Tonatiuh González Heredia | Universidad de Guadalajara (original) (raw)
Papers by Tonatiuh González Heredia
Revista Ciencias de la Salud, 2022
Introduction: Medical students could potentially be considered as a vulnerable group in terms of ... more Introduction: Medical students could potentially be considered as a vulnerable group in terms of increased risk for anxiety and sleep disorders. This could be caused by high academic demands, and high levels of stress. There is little information, however, when it comes to the relationship between anxiety and excessive daytime sleepiness among medical students, and the potentially negative effects this relationship could have upon student health and academic performance. The objective was to identify the association between anxiety and excessive daytime sleepiness in medical students of the University of Guadalajara (Mexico). Materials and methods: A cross-sectional study was carried out, evaluating 173 students between January and April of 2019. The Epworth Sleepiness Scale was used for the determination of excessive daytime sleepiness, while the anxiety symptoms were measured using the Beck Anxiety Inventory. According to the cut-off points for the Epworth scales, the cut-off poin...
Critical Care Research and Practice, 2021
Introduction. Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nu... more Introduction. Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nutritional assessment in the critically ill population are scarce. This study was conducted to evaluate the modified Nutrition Risk in the Critically Ill (mNUTRIC)-Score as a mortality risk factor in mechanically ventilated patients with COVID-19. Methods. We conducted this retrospective observational study in critically ill patients with COVID-19. Patients’ characteristics and clinical information were obtained from electronic medical records. The nutritional risk for each patient was assessed at the time of mechanical ventilation using the mNUTRIC-Score. The major outcome was 28-day mortality. Results. Ninety-eight patients were analyzed (mean age, 57.22 ± 13.66 years, 68.4% male); 46.9% of critically ill COVID-19 patients were categorized as being at high nutrition risk (mNUTRIC-Score of ≥5). A multivariate logistic regression model indicated that high nutritional risk has higher 28-da...
Global Public Health, 2020
ABSTRACT A relationship between anxious depression has been proposed in patients with diabetes, w... more ABSTRACT A relationship between anxious depression has been proposed in patients with diabetes, which may contribute to the lack of medication adherence. The aim of this study was to investigate if there is a relationship between depression and / or anxiety with medication adherence and glycemic control in patients with type 2 Diabetes Mellitus (DM2). An analytical, cross-sectional study was carried out in the internal medicine outpatient clinic of a Hospital in Mexico. Patients with DM2 participated over a period from November 2015 to January 2016. The Morisky scale for medication adherence, and the Goldberg anxiety and depression scale were conducted for each patient. Data was collected from a total of 179 patients. There was a significant difference between anxious depression and medication adherence (p < 0.001) using logistic regression with an R2 of 0.136. There was also a significant difference between anxiety and glycemic control (p < 0.001) with an R2 of 0.175, however no significant difference was found between glycemic control and anxious depression. Our findings demonstrate that patients who suffer from anxious depression also tend to have reduced medication adherence, and anxiety was associated with poor glycemic control in patients with DM2 within the Mexican population.
BackgroundThe incidence of mental disorders during major events is higher in prenatal and postnat... more BackgroundThe incidence of mental disorders during major events is higher in prenatal and postnatal women than in the general population. The COVID-19 pandemic, subsequent lockdown, and social distancing may have caused changes in newborn mothers’ mental health, postpartum depression (PPD), and breastfeeding practices. There is no information about this topic in Mexican mothers who have delivered newborns during the COVID-19 pandemic lockdown. The objective of this study was to explore whether quarantine measures, social distancing, and hospital containment policies altered the incidence rates of PPD, breastfeeding adherence, and skin-to-skin contact (SSC) in women giving birth during the COVID-19 pandemic.MethodsThis cross-sectional study included women who delivered a healthy baby at term in February to July 2020 during the COVID-19 pandemic. Participants completed an anonymous online survey incorporating the Edinburgh Postnatal Depression Scale.ResultsA total of 211 participants ...
Objetivo: Evaluar el efecto de exenatida aplicada 2 veces al dia en diferentes horarios de ingest... more Objetivo: Evaluar el efecto de exenatida aplicada 2 veces al dia en diferentes horarios de ingesta de alimento, sobre variabilidad y control glucemicos en pacientes con diabetes mellitus tipo 2 (DM2). Materiales y metodos: Ensayo clinico aleatorizado, abierto, en 18 adultos con DM2, sobrepeso u obesidad e inadecuado control glucemico con metformina como monoterapia. La glucosa de ayuno fue < 12 mmol/l y la hemoglobina glucosilada A1c entre 7 y 9%. Todos los pacientes recibieron exenatida (5 µg, 2/dia) subcutanea durante cuatro semanas y continuaron la metformina durante el estudio. Se distribuyeron al azar seis sujetos a cada horario de aplicacion preprandial de exenatida: a) desayuno y comida; b) desayuno y cena, o c) comida y cena. Al inicio y cuatro semanas despues, se midio glucosa cada hora durante 24 h. Se calcularon el area bajo la curva (ABC) de glucosa y variabilidad glucemica; esta ultima mediante la media de la amplitud de las excursiones de glucosa (MAEG). Resultados:...
