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Long-term therapy-related reproductive health side effects impact the quality of life of hematopoietic stem cell transplantation (HSCT) survivors. In this study, we evaluated the prevalence of gonadal dysfunction (GD) pre- and post-HSCT, analyzed factors associated with GD, and explored rates of fertility assessment (FA) and fertility preservation (FP) in a resource-limited setting. FA and outcomes of patients age ≤45 years undergoing HSCT between June 2000 and May 2018 were collected retrospectively. We included 213 patients with a median age of 26 years. Pre-HSCT FA was performed in 71.8%, with a GD rate of 17%. The rate of GD was not different between the sexes (females, 19.5% versus males, 16.1%; P = .616) and was only associated with increasing age. The rate of cryopreservation in the cohort was 3.3%. Almost one-half (47.7%) of post-HSCT patients completed FA and evidenced an increase in GD rate to 48.9%. Comparing pre-HSCT and post-HSCT GD rates, women had a significant increase (19.5% versus 81.4%; P.001), whereas men did not (16.1% versus 20.4%; P = .76). These results were confirmed by a multiple imputation analysis accounting for missing data. Female sex, pre-HSCT cytotoxic therapy, myeloablative conditioning, and germ cell tumor (GCT) diagnosis were associated with post-HSCT GD. Reproductive health preservation can be positively impacted when FA and FP are prioritized at the initial diagnosis in HSCT candidates, particularly in women of older age and men with a diagnosis of GCT. The low FP success observed urges implementation of strategies that favor accessibility and improve quality of life of HSCT survivors in low- and middle-income countries.

Guidelines recommend discussing fertility preservation with patients with cancer. In Mexico, internists frequently are the primary care provider (PCP) for adults in reproductive age. The knowledge of oncofertility among PCPs in low and middle income countries is poorly known. Internal medicine residents in a tertiary care hospital in Mexico City participated in a survey regarding fertility concepts in cancer patients. Sixty-three residents participated; their median age was 27. Thirty percent reported 0% self-perceived confidence for providing counseling about fertility issues, and 26% reported more than 50% self-perceived confidence. Twenty-eight percent reported not asking patients in reproductive age about satisfied parity/paternity. Eighty-one percent correctly identified patients that should receive fertility counseling, and 68% identified alkylating chemotherapy as having the highest risk of infertility. Fifty-four percent were able to name at least one fertility preservation (FP) strategy for males, whereas 49% were able to name at least one strategy in females. Residents who reported at least 50% self-perceived confidence for providing fertility counseling were more likely to name at least one FP strategy for men (64.7%) versus those who reported less than 50% self-perceived confidence (52.1%), but this result was not statistically significant (p = 0.378). This was similar for FP strategies in women, with 64.7% of more confident residents naming at least one, compared with 43.4% of less confident residents (p = 0.134). Knowledge of FP in patients with cancer is insufficient among internal medicine residents in our institution. Inclusion of oncofertility concepts in the internal medicine program is needed.

