96% using HIEC, and the highest specificity was of 99% using HOMA-IR, with a cutoff value of 4.68. AUC values varied from 0.59 to 0.88. Cutoff values for IR were variable between studies, limiting its comparability. CONCLUSION In this systematic review, we found moderate-to-low quality evidence about the usefulness of the TyG index as a surrogate biochemical marker of IR. Due to the lack of a standardized IR definition and heterogeneity between studies, further validation and standardized cutoff values are needed to be used in clinical practice.
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Affiliation(s)
- Adriana Sánchez-García
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez”, Endocrinology Division, Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
- Universidad Autonoma de Nuevo Leon, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
| | - René Rodríguez-Gutiérrez
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez”, Endocrinology Division, Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
- Universidad Autonoma de Nuevo Leon, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester 55905, MN, USA
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario“Dr. Jose Eleuterio Gonzalez”, Research Unit, Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
| | - Leonardo Mancillas-Adame
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez”, Endocrinology Division, Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
- Universidad Autonoma de Nuevo Leon, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
| | - Victoria González-Nava
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez”, Endocrinology Division, Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
- Universidad Autonoma de Nuevo Leon, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
| | - Alejandro Díaz González-Colmenero
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez”, Endocrinology Division, Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
- Universidad Autonoma de Nuevo Leon, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
| | - Ricardo Cesar Solis
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez”, Endocrinology Division, Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
- Universidad Autonoma de Nuevo Leon, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
| | - Neri Alejandro Álvarez-Villalobos
- Universidad Autonoma de Nuevo Leon, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester 55905, MN, USA
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario“Dr. Jose Eleuterio Gonzalez”, Research Unit, Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
| | - José Gerardo González-González
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario “Dr. Jose Eleuterio Gonzalez”, Endocrinology Division, Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
- Universidad Autonoma de Nuevo Leon, Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario“Dr. Jose Eleuterio Gonzalez”, Research Unit, Av. Madero y Gonzalitos S/n, Mitras Centro, Monterrey 64460, Nuevo León, Mexico
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Álvarez-Villalobos NA, Millán-Alanís JM. Bioestadística médica y práctica clínica: una necesaria pero poco frecuente relación. RMF 2019. [DOI: 10.24875/rmf.19000158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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González-Saldivar G, Rodríguez-Gutiérrez R, Viramontes-Madrid JL, Salcido-Montenegro A, Álvarez-Villalobos NA, González-Nava V, González-González JG. Participants' awareness of ethical compliance, safety and protection during participation in pharmaceutical industry clinical trials: a controlled survey. BMC Med Ethics 2019; 20:2. [PMID: 30621692 PMCID: PMC6323663 DOI: 10.1186/s12910-018-0344-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rapid increase of industry-sponsored clinical research towards developing countries has led to potentially complex ethical issues to assess. There is scarce evidence about the perception of these participants about the ethical compliance, security, and protection. We sought to evaluate and contrast the awareness and perception of participants and non-participants of industry-sponsored research trials (ISRT) on ethical, safety, and protection topics. METHODS A Cases-control survey conducted at twelve research sites in México. Previous and current participants of ISRT (cases) as well as non-participants (controls) with one of four chronic diseases, were asked to complete the survey which focused on ethical compliance and protection issues of ISRT, and the perception of participating in a trial. RESULTS A total of 604 cases and 604 controls were surveyed. Cases significantly answered that ethics committees are aware of what is happening in studies (50.5% vs. 33.8%, P = ≤ 0.001), and that medical care of industry-sponsored research trials is better than their usual medical care (77.2% vs. 38.2%, P = < 0.001). The same proportion of cases and controls thought patients must receive economical reimbursement for participating in a research study (49.5% vs. 53.1%, P = 0.205). The informed consent of the pharmaceutical clinical trial was fully read by 90.4% of the cases. Most cases were satisfied or very satisfied with their overall study participation (35.6 and 62.3%, respectively). CONCLUSION Previous and current participants of industry-sponsored research trials have a more positive attitude towards ethics committees, the quality of medical care of the research trials, and the main purpose of economical reimbursements, when compared to non-participants.
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Affiliation(s)
| | - René Rodríguez-Gutiérrez
- Endocrinology Division, Department of Internal Medicine, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico.,Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA.,Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Alejandro Salcido-Montenegro
- Endocrinology Division, Department of Internal Medicine, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico
| | - Neri Alejandro Álvarez-Villalobos
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA.,Clinical Research Unit, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico
| | - Victoria González-Nava
- Endocrinology Division, Department of Internal Medicine, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico.,Clinical Research Unit, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico
| | - José Gerardo González-González
- Endocrinology Division, Department of Internal Medicine, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico. .,Clinical Research Unit, "Dr. José E. González" University Hospital, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Mexico. .,Servicio de Endocrinología, Departamento de Medicina Interna, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Av. Francisco I. Madero y Av. Gonzalitos s/n, Colonia Mitras Centro, CP. 64460, Monterrey, Nuevo León, Mexico.