Nutrición Hospitalaria, 2020
Loss of muscle strength in patients under hemodialysis evaluated by dynamometry in the Mexican po... more Loss of muscle strength in patients under hemodialysis evaluated by dynamometry in the Mexican population Pérdida de fuerza muscular en pacientes en hemodiálisis evaluados mediante dinamometría en la población mexicana
Biomedical Research, 2018
Background: Researching the topic of glycemic variability (GV) has been very interesting due to t... more Background: Researching the topic of glycemic variability (GV) has been very interesting due to the possible relationship that exists between this phenomenon and the development of micro-and macrovascular complications. The aim of this investigation was to evaluate the effect that metformin had on the GV in pre-diabetic patients. Materials and methods: A randomized, double-blind, placebo-controlled clinical trial was carried out in 20 subjects, both male and female participants were chosen. These subjects where then divided into 2 groups; 10 subjects received metformin (500 mg) while the remaining 10 subjects received a placebo, twice daily, before breakfast and dinner over the course of 90 days. Metabolic screening, which included glycated hemoglobin A1c, fasting plasma glucose (FPG), 2 h oral glucose tolerance test with 75 g of dextrose and GV [area under the curve of glucose, mean amplitude of glycemic excursion (MAGE)], were measured for all patients at baseline and at the end of the study. Wilcoxon signed-rank, and Mann-Whitney test were performed as part of the statistical analysis. Results: Baseline characteristics of both groups were similar. There was a significant decrease of FPG levels in the metformin group as compared to placebo (6.3 ± 0.7 vs. 5.6 ± 1.0 mmol/L, p=0.047). There were no significant differences in the GV parameters in either of the two study groups. Conclusion: Pre-diabetic subjects treated with metformin for 3 months showed a significant decrease in FPG when compared to placebo.
West Indian Medical Journal, 2016
Aim: The aim of the study is to evaluate the effect of linagliptin versus metformin on insulin se... more Aim: The aim of the study is to evaluate the effect of linagliptin versus metformin on insulin secretion, insulin sensitivity and glucose control in patients with impaired glucose tolerance (IGT). Patients and methods: A randomized, double-blind, clinical trial with parallel groups was performed on 16 adults with IGT. Lipid profile and haemoglobin (HbA 1c) were evaluated prior to and after the intervention. Glucose and insulin were measured at 0, 30, 60, 90 and 120 minutes after a 75-g oral dextrose load. Eight patients received metformin (500 mg) twice a day before meals for three months. The remaining eight patients received placebo (500 mg) in the morning and linagliptin (5 mg) in the evening before meals. The area under the curve (AUC) of glucose and insulin, total insulin secretion, first-phase of insulin secretion, and insulin sensitivity were assessed.
Diabetes Technology & Therapeutics, 2017
BACKGROUND Impaired glucose tolerance (IGT) and glycemic variability may be associated with incre... more BACKGROUND Impaired glucose tolerance (IGT) and glycemic variability may be associated with increased risk of micro- and macrovascular complications. The aim of this study was to assess the effect of linagliptin versus metformin on glycemic variability in patients with IGT. MATERIAL AND METHODS A randomized, double-blind clinical trial with parallel groups was carried out in 16 adult patients with IGT, overweight or obesity. All patients signed an informed consent. The therapies were randomly assigned: (a) metformin 500 mg bid (n = 8) or (b) linagliptin 5 mg a.m. and placebo p.m. (n = 8), both for 90 days. At the beginning of the trial and 3 months later, fasting glucose, glycated hemoglobin A1c, oral glucose tolerance test (OGTT), and glycemic variability [area under the curve (AUC) of glucose, mean amplitude of glycemic excursion (MAGE), standard deviation (SD) of glucose, coefficient of variation (CV) of glucose, and mean blood glucose (MBG)] were measured. Mann-Whitney U, Wilcoxon, and Fisher exact tests were used for statistical analyses. RESULTS Both groups were similar in basal characteristics. After linagliptin administration, a significant decrease in glucose levels at 120 min of OGTT (9.0 ± 0.9 vs. 6.9 ± 2.2 mmol/L, P = 0.012) was observed. Glycemic variability showed a similar behavior and there were no significant differences in the AUC, MAGE, SD of glucose, CV of glucose, and MBG between groups. CONCLUSION Linagliptin administration resulted in better glycemic control according to the decrease of glucose levels by the OGTT at 120 min in patients with IGT. Meanwhile, glycemic variability was not modified in any of the study groups.
Journal of Alzheimer's Disease, 2016
Exposure to fine particulate matter (PM 2.5) and ozone (O 3) above US EPA standards is associated... more Exposure to fine particulate matter (PM 2.5) and ozone (O 3) above US EPA standards is associated with Alzheimer's disease (AD) risk, while Mn toxicity induces parkinsonism. Mexico City Metropolitan Area (MCMA) children have pre-and postnatal sustained and high exposures to PM 2.5 , O 3, polycyclic aromatic hydrocarbons, and metals. Young MCMA residents exhibit frontal tau hyperphosphorylation and amyloid- (A) 1−42 diffuse plaques, and aggregated and hyperphosphorylated ␣-synuclein in olfactory nerves and key brainstem nuclei. We measured total prion protein (TPrP), total tau (T-tau), tau phosphorylated at threonine 181 (P-Tau), A 1-42 , ␣-synuclein (t-␣-syn and d-␣-synuclein), BDNF, insulin, leptin, and/or inflammatory mediators, in 129 normal CSF samples from MCMA and clean air controls. A 1-42 and BDNF concentrations were significantly lower in MCMA children versus controls (p = 0.005 and 0.02, respectively). TPrP increased with cumulative PM 2.5 up to 5 g/m 3 and then decreased, regardless of cumulative value or age (R 2 = 0.56). TPrP strongly correlated with T-Tau and P-Tau, while d-␣-synuclein showed a significant correlation with TNF␣, IL10, and IL6 in MCMA children. Total synuclein showed an increment in childhood years related to cumulated PM 2.5, followed by a decrease after age 12 years
CIERMMI Women in Science Medicine and Health Sciences Handbooks T-XIII, 2021
The promotion of healthy lifestyles amongst medical students is important in reducing alterations... more The promotion of healthy lifestyles amongst medical students is important in reducing alterations in their emotional state and the creation of healthier habits which, when adopted at this stage, could influence the promotion of better lifestyles for their patients. This current study intends to evaluate health risk behaviors and their relationship with the emotional state in medical students. An analytical cross-sectional study was carried out, evaluating 173 students of a public university between January and March of 2019, evaluating anxiety (Beck Anxiety Inventory, BAI), depression (Beck Depression Inventory, BDI-II), alcohol and nicotine dependence (Alcohol Use Disorders Identification Test, AUDIT, Fagerström Physical Nicotine Dependence), and Body mass index (BMI). sociodemographic and clinical data was collected through an interview. An association was found between anxiety and a sedentary (p = 0.01, OR = 0.446, CI = 0.24 - 0.83), and depression with alcohol consumption (p = 0...