Background: Antimalarial drugs were widely used as experimental therapies against COVID-19 in the initial stages of the pandemic. Despite multiple randomized controlled trials demonstrating unfavorable outcomes in both efficacy and adverse effects, antimalarial drugs are still prescribed in developing countries, especially in those experiencing recurrent COVID-19 crises (India and Brazil). Therefore, real-life experience and pharmacovigilance studies describing the use and side effects of antimalarials for COVID-19 in developing countries are still relevant.Objective: To describe the adverse effects associated with the use of antimalarial drugs in hospitalized patients with COVID-19 pneumonia at a reference center in Mexico City.Methods: We integrated a retrospective cohort with all adult patients hospitalized for COVID-19 pneumonia from March 13th, 2020, to May 17th, 2020. We compared the baseline characteristics (demographic and clinical) and the adverse effects between the groups of patients treated with and without antimalarial drugs. The mortality analysis was performed in 491 patients who received optimal care and were not transferred to other institutions (210 from the antimalarial group and 281 from the other group).Results: We included 626 patients from whom 38% (n = 235) received an antimalarial drug. The mean age was 51.2 ± 13.6 years, and 64% were males. At baseline, compared with the group treated with antimalarials, the group that did not receive antimalarials had more dyspnea (82 vs. 73%, p = 0.017) and cyanosis (5.3 vs. 0.9%, p = 0.009), higher respiratory rate (median of 28 vs. 24 bpm, p < 0.001), and lower oxygen saturation (median of 83 vs. 87%, p < 0.001). In the group treated with antimalarials, 120 patients had two EKG evaluations, from whom 12% (n = 16) prolonged their QTc from baseline in more than 50 ms, and six developed a ventricular arrhythmia. Regarding the trajectories of the liver function tests over time, no significant differences were found for the change in the mean value per day between the two groups. Among patients who received optimal care, the mortality was 16% (33/210) in those treated with antimalarials and 15% (41/281) in those not receiving antimalarials (RR 1.08, 95% 0.75–1.64, and adjusted RR 1.12, 95% CI 0.69–1.82).Conclusion: The adverse events in patients with COVID-19 treated with antimalarials were similar to those who did not receive antimalarials at institutions with rigorous pharmacological surveillance. However, they do not improve survival in patients who receive optimal medical care.

Background Metabolic diseases are risk factors for severe Coronavirus disease (COVID-19), which have a close relationship with metabolic dysfunction-associated fatty liver disease (MAFLD). Aims To evaluate the presence of MAFLD and fibrosis in patients with COVID-19 and its association with prognosis. Methods Retrospective cohort study. In hospitalized patients with COVID-19, the presence of liver steatosis was determined by computed tomography scan (CT). Liver fibrosis was assessed using the NAFLD fibrosis score (NFS score), and when altered, the AST to platelet ratio index (APRI) score. Mann-Whitney U, Student´s t-test, logistic regression analysis, Kaplan-Meier curves and Cox regression analysis were used. Results 432 patients were analyzed, finding steatosis in 40.6%. No differences in pulmonary involvement on CT scan, treatment, or number of days between the onset of symptoms and hospital admission were found between patients with and without MAFLD. The presence of liver fibrosis was associated with higher severity scores, higher levels of inflammatory markers, requirement of mechanical ventilation, incidence of acute kidney injury (AKI), and higher mortality than patients without fibrosis. Conclusion The presence of fibrosis rather than the presence of MAFLD is associated with increased risk for mechanical ventilation, development of AKI, and higher mortality in COVID-19 patients.