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13
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González-Saldivar G, Rodríguez-Gutiérrez R, Treviño-Alvarez AM, Gómez-Flores M, Montes-Villarreal J, Álvarez-Villalobos NA, Elizondo-Plazas A, Salcido-Montenegro A, Ocampo-Candiani J, González-González JG. Acanthosis nigricans in the knuckles: An early, accessible, straightforward, and sensitive clinical tool to predict insulin resistance. Dermatoendocrinol 2018; 10:e1471958. [PMID: 30279953 PMCID: PMC6166604 DOI: 10.1080/19381980.2018.1471958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/18/2018] [Accepted: 04/27/2018] [Indexed: 11/02/2022]
Abstract
Any clinical/biochemical marker revealing obesity or diabetes before their appearance is valuable. Insulin resistance (IR) is present in both disorders many years before occurrence. Accordingly, we determined whether acanthosis nigricans (AN) in the knuckles is associated to higher insulin and homeostasis model assessment for estimated insulin resistance (HOMA-IR) index values, and assessed the influence of body-mass index (BMI) and the diagnostic performance of AN in the knuckles to detect IR. In this cross-sectional controlled study, we included men or women, 18 to 23 years old, with or without AN in the knuckles. In 149 cases with AN in the knuckles and 145 controls, fasting insulin was higher in cases (13.45 µU/mL ± 7.8 vs. 8.59 µU/mL ± 3.63, P < .001, respectively). Mean HOMA-IR index was also higher (2.86 ± 1.68 vs. 1.78 ± 0.77, P < .001). A significant increase in fasting insulin and HOMA-IR values between and within BMI groups from normal through obese category was identified in controls and cases. By multivariate regression analysis, cases with normal BMI were significantly associated to a HOMA-IR ≥2.5 (OR = 3.09, CI95% = 1.75-5.48, P = .001). A model of AN in the knuckles, normal BMI, and increased waist circumference allowed identifying 2 out of 3 cases with HOMA-IR index ≥2.5. AN in the knuckles could be addressed with two aims: as an easy, accessible, and costless diagnostic tool suggesting hyperinsulinemia secondary to IR, and, an early marker of IR even in the absence of overweight or obesity.
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Affiliation(s)
- Gloria González-Saldivar
- Dermatology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - René Rodríguez-Gutiérrez
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico.,Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Andrés Marcelo Treviño-Alvarez
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Minerva Gómez-Flores
- Dermatology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Juan Montes-Villarreal
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Neri Alejandro Álvarez-Villalobos
- Clinical Research Unit, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Anasofía Elizondo-Plazas
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Alejandro Salcido-Montenegro
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Jorge Ocampo-Candiani
- Dermatology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - José Gerardo González-González
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
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Ramírez-Galván YA, Cardona-Huerta S, Elizondo-Riojas G, Álvarez-Villalobos NA. Apparent Diffusion Coefficient Value to Evaluate Tumor Response After Neoadjuvant Chemotherapy in Patients with Breast Cancer. Acad Radiol 2018; 25:179-187. [PMID: 29033147 DOI: 10.1016/j.acra.2017.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/10/2017] [Accepted: 08/28/2017] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES This study explored tumor behavior in patients with breast cancer during neoadjuvant chemotherapy (NAC) by sequential measurements of tumor apparent diffusion coefficient (ADC) after each chemotherapy cycle. The aim was to determine if the tumor ADC is useful to differentiate complete pathological response (cPR) from partial pathological response (pPR) during NAC. MATERIALS AND METHODS A total of 16 cases (in 14 patients) with diagnosis of breast cancer eligible to receive NAC were included. There were 70 magnetic resonance imaging examinations performed, 5 for each patient, during NAC cycles. Diffusion-weighted imaging was performed on a 1.5T system (b values of 0 and 700s/mm2). Four ADC ratios between the five MRI examinations were obtained to assess ADC changes during NAC. Absence of invasive breast cancer at surgical specimens (Miller-Payne 5) was considered as cPR and was used as reference for ADC cutoff ratios. RESULTS In this study, we were able to differentiate between cPR and pPR, after two cycles of NAC until the end of NAC before surgery (ADC ratios 2-4). The thresholds to differentiate between cPR and pPR of ADC ratios 2, 3, and 4, were 1.14 × 10-3mm2/s, 1.08 × 10-3mm2/s, and 1.25 × 10-3mm2/s, respectively, and have a cross-validated sensitivity and specificity of 79.2%, 79.7% (ADC ratio 2); 100%, 66.7% (ADC ratio 3); and 100%, 83.8% (ADC ratio 4), respectively. CONCLUSIONS The ADC ratios were useful to differentiate cPR from pPR in breast cancer tumors after NAC. Thus, it may be useful in tailoring treatment in these patients.