BMC Public Health
Background The national health and nutrition survey allows to know the state of health of the Mex... more Background The national health and nutrition survey allows to know the state of health of the Mexican population, it provides data for the analysis of different factors and / or indicators of health, diseases and nutritional conditions, such as chronic degenerative diseases and depressive symptoms, which, in turn, if both occur simultaneously, they will have a negative impact on health. This article studies the four factors involved in the overall health of the population in Mexico: excess weight, diabetes, high blood pressure, and depressive symptoms, which are used to conduct a multidimensional characterization and analysis. Methods Two methodological resources are applied, a descriptive statistical characterization and the construction of a multidimensional health index with the use of fuzzy sets, through the National Health and Nutrition Survey (ENSANUT 2018–19 - for its acronym in Spanish) in Mexico. Results The results reveal a growing percentage of individuals who experience ...
BMC Gastroenterology, Mar 26, 2020
BackgroundThe prevalence of malnutrition remains high in hospitals but no “gold standard” has bee... more BackgroundThe prevalence of malnutrition remains high in hospitals but no “gold standard” has been established to identify nutritional risks adequately. The Nutrition Risk Screening-2002 (NRS-2002), Subjective Global Assessment (SGA), and Controlling Nutritional Status Index (CONUT) are widely used screening tools, but their efficacy has not yet been compared in Mexican patients. Here, we aimed to compare the efficacy of these tools in identifying nutritional risks within the first 48 h of admission in a group of patients with gastrointestinal diseases.MethodsThis was a cross-sectional study of 196 patients. The results of the screening tools, length of hospital stay, serum albumin and cholesterol concentrations, lymphocyte counts, age, body mass index (BMI), complications, and mortality were analyzed. Kappa (κ) statistics were applied to determine the degree of agreement between tools. The performances of the screening tools in predicting complications and mortality were assessed using binary logistic regression.ResultsThe NRS-2002, SGA, and CONUT tools identified nutritional risk in 67, 74, and 51% of the patients, respectively. The observed agreements between tools were: NRS2002/SGA, κ = 0.53; CONUT/NRS-2002, κ = 0.42; and SGA/CONUT, κ = 0.36. Within age groups, the best agreement was found in those aged 51–65 years (κ = 0.68). CONUT and length of stay were both predictive for the number of complications. The number of complications and serum cholesterol concentrations were predictive for mortality.ConclusionsThe proportion of patients identified as having nutritional risk was high using all three screening tools. SGA, NRS-2002, and CONUT had similar capacities for screening risk, but the best agreement was observed between NRS-2002 and SGA. Only CONUT predicted complications, but none of these tools performed well in predicting mortality.
West Indian Med J, 2016
Aim: to evaluate the effect of linagliptin vs. metformin on insulin secretion, insulin sensitivit... more Aim: to evaluate the effect of linagliptin vs. metformin on insulin secretion, insulin sensitivity and glucose control in patients with impaired glucose tolerance (IGT). Patients and methods: a randomized, double-blind, clinical trial with parallel groups was performed in 16 adults with IGT. Lipid profile and A1C were evaluated prior to and after the intervention. Glucose and insulin were measured at 0, 30, 60, 90 and 120 min after a 75-g oral dextrose load. Eight patients received metformin (500 mg) twice a day before meals for 3 months. The remaining eight patients received placebo (500 mg) in the morning and linagliptin (5 mg) in the evening before meals. Area under the curve (AUC) of glucose and insulin, total insulin secretion, first-phase of insulin secretion, and insulin sensitivity were assessed. Results: after linagliptin administration, a significant decrease in glucose at 90 min (10.8 ± 2.6 vs. 7.9 ± 2.2 mmol/L; p <0.05), 120 min (8.8 ± 0.9 mmol/L; p <0.05) and AUC of glucose (1168 ± 210 vs. 953 ± 207 mmol/l; p <0.05) were observed. Metformin administration decreased insulin significantly at 0 min (94.8 ± 25.8 vs. 73.8 ± 24.6 pmol/L; p <0.05). Conclusion: 3-month administration of linagliptin in patients with IGT decreased glucose at 90 and 120 min after a 75-g oral dextrose load and AUC of glucose. Metformin decreased insulin at 0 min.