espanolAntecedentes: la informacion regional sobre las caracteristicas de los pacientes con enfermedad por coronavirus (COVID) -19 es necesaria para una mejor comprension de la pandemia. Objetivo: El objetivo del estudio es describir las caracteristicas clinicas de los pacientes con COVID-19 diagnosticados en un centro de atencion terciaria en la Ciudad de Mexico y evaluar las diferencias segun el ambito del tratamiento (ambulatorio versus hospitalario) y la necesidad de cuidados intensivos ( IC). Metodos: Realizamos una cohorte prospectiva, que incluyo pacientes consecutivos con COVID-19 desde el 26 de febrero de 2020 hasta el 11 de abril de 2020. Resultados:Se identificaron 309 pacientes (140 pacientes hospitalizados y 169 pacientes ambulatorios). La mediana de edad fue de 43 anos (rango intercuartilico, 33-54), 59,2% varones y 18,6% trabajadores sanitarios (12,3% de nuestro centro). La mediana del indice de masa corporal (IMC) fue de 29,00 kg / m2 y el 39,6% tenia obesidad. En comparacion con los pacientes ambulatorios, los pacientes hospitalizados eran de mayor edad, tenian comorbilidades, tos y disnea con mayor frecuencia. Veintinueve (20,7%) pacientes hospitalizados requirieron tratamiento en la unidad de CI (UCI). Los antecedentes de diabetes (tipo 1 o 2) y el dolor abdominal fueron mas comunes en los pacientes de la UCI en comparacion con los pacientes que no estaban en la UCI. Los pacientes de la UCI tenian IMC mas altos, frecuencias respiratorias mas altas y saturaciones de oxigeno capilar de aire ambiente mas bajas. Los pacientes de la UCI mostraron una respuesta inflamatoria mas severa segun lo evaluado por el recuento de globulos blancos, recuento de neutrofilos y plaquetas, proteina C reactiva, ferritina, procalcitonina y niveles de albumina. Conclusiones: Los pacientes con comorbilidades, ya sean obesos de mediana edad o ancianos que se quejan de fiebre, tos o disnea, fueron mas propensos a ser ingresados. Al ingreso, los pacientes con diabetes, IMC alto y hallazgos clinicos o de laboratorio compatibles con un estado inflamatorio severo tenian mas probabilidades de requerir IC. EnglishBackground: Regional information regarding the characteristics of patients with coronavirus disease (COVID)-19 is needed for a better understanding of the pandemic. Objective: The objective of the study to describe the clinical features of COVID-19 patients diagnosed in a tertiary-care center in Mexico City and to assess differences according to the treatment setting (ambulatory vs. hospital) and to the need of intensive care (IC). Methods: We conducted a prospective cohort, including consecutive patients with COVID-19 from February 26, 2020 to April 11, 2020. Results: We identified 309 patients (140 inpatients and 169 outpatients). The median age was 43 years (interquartile range, 33-54), 59.2% men, and 18.6% healthcare workers (12.3% from our center). The median body mass index (BMI) was 29.00 kg/m2 and 39.6% had obesity. Compared to outpatients, inpatients were older, had comorbidities, cough, and dyspnea more frequently. Twenty-nine (20.7%) inpatients required treatment in the IC unit (ICU). History of diabetes (type 1 or 2) and abdominal pain were more common in ICU patients compared to non-ICU patients. ICU patients had higher BMIs, higher respiratory rates, and lower room-air capillary oxygen saturations. ICU patients showed a more severe inflammatory response as assessed by white blood cell count, neutrophil and platelet count, C-reactive protein, ferritin, procalcitonin, and albumin levels. By the end of the study period, 65 inpatients had been discharged because of improvement, 70 continued hospitalized, and five had died. Conclusions: Patients with comorbidities, either middle-age obese or elderly complaining of fever, cough, or dyspnea, were more likely to be admitted. At admission, patients with diabetes, high BMI, and clinical or laboratory findings consistent with a severe inflammatory state were more likely to require IC.

Guidelines recommend discussing fertility preservation with patients with cancer. In Mexico, internists frequently are the primary care provider (PCP) for adults in reproductive age. The knowledge of oncofertility among PCPs in low and middle income countries is poorly known. Internal medicine residents in a tertiary care hospital in Mexico City participated in a survey regarding fertility concepts in cancer patients. Sixty-three residents participated; their median age was 27. Thirty percent reported 0% self-perceived confidence for providing counseling about fertility issues, and 26% reported more than 50% self-perceived confidence. Twenty-eight percent reported not asking patients in reproductive age about satisfied parity/paternity. Eighty-one percent correctly identified patients that should receive fertility counseling, and 68% identified alkylating chemotherapy as having the highest risk of infertility. Fifty-four percent were able to name at least one fertility preservation (FP) strategy for males, whereas 49% were able to name at least one strategy in females. Residents who reported at least 50% self-perceived confidence for providing fertility counseling were more likely to name at least one FP strategy for men (64.7%) versus those who reported less than 50% self-perceived confidence (52.1%), but this result was not statistically significant (p = 0.378). This was similar for FP strategies in women, with 64.7% of more confident residents naming at least one, compared with 43.4% of less confident residents (p = 0.134). Knowledge of FP in patients with cancer is insufficient among internal medicine residents in our institution. Inclusion of oncofertility concepts in the internal medicine program is needed.