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González-Saldivar G, Rodríguez-Gutiérrez R, Viramontes-Madrid JL, Salcido-Montenegro A, Carlos-Reyna KEG, Treviño-Alvarez AM, Álvarez-Villalobos NA, González-González JG. Participants' perception of pharmaceutical clinical research: a cross-sectional controlled study. Patient Prefer Adherence 2016; 10:727-34. [PMID: 27199549 PMCID: PMC4857804 DOI: 10.2147/ppa.s96021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is scarce scientific information assessing participants' perception of pharmaceutical research in developed and developing countries concerning the risks, safety, and purpose of clinical trials. METHODS To assess the perception that 604 trial participants (cases) and 604 nonparticipants (controls) of pharmaceutical clinical trials have about pharmaceutical clinical research, we surveyed participants with one of four chronic diseases from 12 research sites throughout Mexico. RESULTS Participation in clinical trials positively influences the perception of pharmaceutical clinical research. More cases (65.4%) than controls (50.7%) perceived that the main purpose of pharmaceutical research is to cure more diseases and to do so more effectively. In addition, more cases considered that there are significant benefits when participating in a research study, such as excellent medical care and extra free services, with this being the most important motivation to participate for both groups (cases 52%, controls 54.5%). We also found a sense of trust in their physicians to deal with adverse events, and the perception that clinical research is a benefit to their health, rather than a risk. More controls believed that clinical trial participants' health is put at risk (57% vs 33.3%). More cases (99.2%) than controls (77.5%) would recommend participating in a clinical trial, and 90% of cases would enroll in a clinical trial again. CONCLUSION Participation in clinical trials positively influences the perception that participants have about pharmaceutical clinical research when compared to nonparticipants. This information needs to be conveyed to clinicians, public health authorities, and general population to overcome misconceptions.
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Affiliation(s)
- Gerardo González-Saldivar
- Ophthalmology Department, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - René Rodríguez-Gutiérrez
- Endocrinology Division, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | | | - Alejandro Salcido-Montenegro
- Endocrinology Division, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Kevin Erick Gabriel Carlos-Reyna
- Endocrinology Division, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Andrés Marcelo Treviño-Alvarez
- Endocrinology Division, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Neri Alejandro Álvarez-Villalobos
- Medical Statistics Department, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - José Gerardo González-González
- Endocrinology Division, Hospital Universitario “Dr. José E. González”, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
- Correspondence: José Gerardo González-González, Endocrinology Division, Hospital Universitario “Dr. José E. González,” Facultad de Medicina, Universidad Autónoma de Nuevo León, Ave Madero y Gonzalitos s/n, Col Mitras Centro, CP 64460 Monterrey, Nuevo León, Mexico, Tel/fax +52 81 8348 3220, Email
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Rodríguez-Gutiérrez R, Rendon A, Barrera-Sánchez M, Carlos-Reyna KEG, Álvarez-Villalobos NA, González-Saldivar G, González-González JG. Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test. Int J Endocrinol 2016; 2016:9051865. [PMID: 27006656 PMCID: PMC4781954 DOI: 10.1155/2016/9051865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/14/2016] [Accepted: 01/26/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Multidrug-resistant tuberculosis (MDR-TB) is a major public health care concern that affects the life of millions of people around the world. The association of tuberculosis and adrenal insufficiency is well known; however, it is thought to be less prevalent every time. A spike in TB incidence and a lack of evidence of this association in patients with MDR-TB call for reassessment of an illness (adrenal dysfunction) that if not diagnosed could seriously jeopardize patients' health. Objective. To determine the prevalence of adrenocortical insufficiency in patients with MDR-TB using the low-dose (1 μg) ACTH stimulation test at baseline and at 6-12 months of follow-up after antituberculosis treatment and culture conversion. Methods. A total of 48 men or women, aged ≥18 years (HIV-negative patients diagnosed with pulmonary MDR-TB) were included in this prospective observational study. Blood samples for serum cortisol were taken at baseline and 30 and 60 minutes after 1 μg ACTH stimulation at our tertiary level university hospital before and after antituberculosis treatment. Results. Forty-seven percent of subjects had primary MDR-TB; 43.8% had type 2 diabetes; none were HIV-positive. We found at enrollment 2 cases (4.2%) of adrenal insufficiency taking 500 nmol/L as the standard cutoff point value and 4 cases (8.3%) alternatively, using 550 nmol/L. After antituberculosis intensive phase drug-treatment and a negative mycobacterial culture (10.2 ± 3.6 months) adrenocortical function was restored in all cases. Conclusions. In patients with MDR-TB, using the low-dose ACTH stimulation test, a low prevalence of mild adrenal insufficiency was observed. After antituberculosis treatment adrenal function was restored in all cases. Given the increasing and worrying epidemic of MDR-TB these findings have important clinical implications that may help clinicians and patients make better decisions when deciding to test for adrenocortical dysfunction or treat insufficient stimulated cortisol levels in the setting of MDR-TB.
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Affiliation(s)
- René Rodríguez-Gutiérrez
- Endocrinology Division, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
- Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN 55905, USA
- Division of Endocrinology, Diabetes, Metabolism & Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Adrian Rendon
- Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
- Centro de Investigacion, Prevencion y Tratamiento de Infecciones Respiratorias (CIPTIR), Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
| | - Maximiliano Barrera-Sánchez
- Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
| | - Kevin Erick Gabriel Carlos-Reyna
- Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
| | | | - Gloria González-Saldivar
- Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
| | - José Gerardo González-González
- Endocrinology Division, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
- Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
- Clinical Research Unit, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
- *José Gerardo González-González:
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