The Journal of Alzheimer’s Disease, 2016
Abstract. Exposure to fine particulate matter (PM2.5) and ozone (O3) above US EPA standards is as... more Abstract. Exposure to fine particulate matter (PM2.5) and ozone (O3) above US EPA standards is associated with Alzheimer’s disease (AD) risk, while Mn toxicity induces parkinsonism. Mexico City Metropolitan Area (MCMA) children have pre- and postnatal sustained and high exposures to PM2.5, O3, polycyclic aromatic hydrocarbons, and metals. Young MCMA residents exhibit frontal tau hyperphosphorylation and amyloid- (A)1− 42 diffuse plaques, and aggregated and hyperphosphorylated -synuclein in olfactory nerves and key brainstem nuclei. We measured total prion protein (TPrP), total tau (T-tau), tau phosphorylated at threonine 181 (P-Tau), A1–42, -synuclein (t--syn and d--synuclein), BDNF, insulin, leptin, and/or inflammatory mediators, in 129 normal CSF samples from MCMA and clean air controls. A1–42 and BDNF concentrations were significantly lower in MCMA children versus controls (p = 0.005 and 0.02, respectively). TPrP increased with cumu- lative PM2.5 up to 5 g/m3 and then decreased, regardless of cumulative value or age (R2 = 0.56). TPrP strongly correlated with T-Tau and P-Tau, while d--synuclein showed a significant correlation with TNF, IL10, and IL6 in MCMA children. Total synuclein showed an increment in childhood years related to cumulated PM2.5, followed by a decrease after age 12 years (R2 =0.47), while d--synuclein exhibited a tendency to increase with cumulated PM2.5 (R2 =0.30). CSF A1–42, BDNF, -synuclein, and TPrP changes are evolving in young MCMA urbanites historically showing underperformance in cognitive processes, odor identification deficits, downregulation of frontal cellular PrP, and neuropathological AD and PD hallmarks. Neuroprotection of young MCMA residents ought to be a public health priority.
Biomedical Research, 2018
Background: Researching the topic of glycemic variability (GV) has been very interesting due to t... more Background: Researching the topic of glycemic variability (GV) has been very interesting due to the possible relationship that exists between this phenomenon and the development of micro-and macrovascular complications. The aim of this investigation was to evaluate the effect that metformin had on the GV in pre-diabetic patients. Materials and methods: A randomized, double-blind, placebo-controlled clinical trial was carried out in 20 subjects, both male and female participants were chosen. These subjects where then divided into 2 groups; 10 subjects received metformin (500 mg) while the remaining 10 subjects received a placebo, twice daily, before breakfast and dinner over the course of 90 days. Metabolic screening, which included glycated hemoglobin A1c, fasting plasma glucose (FPG), 2 h oral glucose tolerance test with 75 g of dextrose and GV [area under the curve of glucose, mean amplitude of glycemic excursion (MAGE)], were measured for all patients at baseline and at the end of the study. Wilcoxon signed-rank, and Mann-Whitney test were performed as part of the statistical analysis. Results: Baseline characteristics of both groups were similar. There was a significant decrease of FPG levels in the metformin group as compared to placebo (6.3 ± 0.7 vs. 5.6 ± 1.0 mmol/L, p=0.047). There
REVISTA MEXICANA DE ENDOCRINOLOGÍA, METABOLISMO & NUTRICIÓN., 2016
ABSTRACT Objective: To assess the effect of exenatide twice daily ac- cording to different meal s... more ABSTRACT
Objective: To assess the effect of exenatide twice daily ac- cording to different meal schedules on glycemic control and variability in patients with type 2 diabetes mellitus. Materi- als and methods: A randomized, open clinical trial was per- formed in 18 adults with type 2 diabetes mellitus who were overweight or obesity and inadequate glycemic control with metformin as monotherapy. Fasting glucose was < 12 mmol/l and glycated hemoglobin A1c between 7-9%. All patients received exenatide (5 μg twice daily) subcutaneously for four weeks and continued taking metformin at the same dose throughout the study. A randomized distribution of six sub- jects was conducted to each of the following pre-prandial times of application of exenatide: (i) breakfast and lunch, (ii) breakfast and dinner, or (iii) lunch and dinner. At the begin- ning and four weeks later, glucose concentrations were mea- sured every hour during a 24-hour period. Area under the curve of glucose and glycemic variability according to the mean amplitude of glycemic excursions was calculated.
DIABETES TECHNOLOGY & THERAPEUTICS, 2017
Abstract Background: Impaired glucose tolerance (IGT) and glycemic variability may be associated... more Abstract
Background: Impaired glucose tolerance (IGT) and glycemic variability may be associated with increased risk of micro- and macrovascular complications. The aim of this study was to assess the effect of linagliptin versus metformin on glycemic variability in patients with IGT.
Material and Methods: A randomized, double-blind clinical trial with parallel groups was carried out in 16 adult patients with IGT, overweight or obesity. All patients signed an informed consent. The therapies were randomly assigned: (a) metformin 500 mg bid (n = 8) or (b) linagliptin 5 mg a.m. and placebo p.m. (n = 8), both for 90 days. At the beginning of the trial and 3 months later, fasting glucose, glycated hemoglobin A1c, oral glucose tolerance test (OGTT), and glycemic variability [area under the curve (AUC) of glucose, mean am- plitude of glycemic excursion (MAGE), standard deviation (SD) of glucose, coefficient of variation (CV) of glucose, and mean blood glucose (MBG)] were measured. Mann–Whitney U, Wilcoxon, and Fisher exact tests were used for statistical analyses.
Results: Both groups were similar in basal characteristics. After linagliptin administration, a significant de- crease in glucose levels at 120 min of OGTT (9.0 –0.9 vs. 6.9 –2.2 mmol/L, P = 0.012) was observed. Glycemic variability showed a similar behavior and there were no significant differences in the AUC, MAGE, SD of glucose, CV of glucose, and MBG between groups.
Conclusion: Linagliptin administration resulted in better glycemic control according to the decrease of glucose levels by the OGTT at 120 min in patients with IGT. Meanwhile, glycemic variability was not modified in any of the study groups.