Aims Insulin resistance (IR) predisposes to type 2 diabetes mellitus (T2DM). Although previous studies have associated serum uric acid concentration with IR in T2DM, its association with impaired insulin secretion and beta-cell dysfunction in subjects at risk for developing T2DM remains uncertain. Thus, we aimed to analyze the association of serum uric acid concentration with IR using surrogate insulin resistance/secretion and beta-cell function indices in subjects at risk for developing T2DM. Methods This is a cross-sectional study that included 354 subjects who underwent an oral glucose tolerance test who had at least two risk factors for T2DM without any chronic disease. Results Participants were 51 ± 8 years old, 72.2% were women, had a mean body mass index of 29.9 ± 6.5 kg/m2 and mean serum uric acid concentration of 5.7 ± 1.3 mg/dL. HOMA-IR, first-phase insulin secretion (S1PhOGTT), second-phase insulin secretion (S2PhOGTT), Matsuda and disposition indices were significantly correlated with serum uric acid concentrations (r = 0.239, r = 0.225, r = 0.201, r = −0.287, r = −0.208; respectively). After multiple linear regression analysis, serum uric acid concentration was independently associated with HOMA-IR (β = 0.283), HOMA-B (β = 0.185), S1PhOGTT (β = 0.203), S2PhOGTT (β = 0.186), and Matsuda Index (β = −0.322). A serum uric acid concentration of 5.5 mg/dL had the best sensitivity/sensibility to identify subjects with IR (HOMA-IR ≥2.5). Conclusions Serum uric acid concentration is significantly associated with IR and impaired insulin secretion, but not with beta-cell dysfunction, in subjects at risk for developing T2DM.

Background Rheumatoid arthritis (RA) patients present an increased risk of cardiovascular (CV) morbidity and mortality compared to the general population. Patients from Latin-America present distinctive features and some of them are relevant when assessing CV risk. EULAR recommendations include CV risk assessment for all the patients at least once every 5 years and its reconsideration following major changes in anti-rheumatic therapy. Importantly, failure to identify and manage CV comorbidity in RA patients has been recognized by rheumatologists, although there is no information in Latin-America. Objectives To investigate knowledge about EULAR recommendations for RA-CV risk assessment/management (K-EULAR-R) among internal medicine and rheumatology fellows from an academic and tertiary care level center, to identify physician’s perception about responsible(s) for CV risk assessments and about major barriers to perform the assessments and to investigate the appropriated identification of major CV risk factors. Potential differences among both group of trainees were additionally investigated. Methods Internal medicine fellows (N=105, 1st to 4th grade participants were represented) and rheumatology fellows (N=10, 4 from first grade and 6 from second grade) were invited to anonymously answer a questionnaire designed by 2 investigators to investigate K-EULAR-R and integrated by 11 items classified in 3 categories: “general knowledge about CV risk in RA patients” (4 items), “timing of CV risk assessment” (4 items) and “appropriated statin use” (3 items). In addition, fellows were directed to select and rate main responsible for CV risk assessment (5 options), major barriers to apply EULAR recommendations (6 options), and to correctly identify CV risk factors (20 options). After questionnaire completion, an overall-CV-knowledge-Likert scale (superior, borderline or inferior) was assigned to each participant by an independent observer. The study received IRB approval. Descriptive statistic was used and questionnaire was scored to a decimal scale. Results Ninety-three (85%) internal medicine fellows and 10 (100%) rheumatology fellows participated. Rheumatology fellows scored higher in the K-EULAR-R questionnaire when compared to internal medicine fellows (6.9±1.4 vs. 5.5±1.4, p=0.004) and the higher score was replicated in the category of “general knowledge about CV risk” (8.3±2.0 vs 5.3±2.5, p=0.001), meanwhile no differences were detected in the scoring of the categories “timing of CV risk assessment” and “appropriated statin use”. No differences among grades within each group were identified. The majority of the rheumatology fellows rated themselves as the specialist responsible for CV risk assessment (80%); meanwhile this percentage decreased to 45.7% among the internal medicine fellows (p=0.084); fellows from both groups identified lack of time during rheumatic evaluations as the main barrier to perform CV risk assessment (60% and 57%, respectively). Adequate CV risk factor identification varied from 30% (for contraceptive use) to 100% (for smoking habit), and these% were similar among both groups. Up to 82.5% of the fellows identified incorrectly ≥ 1 CV risk factor and high serum triglyceride levels was the highest (49%). Conclusion Knowledge about CV risk management in RA patients was suboptimal among trainees in internal medicine and rheumatology from an academic and tertiary care level center in Mexico City; trainees in rheumatology performed better. There is a need to reinforce the topic during fellow’s residency. Disclosure of Interests None declared