Revista Ciencias de la Salud, 2022
Introduction: Medical students could potentially be considered as a vulnerable group in terms of ... more Introduction: Medical students could potentially be considered as a vulnerable group in terms of increased risk for anxiety and sleep disorders. This could be caused by high academic demands, and high levels of stress. There is little information, however, when it comes to the relationship between anxiety and excessive daytime sleepiness among medical students, and the potentially negative effects this relationship could have upon student health and academic performance. The objective was to identify the association between anxiety and excessive daytime sleepiness in medical students of the University of Guadalajara (Mexico). Materials and methods: A cross-sectional study was carried out, evaluating 173 students between January and April of 2019. The Epworth Sleepiness Scale was used for the determination of excessive daytime sleepiness, while the anxiety symptoms were measured using the Beck Anxiety Inventory. According to the cut-off points for the Epworth scales, the cut-off poin...
Critical Care Research and Practice, 2021
Introduction. Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nu... more Introduction. Nutritional risk is highly prevalent in patients with COVID-19. Relevant data on nutritional assessment in the critically ill population are scarce. This study was conducted to evaluate the modified Nutrition Risk in the Critically Ill (mNUTRIC)-Score as a mortality risk factor in mechanically ventilated patients with COVID-19. Methods. We conducted this retrospective observational study in critically ill patients with COVID-19. Patients’ characteristics and clinical information were obtained from electronic medical records. The nutritional risk for each patient was assessed at the time of mechanical ventilation using the mNUTRIC-Score. The major outcome was 28-day mortality. Results. Ninety-eight patients were analyzed (mean age, 57.22 ± 13.66 years, 68.4% male); 46.9% of critically ill COVID-19 patients were categorized as being at high nutrition risk (mNUTRIC-Score of ≥5). A multivariate logistic regression model indicated that high nutritional risk has higher 28-da...
Global Public Health, 2020
ABSTRACT A relationship between anxious depression has been proposed in patients with diabetes, w... more ABSTRACT A relationship between anxious depression has been proposed in patients with diabetes, which may contribute to the lack of medication adherence. The aim of this study was to investigate if there is a relationship between depression and / or anxiety with medication adherence and glycemic control in patients with type 2 Diabetes Mellitus (DM2). An analytical, cross-sectional study was carried out in the internal medicine outpatient clinic of a Hospital in Mexico. Patients with DM2 participated over a period from November 2015 to January 2016. The Morisky scale for medication adherence, and the Goldberg anxiety and depression scale were conducted for each patient. Data was collected from a total of 179 patients. There was a significant difference between anxious depression and medication adherence (p < 0.001) using logistic regression with an R2 of 0.136. There was also a significant difference between anxiety and glycemic control (p < 0.001) with an R2 of 0.175, however no significant difference was found between glycemic control and anxious depression. Our findings demonstrate that patients who suffer from anxious depression also tend to have reduced medication adherence, and anxiety was associated with poor glycemic control in patients with DM2 within the Mexican population.
BackgroundThe incidence of mental disorders during major events is higher in prenatal and postnat... more BackgroundThe incidence of mental disorders during major events is higher in prenatal and postnatal women than in the general population. The COVID-19 pandemic, subsequent lockdown, and social distancing may have caused changes in newborn mothers’ mental health, postpartum depression (PPD), and breastfeeding practices. There is no information about this topic in Mexican mothers who have delivered newborns during the COVID-19 pandemic lockdown. The objective of this study was to explore whether quarantine measures, social distancing, and hospital containment policies altered the incidence rates of PPD, breastfeeding adherence, and skin-to-skin contact (SSC) in women giving birth during the COVID-19 pandemic.MethodsThis cross-sectional study included women who delivered a healthy baby at term in February to July 2020 during the COVID-19 pandemic. Participants completed an anonymous online survey incorporating the Edinburgh Postnatal Depression Scale.ResultsA total of 211 participants ...
Objetivo: Evaluar el efecto de exenatida aplicada 2 veces al dia en diferentes horarios de ingest... more Objetivo: Evaluar el efecto de exenatida aplicada 2 veces al dia en diferentes horarios de ingesta de alimento, sobre variabilidad y control glucemicos en pacientes con diabetes mellitus tipo 2 (DM2). Materiales y metodos: Ensayo clinico aleatorizado, abierto, en 18 adultos con DM2, sobrepeso u obesidad e inadecuado control glucemico con metformina como monoterapia. La glucosa de ayuno fue < 12 mmol/l y la hemoglobina glucosilada A1c entre 7 y 9%. Todos los pacientes recibieron exenatida (5 µg, 2/dia) subcutanea durante cuatro semanas y continuaron la metformina durante el estudio. Se distribuyeron al azar seis sujetos a cada horario de aplicacion preprandial de exenatida: a) desayuno y comida; b) desayuno y cena, o c) comida y cena. Al inicio y cuatro semanas despues, se midio glucosa cada hora durante 24 h. Se calcularon el area bajo la curva (ABC) de glucosa y variabilidad glucemica; esta ultima mediante la media de la amplitud de las excursiones de glucosa (MAEG). Resultados:...