Background The prescription of parenteral nutrition (PN) in hospitalised patients requires an estimation of the energy requirements. Most studies employing prediction equations (PEs) to estimate energy requirements have focused on critically ill patients. The present study aimed to evaluate several PEs of the resting energy expenditure (REE) to identify the most accurate equation for estimating the REE required for PN. Methods This cross-sectional and descriptive study included patients hospitalised with medical or surgical diagnoses, making them candidates for PN. Epidemiological data, the reason for hospital admission, nutritional screening results, characteristics of the PN administered and REE by indirect calorimetry (IC) were recorded and, subsequently, PEs were calculated. Results In total, 116 patients were recruited with a mean (SD) age of 56.7 (13.8) years and body mass index of 21.3 (4.25) kg m-2 . The diagnosis was medical in 52% of patients and surgical in 48%. The mean (SD) REEs of patients, according to IC, were: 6.11 (1.18) MJ [1461 (281) kcal]; and according to PEs: Mifflin, 5.07 (1.05) MJ [1212 (252) kcal]; Owen, 5.43 (0.72) MJ [1298 (172) kcal]; Harris-Benedict, 5.38 (0.85) MJ [1285 (204) kcal]; Ireton-Jones, 6.20 (1.69) MJ [1481 (403) kcal]; and short equation, 6.12 (0.92) MJ [1464 (220) kcal]. A comparison of the results obtained for the REE by IC and with PEs indicated that the short equation had less bias than the other equations, with an accuracy of 54% CONCLUSIONS: In hospitalised patients who receive PN, determination of the REE should ideally be made by IC. PEs are acceptable but not exact and so their estimation could overfeed or underfeed the patient.

Table S1. Repeated measures ANOVA. (DOCX 13 kb)

Background Type 2 diabetes mellitus has become one of the most important public health concerns worldwide. Due to its high prevalence and morbidity, there is an avid necessity to find new therapies that slow the progression and promote the regression of the disease. Imatinib mesylate is a tyrosine kinase inhibitor that binds to the Abelson tyrosine kinase and related proteins. It enhances β-cell survival in response to toxins and pro-inflammatory cytokine. The aim of this study is to evaluate the effect of imatinib on fasting plasma glucose in subjects with normal fasting glucose, subjects with impaired fasting glucose and in subjects with type 2 diabetes mellitus. Methods We identified 284 subjects diagnosed with chronic myeloid leukemia or gastrointestinal stromal tumors from the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran database. 106/284 subjects were treated with imatinib. We compared the effect of imatinib on fasting plasma glucose after 1 and 6 months of treatment. We used ANOVA test of repeated samples to determine statistical significance in fasting plasma glucose before imatinib treatment and the follow-up. Statistical analysis was performed with Statistical Package for the Social Sciences v22. Results We included a total of 106 subjects: 76 with fasting plasma glucose concentrations