Nutrición Hospitalaria, 2020
Loss of muscle strength in patients under hemodialysis evaluated by dynamometry in the Mexican po... more Loss of muscle strength in patients under hemodialysis evaluated by dynamometry in the Mexican population Pérdida de fuerza muscular en pacientes en hemodiálisis evaluados mediante dinamometría en la población mexicana
Biomedical Research, 2018
Background: Researching the topic of glycemic variability (GV) has been very interesting due to t... more Background: Researching the topic of glycemic variability (GV) has been very interesting due to the possible relationship that exists between this phenomenon and the development of micro-and macrovascular complications. The aim of this investigation was to evaluate the effect that metformin had on the GV in pre-diabetic patients. Materials and methods: A randomized, double-blind, placebo-controlled clinical trial was carried out in 20 subjects, both male and female participants were chosen. These subjects where then divided into 2 groups; 10 subjects received metformin (500 mg) while the remaining 10 subjects received a placebo, twice daily, before breakfast and dinner over the course of 90 days. Metabolic screening, which included glycated hemoglobin A1c, fasting plasma glucose (FPG), 2 h oral glucose tolerance test with 75 g of dextrose and GV [area under the curve of glucose, mean amplitude of glycemic excursion (MAGE)], were measured for all patients at baseline and at the end of the study. Wilcoxon signed-rank, and Mann-Whitney test were performed as part of the statistical analysis. Results: Baseline characteristics of both groups were similar. There was a significant decrease of FPG levels in the metformin group as compared to placebo (6.3 ± 0.7 vs. 5.6 ± 1.0 mmol/L, p=0.047). There were no significant differences in the GV parameters in either of the two study groups. Conclusion: Pre-diabetic subjects treated with metformin for 3 months showed a significant decrease in FPG when compared to placebo.
West Indian Medical Journal, 2016
Aim: The aim of the study is to evaluate the effect of linagliptin versus metformin on insulin se... more Aim: The aim of the study is to evaluate the effect of linagliptin versus metformin on insulin secretion, insulin sensitivity and glucose control in patients with impaired glucose tolerance (IGT). Patients and methods: A randomized, double-blind, clinical trial with parallel groups was performed on 16 adults with IGT. Lipid profile and haemoglobin (HbA 1c) were evaluated prior to and after the intervention. Glucose and insulin were measured at 0, 30, 60, 90 and 120 minutes after a 75-g oral dextrose load. Eight patients received metformin (500 mg) twice a day before meals for three months. The remaining eight patients received placebo (500 mg) in the morning and linagliptin (5 mg) in the evening before meals. The area under the curve (AUC) of glucose and insulin, total insulin secretion, first-phase of insulin secretion, and insulin sensitivity were assessed.
Diabetes Technology & Therapeutics, 2017
BACKGROUND Impaired glucose tolerance (IGT) and glycemic variability may be associated with incre... more BACKGROUND Impaired glucose tolerance (IGT) and glycemic variability may be associated with increased risk of micro- and macrovascular complications. The aim of this study was to assess the effect of linagliptin versus metformin on glycemic variability in patients with IGT. MATERIAL AND METHODS A randomized, double-blind clinical trial with parallel groups was carried out in 16 adult patients with IGT, overweight or obesity. All patients signed an informed consent. The therapies were randomly assigned: (a) metformin 500 mg bid (n = 8) or (b) linagliptin 5 mg a.m. and placebo p.m. (n = 8), both for 90 days. At the beginning of the trial and 3 months later, fasting glucose, glycated hemoglobin A1c, oral glucose tolerance test (OGTT), and glycemic variability [area under the curve (AUC) of glucose, mean amplitude of glycemic excursion (MAGE), standard deviation (SD) of glucose, coefficient of variation (CV) of glucose, and mean blood glucose (MBG)] were measured. Mann-Whitney U, Wilcoxon, and Fisher exact tests were used for statistical analyses. RESULTS Both groups were similar in basal characteristics. After linagliptin administration, a significant decrease in glucose levels at 120 min of OGTT (9.0 ± 0.9 vs. 6.9 ± 2.2 mmol/L, P = 0.012) was observed. Glycemic variability showed a similar behavior and there were no significant differences in the AUC, MAGE, SD of glucose, CV of glucose, and MBG between groups. CONCLUSION Linagliptin administration resulted in better glycemic control according to the decrease of glucose levels by the OGTT at 120 min in patients with IGT. Meanwhile, glycemic variability was not modified in any of the study groups.
Journal of Alzheimer's Disease, 2016
Exposure to fine particulate matter (PM 2.5) and ozone (O 3) above US EPA standards is associated... more Exposure to fine particulate matter (PM 2.5) and ozone (O 3) above US EPA standards is associated with Alzheimer's disease (AD) risk, while Mn toxicity induces parkinsonism. Mexico City Metropolitan Area (MCMA) children have pre-and postnatal sustained and high exposures to PM 2.5 , O 3, polycyclic aromatic hydrocarbons, and metals. Young MCMA residents exhibit frontal tau hyperphosphorylation and amyloid- (A) 1−42 diffuse plaques, and aggregated and hyperphosphorylated ␣-synuclein in olfactory nerves and key brainstem nuclei. We measured total prion protein (TPrP), total tau (T-tau), tau phosphorylated at threonine 181 (P-Tau), A 1-42 , ␣-synuclein (t-␣-syn and d-␣-synuclein), BDNF, insulin, leptin, and/or inflammatory mediators, in 129 normal CSF samples from MCMA and clean air controls. A 1-42 and BDNF concentrations were significantly lower in MCMA children versus controls (p = 0.005 and 0.02, respectively). TPrP increased with cumulative PM 2.5 up to 5 g/m 3 and then decreased, regardless of cumulative value or age (R 2 = 0.56). TPrP strongly correlated with T-Tau and P-Tau, while d-␣-synuclein showed a significant correlation with TNF␣, IL10, and IL6 in MCMA children. Total synuclein showed an increment in childhood years related to cumulated PM 2.5, followed by a decrease after age 12 years
CIERMMI Women in Science Medicine and Health Sciences Handbooks T-XIII, 2021
The promotion of healthy lifestyles amongst medical students is important in reducing alterations... more The promotion of healthy lifestyles amongst medical students is important in reducing alterations in their emotional state and the creation of healthier habits which, when adopted at this stage, could influence the promotion of better lifestyles for their patients. This current study intends to evaluate health risk behaviors and their relationship with the emotional state in medical students. An analytical cross-sectional study was carried out, evaluating 173 students of a public university between January and March of 2019, evaluating anxiety (Beck Anxiety Inventory, BAI), depression (Beck Depression Inventory, BDI-II), alcohol and nicotine dependence (Alcohol Use Disorders Identification Test, AUDIT, Fagerström Physical Nicotine Dependence), and Body mass index (BMI). sociodemographic and clinical data was collected through an interview. An association was found between anxiety and a sedentary (p = 0.01, OR = 0.446, CI = 0.24 - 0.83), and depression with alcohol consumption (p = 0...
BMC Public Health
Background The national health and nutrition survey allows to know the state of health of the Mex... more Background The national health and nutrition survey allows to know the state of health of the Mexican population, it provides data for the analysis of different factors and / or indicators of health, diseases and nutritional conditions, such as chronic degenerative diseases and depressive symptoms, which, in turn, if both occur simultaneously, they will have a negative impact on health. This article studies the four factors involved in the overall health of the population in Mexico: excess weight, diabetes, high blood pressure, and depressive symptoms, which are used to conduct a multidimensional characterization and analysis. Methods Two methodological resources are applied, a descriptive statistical characterization and the construction of a multidimensional health index with the use of fuzzy sets, through the National Health and Nutrition Survey (ENSANUT 2018–19 - for its acronym in Spanish) in Mexico. Results The results reveal a growing percentage of individuals who experience ...
BMC Gastroenterology, Mar 26, 2020
BackgroundThe prevalence of malnutrition remains high in hospitals but no “gold standard” has bee... more BackgroundThe prevalence of malnutrition remains high in hospitals but no “gold standard” has been established to identify nutritional risks adequately. The Nutrition Risk Screening-2002 (NRS-2002), Subjective Global Assessment (SGA), and Controlling Nutritional Status Index (CONUT) are widely used screening tools, but their efficacy has not yet been compared in Mexican patients. Here, we aimed to compare the efficacy of these tools in identifying nutritional risks within the first 48 h of admission in a group of patients with gastrointestinal diseases.MethodsThis was a cross-sectional study of 196 patients. The results of the screening tools, length of hospital stay, serum albumin and cholesterol concentrations, lymphocyte counts, age, body mass index (BMI), complications, and mortality were analyzed. Kappa (κ) statistics were applied to determine the degree of agreement between tools. The performances of the screening tools in predicting complications and mortality were assessed using binary logistic regression.ResultsThe NRS-2002, SGA, and CONUT tools identified nutritional risk in 67, 74, and 51% of the patients, respectively. The observed agreements between tools were: NRS2002/SGA, κ = 0.53; CONUT/NRS-2002, κ = 0.42; and SGA/CONUT, κ = 0.36. Within age groups, the best agreement was found in those aged 51–65 years (κ = 0.68). CONUT and length of stay were both predictive for the number of complications. The number of complications and serum cholesterol concentrations were predictive for mortality.ConclusionsThe proportion of patients identified as having nutritional risk was high using all three screening tools. SGA, NRS-2002, and CONUT had similar capacities for screening risk, but the best agreement was observed between NRS-2002 and SGA. Only CONUT predicted complications, but none of these tools performed well in predicting mortality.
West Indian Med J, 2016
Aim: to evaluate the effect of linagliptin vs. metformin on insulin secretion, insulin sensitivit... more Aim: to evaluate the effect of linagliptin vs. metformin on insulin secretion, insulin sensitivity and glucose control in patients with impaired glucose tolerance (IGT). Patients and methods: a randomized, double-blind, clinical trial with parallel groups was performed in 16 adults with IGT. Lipid profile and A1C were evaluated prior to and after the intervention. Glucose and insulin were measured at 0, 30, 60, 90 and 120 min after a 75-g oral dextrose load. Eight patients received metformin (500 mg) twice a day before meals for 3 months. The remaining eight patients received placebo (500 mg) in the morning and linagliptin (5 mg) in the evening before meals. Area under the curve (AUC) of glucose and insulin, total insulin secretion, first-phase of insulin secretion, and insulin sensitivity were assessed. Results: after linagliptin administration, a significant decrease in glucose at 90 min (10.8 ± 2.6 vs. 7.9 ± 2.2 mmol/L; p <0.05), 120 min (8.8 ± 0.9 mmol/L; p <0.05) and AUC of glucose (1168 ± 210 vs. 953 ± 207 mmol/l; p <0.05) were observed. Metformin administration decreased insulin significantly at 0 min (94.8 ± 25.8 vs. 73.8 ± 24.6 pmol/L; p <0.05). Conclusion: 3-month administration of linagliptin in patients with IGT decreased glucose at 90 and 120 min after a 75-g oral dextrose load and AUC of glucose. Metformin decreased insulin at 0 min.