Background: Magnesium acts as a cofactor in many intracellular reactions including phosphorylation of the insulin receptor; therefore, its imbalance can potentially cause insulin resistance. Low serum magnesium concentration has been associated with the development of metabolic syndrome and type 2 diabetes mellitus. Objective: To study the association between the daily dietary magnesium intake and insulin resistance estimated by the homeostatic model assessment of insulin resistance and homeostatic model assessment 2, as well as insulin sensitivity estimated by the Matsuda index. Methods: In a university affiliated medical center, 32 participants (22 women, 10 men) that had an indication for testing for type 2 diabetes mellitus with an oral glucose tolerance test were enrolled in this cross-sectional, comparative study. Clinical and biochemical evaluations were carried out including an oral glucose tolerance test. Hepatic insulin resistance index, homeostatic model assessment 2, homeostatic model assessment of insulin resistance, and Matsuda insulin sensitivity were calculated for each participant. They were asked to recall their food ingestion (24 hours) of three days of the past week, including a weekend day; magnesium intake was calculated according to the food nutritional information. Results: The low dietary magnesium intake group (< 4.5 mg/kg/day) had a higher two-hour insulin concentration after an oral glucose tolerance test compared to those with high dietary magnesium (119.5 [73.0-190.6] vs. 63.5 [25.4-114.2]; p = 0.008), and insulin sensitivity assessed by the Matsuda index was higher in the high dietary magnesium intake group (4.3 ± 3.1 vs. 2.4 ± 1.5; p = 0.042). In multiple linear regression analysis a higher dietary magnesium intake was independently associated (β = 4.93; p = 0.05) with a better insulin sensitivity estimated by the Matsuda index. Conclusions: Our results suggest that higher magnesium intake is independently associated with better insulin sensitivity in patients at risk for type 2 diabetes mellitus. (Rev Inves ClIn. 2017;69:40-6)

Introduction: There is little information about the association of thyroid function (TF) with body fat percentage (BF%). Objective: We aimed to evaluate the association between TF and BF%. We also evaluated the association of TF with other variables including insulin resistance (IR). Methods: We included patients from our outpatient clinic with normal TF. A complete evaluation was done, including TF tests: thyroid stimulating hormone (TSH), total triiodothyronine (T3), total thyroxine (T4), 3 hr oral glucose tolerance test (OGTT), and BF% measured with electrical bioimpedance. We divided the population in 2 groups in terms of BF% and compared the TF in each group. Correlation and linear regression analyses were done to evaluate the association of TSH and T3 with BF%, and IR. Results: We evaluated 203 patients (35.9% male). The mean age of the studied subjects was 38.9±13.5 years, with a body mass index (BMI) of 32.7±8.7kg/m2, and a mean BF% of 38.4±9.5%. Between men and women, there were no differences in T3, T4, free thyroxine index (FTI), and TSH. In men, obese patients had more T3 (1.81±0.53 vs 1.57±0.25nmol/L, p=0.04). In women, there were no differences in T3 concentrations, and obese patients had more TSH (2.12±0.9 vs 1.65±0.8mIU/mL, p=0.04). After weight adjustment, we identified a significant correlation between BF% and TSH (r=0.17, p=0.02), and after age and weight adjustment, we identified a significant correlation between T3 and the Homeostasis Model Assessment of insulin resistance (HOMA-IR) (r=0.38, p

An outbreak caused by the novel swine-origin influenza A (H1N1) virus was identified in Mexico in late March 2009. The objective of this report is to describe the organization of a tertiary care center in Mexico City during the contingency. We describe the education program, the hospital organization and triaging, and unforeseen overwhelming circumstances. Educational plans were directed to follow standard, contact, and droplet precautions and to condition behavior to avoid touching the eyes, nose, or mouth. N95 respirators were distributed only to perform respiratory procedures. By the fifth month into the epidemic, four patients with hospital-acquired influenza, 467 workers with respiratory symptoms suggestive of influenza (16% of our staff), and 96 workers with confirmed novel influenza A (3% of our staff) were identified. During the first 2 months of the epidemic, 44,225 people went through the triages and only 1503 (3.3%) reached the emergency room. By the fifth month into the epidemic, four small institutional influenza outbreaks (