The Journal of Alzheimer’s Disease, 2016
Abstract. Exposure to fine particulate matter (PM2.5) and ozone (O3) above US EPA standards is as... more Abstract. Exposure to fine particulate matter (PM2.5) and ozone (O3) above US EPA standards is associated with Alzheimer’s disease (AD) risk, while Mn toxicity induces parkinsonism. Mexico City Metropolitan Area (MCMA) children have pre- and postnatal sustained and high exposures to PM2.5, O3, polycyclic aromatic hydrocarbons, and metals. Young MCMA residents exhibit frontal tau hyperphosphorylation and amyloid- (A)1− 42 diffuse plaques, and aggregated and hyperphosphorylated -synuclein in olfactory nerves and key brainstem nuclei. We measured total prion protein (TPrP), total tau (T-tau), tau phosphorylated at threonine 181 (P-Tau), A1–42, -synuclein (t--syn and d--synuclein), BDNF, insulin, leptin, and/or inflammatory mediators, in 129 normal CSF samples from MCMA and clean air controls. A1–42 and BDNF concentrations were significantly lower in MCMA children versus controls (p = 0.005 and 0.02, respectively). TPrP increased with cumu- lative PM2.5 up to 5 g/m3 and then decreased, regardless of cumulative value or age (R2 = 0.56). TPrP strongly correlated with T-Tau and P-Tau, while d--synuclein showed a significant correlation with TNF, IL10, and IL6 in MCMA children. Total synuclein showed an increment in childhood years related to cumulated PM2.5, followed by a decrease after age 12 years (R2 =0.47), while d--synuclein exhibited a tendency to increase with cumulated PM2.5 (R2 =0.30). CSF A1–42, BDNF, -synuclein, and TPrP changes are evolving in young MCMA urbanites historically showing underperformance in cognitive processes, odor identification deficits, downregulation of frontal cellular PrP, and neuropathological AD and PD hallmarks. Neuroprotection of young MCMA residents ought to be a public health priority.
Biomedical Research, 2018
Background: Researching the topic of glycemic variability (GV) has been very interesting due to t... more Background: Researching the topic of glycemic variability (GV) has been very interesting due to the possible relationship that exists between this phenomenon and the development of micro-and macrovascular complications. The aim of this investigation was to evaluate the effect that metformin had on the GV in pre-diabetic patients. Materials and methods: A randomized, double-blind, placebo-controlled clinical trial was carried out in 20 subjects, both male and female participants were chosen. These subjects where then divided into 2 groups; 10 subjects received metformin (500 mg) while the remaining 10 subjects received a placebo, twice daily, before breakfast and dinner over the course of 90 days. Metabolic screening, which included glycated hemoglobin A1c, fasting plasma glucose (FPG), 2 h oral glucose tolerance test with 75 g of dextrose and GV [area under the curve of glucose, mean amplitude of glycemic excursion (MAGE)], were measured for all patients at baseline and at the end of the study. Wilcoxon signed-rank, and Mann-Whitney test were performed as part of the statistical analysis. Results: Baseline characteristics of both groups were similar. There was a significant decrease of FPG levels in the metformin group as compared to placebo (6.3 ± 0.7 vs. 5.6 ± 1.0 mmol/L, p=0.047). There
REVISTA MEXICANA DE ENDOCRINOLOGÍA, METABOLISMO & NUTRICIÓN., 2016
ABSTRACT Objective: To assess the effect of exenatide twice daily ac- cording to different meal s... more ABSTRACT
Objective: To assess the effect of exenatide twice daily ac- cording to different meal schedules on glycemic control and variability in patients with type 2 diabetes mellitus. Materi- als and methods: A randomized, open clinical trial was per- formed in 18 adults with type 2 diabetes mellitus who were overweight or obesity and inadequate glycemic control with metformin as monotherapy. Fasting glucose was < 12 mmol/l and glycated hemoglobin A1c between 7-9%. All patients received exenatide (5 μg twice daily) subcutaneously for four weeks and continued taking metformin at the same dose throughout the study. A randomized distribution of six sub- jects was conducted to each of the following pre-prandial times of application of exenatide: (i) breakfast and lunch, (ii) breakfast and dinner, or (iii) lunch and dinner. At the begin- ning and four weeks later, glucose concentrations were mea- sured every hour during a 24-hour period. Area under the curve of glucose and glycemic variability according to the mean amplitude of glycemic excursions was calculated.
DIABETES TECHNOLOGY & THERAPEUTICS, 2017
Abstract Background: Impaired glucose tolerance (IGT) and glycemic variability may be associated... more Abstract
Background: Impaired glucose tolerance (IGT) and glycemic variability may be associated with increased risk of micro- and macrovascular complications. The aim of this study was to assess the effect of linagliptin versus metformin on glycemic variability in patients with IGT.
Material and Methods: A randomized, double-blind clinical trial with parallel groups was carried out in 16 adult patients with IGT, overweight or obesity. All patients signed an informed consent. The therapies were randomly assigned: (a) metformin 500 mg bid (n = 8) or (b) linagliptin 5 mg a.m. and placebo p.m. (n = 8), both for 90 days. At the beginning of the trial and 3 months later, fasting glucose, glycated hemoglobin A1c, oral glucose tolerance test (OGTT), and glycemic variability [area under the curve (AUC) of glucose, mean am- plitude of glycemic excursion (MAGE), standard deviation (SD) of glucose, coefficient of variation (CV) of glucose, and mean blood glucose (MBG)] were measured. Mann–Whitney U, Wilcoxon, and Fisher exact tests were used for statistical analyses.
Results: Both groups were similar in basal characteristics. After linagliptin administration, a significant de- crease in glucose levels at 120 min of OGTT (9.0 –0.9 vs. 6.9 –2.2 mmol/L, P = 0.012) was observed. Glycemic variability showed a similar behavior and there were no significant differences in the AUC, MAGE, SD of glucose, CV of glucose, and MBG between groups.
Conclusion: Linagliptin administration resulted in better glycemic control according to the decrease of glucose levels by the OGTT at 120 min in patients with IGT. Meanwhile, glycemic variability was not modified in any of the study groups.