The prevalence of overweight and obesity in Mexico is approximately 70%; thus, obtaining a reliable measurement of the resting energy expenditure (REE) in these patients is of extreme importance. The aim of the study was to obtain a prediction equation of REE in overweight or obese outpatients in the Mexican population.The study was conducted at The National Institute for Medical Sciences and Nutrition Salvador Zubiran (Mexico, D.F.). Consecutive outpatients (18-70 years old) at the Clinical Nutrition were evaluated between March 2010 and August 2012 after being diagnosed with overweight or obesity (body mass index [BMI] ≥ 25 kg/m2). Patients with any disease that could affect the measurement of gas exchange were excluded. Participants were evaluated by indirect calorimetry (IC), bioelectrical impedance analysis (BIA) and anthropometric measurements to design the REE prediction equation. Two groups were evaluated: one group for derivation and another group for validation. The REE was also estimated using the equations of Harris-Benedict, Mifflin St-Jeor, Ireton-Jones, Carrasco, Kleiber and Owen, assessing current weight, ideal weight and adjusted weight. A REE equation was obtained by multiple linear regression based on the evaluated variables, and those that gave the best precision to the model were selected. The real REE and the estimated REE were then compared using Student's t-test. To highlight differences, pairs of measurements were further analyzed using the BlandAltman plot. Pearson correlation coefficients and coefficients of determination between REE values measured by IC and REE values estimated using various formulas were calculated.A total of 77 patients were included in the derivation group: 38 men (49.4%) and 39 women (50.6%). The mean age was 48.5 ± 13.9 years, and the mean BMI was 34.7 ± 5.7 kg/m2. A total of 50 participants were included in the validation group: 16 men (32%) and 34 women (68%). The mean age was 48.5 ± 15.5 years, and the mean BMI was 34.2 ± 5.2 kg/m2. The baseline characteristics of both groups were homogeneous. IC reported an average of 2001 ± 552 kcal, with a respiratory quotient (RQ) of 0.75 ± 0.04. The new REE equation that resulted from the statistical model had an R2 = 0.52 and a bias of ± 3.39 kcal. When the REE obtained from IC was compared with the REE estimated by the new formula, there was no significant difference between the results, and the correlation for all participants was 0.71 (p.0.0001). When the equations were analyzed using the Bland-Altman method, the difference between the new formula and the REE measurement by IC was a bias of 3.39 ± 384 kcal.Furthermore, a correlation was obtained between the real and estimated REE values using different equations; the most accurate correlation with the new formula was Owen's formula (r=0.712).The new formula had an acceptable correlation with IC REE measurement in overweight and obese patients in the Mexican population. This equation may represent a useful tool for health care professionals who do not have access to IC equipment for the estimation of REE.Antecedentes: La prevalencia de sobrepeso y obesidad en Mexico se situa aproximadamente en el 70%; asi, la obtencion de una medicion fiable del gasto energetico en reposo (GER) en estos pacientes tiene una importancia crucial. El objetivo del estudio consistio en obtener una ecuacion de prediccion de GER en pacientes ambulatorios con sobrepeso u obesidad en la poblacion mexicana. Métodos: El estudio fue realizado en el Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran (Mexico, D.F.). Se evaluo a pacientes ambulatorios consecutivos (18-70 anos) en el servicio de Nutriologia Clinica entre marzo de 2010 y agosto 2012 tras un diagnostico de sobrepeso u obesidad (indice de masa corporal [IMC] ≥ 25 kg/ m2). Los pacientes con cualquier enfermedad que pudiera afectar la medicion de intercambio de gases fueron excluidos. Los participantes fueron evaluados mediante calorimetria indirecta (CI), analisis de impedancia bioelectrica (AIB) y mediciones antropometricas para disenar la ecuacion de prediccion de GER. Fueron evaluados dos grupos: un grupo para diseno y otro para validacion. El GER tambien fue calculado empleando las ecuaciones de Harris-Benedict, Mifflin St-Jeor, Ireton-Jones, Carrasco, Kleiber y Owen, calculando el peso actual, el peso ideal y un peso ajustado. Se obtuvo una ecuacion GER mediante regresion lineal multiple basada en las variables evaluadas, y fueron seleccionadas aquellas que aportaron la mayor precision al modelo. Luego se compararon el GER real y el GER estimado, utilizando la prueba de t de student. Para destacar las diferencias entre pares de mediciones se utilizo el metodo de BlandAltman. Se calcularon los coeficientes de correlacion de Pearson y los coeficientes de determinacion entre valores GER medidos mediante valores de CI y GER con diversas formulas. Resultados: Un total de 77 pacientes fueron incluidos en el grupo de diseno: 38 hombres (49.4%) y 39 mujeres (50.6%). La edad media fue 48.5 } 13.9 anos, y el IMC medio fue 34.7 } 5.7 kg/m2. Un total de 50 participantes fueron incluidos en el grupo de validacion: 16 hombres (32%) y 34 mujeres (68%). La edad media fue 48.5 } 15.5 anos, y el IMC medio fue 34.2 } 5.2 kg/m2. Las ca racteristicas iniciales de ambos grupos eran homogeneas. La CI indico una media de 2001 } 552 kcal, con un cociente respiratorio (CR) de 0.75 } 0.04. La nueva ecuacion de GER resultante del modelo estadistico presento un R2 = 0.52 y una desviacion de } 3.39 kcal. Al comparar el GER obtenido de CI con el GER calculado mediante la nueva formula, no se aprecio diferencia significativa entre los resultados, y la correlacion para todos los participantes fue 0.71 (p.

To determine the change in the hepatic insulin resistance index (HIRI) after metformin treatment.In this retrospective cohort study, Mexican mestizo patients with a body mass index (BMI) of 25 kg/m(2) or greater were evaluated. Participants were classified into 2 groups: patients who received metformin and patients who did not. Both groups were followed up for a median of 6 months (range, 4-10 months). The HIRI was calculated at baseline and at follow-up in both groups. We evaluated the independent effect of metformin on HIRI after adjustment for the difference in basal and final values (DELTA) of BMI, waist circumference, glucose, and insulin.A total of 71 patients were enrolled (51 [72%] female). Forty-one patients received metformin and 30 patients did not. Mean age was 36.3 ± 12.2 years and mean BMI was 42.2 ± 10.7 kg/m(2). After metformin treatment, HIRI significantly decreased from 38 ± 10.7 to 34.7 ± 9.5 (P = .03). In contrast, the control group had a nonsignificant increase in HIRI (37.6 ± 11.7 to 40.0 ± 14.0, P = .22). Weight significantly decreased in both groups (group 1: 114.6 ± 33.8 kg to 107.6 ± 28.9 kg, P.01; group 2: 104.8 ± 28.5 kg to 98.9 ± 26.0 kg, P.01). After BMI adjustment, the total metformin dosage correlated negatively with HIRI (r = -0.36, P = .03). Using a linear regression model (F = 6.0, r2 = 0.37, P = .002) adjusted for DELTA BMI and DELTA waist circumference, the administration of metformin resulted in independent improvement in the HIRI level (standardized β = -0.29, t = -2.0, P = .04).Metformin improves HIRI independently of anthropometric changes. In persons with elevated HIRI levels, metformin may be considered among the treatment options.

The aim of the present study was to describe the mechanism by which the combination glyburide/metformin exerts its additive hypoglycemic effects. This is a double-blind, randomized and crossover clinical trial. Patients (n = 20) were included in a run-in period of 8 weeks in which an isocaloric diet was prescribed. If they did not achieve the treatment goals (n = 15), they received glyburide, metformin or combined treatment for 10 weeks each using three possible sequences. The dosage was adjusted to reach fasting plasma glucose (FPG)7.7 mmol/l. Treatment periods were separated by a 6-12 week washout period. At the beginning and the end of every treatment, insulin sensitivity and insulin secretion were measured by means of a minimal model and an oral glucose tolerance test. All treatment periods were completed by 12 cases. The glycemic goal was reached in 1 case during metformin, in 5 during glyburide and in 10 during the combination. The greatest reduction in HbA1c was achieved during the combination (HbA1c 11 +/- 1.6 vs 9.8 +/- 1.9 vs 9.0 +/- 2.1% for metformin, glyburide and the combination, p0.001). Increased insulin secretion was the explanation for the additive effects of the combination (percentual change in acute insulin response during the minimal model = 5.8 vs 51.5 vs 88.2% for metformin, glyburide and the combination, p0.05). No change in insulin sensitivity resulted from the treatments. In conclusion, the additive hypoglycemic effects of the combination glyburide/metformin was caused by increased insulin secretion.