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BACKGROUND & AIMS: The accuracy of estimating body composition compartments is critical in the clinical setting. Currently, there are different bioelectrical impedance analysis (BIA) devices available for obtaining raw BIA parameters. The aim of this study was to determine the level of agreement between multiple frequency (MF)-BIA and single frequency (SF)-BIA devices in obtaining raw BIA measurements (resistance (R), reactance (Xc), and phase angle (PhA)), as well as the agreement on the classification of hydration status and body cell mass by the bioelectrical impedance vector analysis (BIVA) method. METHODS: This cross-sectional study included 406 outpatients with stable chronic heart failure (HF). The raw BIA measurements at 50 kHz obtained by tetrapolar MF-BIA (Bodystat QuadScan 4000) were compared with those obtained by tetrapolar SF-BIA (RJL Quantum X). In addition, the patients were classified by their hydration status and body cell mass according to the BIVA method. RESULTS: Strong and significant correlations were observed between the two methods in all raw BIA variables (r ≥ 0.90). Lin's concordance correlation coefficient (CCC) values were almost perfect for R (CCC = 0.99; 95% CI 0.997 to 0.998), moderate for Xc (CCC = 0.93; 95% CI 0.92 to 0.94), and poor for PhA (CCC = 0.88; 95% CI 0.85 to 0.90). The agreement obtained in the two classifications (quadrants and hydration status) was >0.81. CONCLUSIONS: MF-BIA and SF-BIA demonstrated good agreement for measurement of the R parameter; however, the Xc and PhA parameters must be used carefully due to the previously reported variability. Likewise, the agreement in all classifications by the BIVA method was almost perfect.

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OBJECTIVES: At the end of 2019, SARS-CoV-2 was identified, the one responsible for the COVID-19 disease. Between a 5.1% and a 98% of COVID-19 patients present some form of alteration in their sense of smell. The objective of this study is to determine the diagnostic yield of the smell dysfunction as screening tool for COVID-19. METHODS: Cross-sectional, observational, and pro-elective study was performed in a tertiary care hospital from May 25th to June 30th, 2020. One hundred and thirty-nine patients were included in the study. Demographic characteristics were collected from anamnesis. A Self-Perception Questionnaire and psychophysical olfactory test (POT) were applied to all participants. The presence of SARS-CoV2, was detected by RT-PCR methods. RESULTS: 51.7% of patients were SARS-CoV-2 positive. A sensitivity of 50% was obtained for the self-perception questionnaire as a screening tool for SARS-CoV2, with a specificity of 80.59%. The positive predictive value (PPV) was of 73.46%, the negative predictive value (NPV) was of 60%. The POT as a screening tool had a PPV of 82.35%, a NPV of 52.45%, a LR+ of 4.34, a LR- 0.84. The combination of anosmia (according to the POT) plus cough and asthenia got an OR of 8.25 for the SARS CoV-2 infection. CONCLUSION: There is a strong association between olfactory dysfunction and COVID-19. However, it is not really efficient in the screening of SARS-CoV-2 infection and thus, they should not be considered as a single diagnostic instrument. LEVEL OF EVIDENCE: 4.

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BACKGROUND: The association between diabetes, hearing loss and depression is unknown, and needs to be understood clearly and precisely. Our objective was to estimate the association between depression and hearing loss in patients with type 2 diabetes. METHODS: Cross-sectional analytical study. Patients of 40 years or older with type 2 diabetes were studied. Anthropometric measurements and biochemical parameters were recorded. The Beck Depression Inventory and a pure tone audiometry were applied. Groups were compared with chi squared test and logistic regression for confounders. RESULTS: 150 patients were included (76 % women). Average age was 56 ± 9.3 years, with 12.4 ± 6.5 years of progression of diabetes, weight 67.4 ± 11.6 kg; 31 % were obese; 25.5 % hypertensive (126.3 ± 19.3 / 79.4 ± 19.7 mm Hg) and 80.7 % had poor metabolic control (HbA1c ≥ 7 %). Of all the patients, 45.3 % presented hearing loss and 32.4 % depression. Diagnosis of depression in patients with hearing loss remained significant after adjusting for confounders (odds ratio [OR] = 2.3; 95 % confidence interval [CI] = 1.051-5.333, p = 0.037). Women had greater risk of depression, difference that remained significant (OR = 3.2; 95 % CI = 1.268-8.584, p = 0.014) after adjustment. CONCLUSIONS: Almost half of the patients with diabetes presented hearing loss and more than three times the risk of depression. Subjects with depression and diabetes presented more hearing loss (> 20 dB) than those without diabetes and/or without depression.

Introducción: se desconoce y es necesario entender con mayor claridad y precisión cuál es la asociación entre la diabetes, la hipoacusia y la depresión. Nuestro objetivo fue estimar la asociación entre depresión e hipoacusia en pacientes con diabetes tipo 2 (DT2). Métodos: estudio transversal analítico. Se estudiaron pacientes con DT2 mayores de 40 años. Se registraron medidas antropométricas y parámetros bioquímicos. Se aplicó el cuestionario de depresión de Beck y un estudio audiológico tonal. Se compararon los grupos con chi cuadrada y regresión logística. Resultados: se incluyeron 150 pacientes (76 % mujeres). El promedio de edad fue de 56 ± 9.3 años, con 12.4 ± 6.5 años de evolución de diabetes, con peso de 67.4 ± 11.6kg; fueron obesos el 31 %; 25.5 % hipertensos (126.3 ± 19.3/79.4 ± 19.7 mm Hg) y el 80.7 % presentó descontrol metabólico (HbA1c ≥ 7 %). El 45.3 % presentó hipoacusia y el 32.4 % depresión. El diagnóstico de depresión en pacientes con hipoacusia permaneció significativo después de ajustar para conseguir confusores (razón de momios [RM] = 2.3; intervalo de confianza [IC] al 95 % 1.051-5.333, p = 0.037). Las mujeres tuvieron mayor riesgo de padecer depresión, diferencia que permaneció significativa al ajustarse (RM = 3.2; IC 95 % 1.268-8.584, p = 0.014). Conclusiones: casi la mitad de los pacientes con diabetes presentaron hipoacusia y más de tres veces el riesgo de depresión. Los sujetos con depresión y diabetes mostraron mayor hipoacusia (> 20 dB) que aquellos sin diabetes o sin depresión.

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Screening and treatment of plasma lipid abnormalities secondary to obesity are among the interventions that should be implemented in children who are overweight or obese, in order to prevent a cardiovascular event. Dyslipidemias are a group of asymptomatic diseases that are commonly caused by abnormal levels of lipoproteins in blood; they are a comorbidity that is commonly related to obesity, without considering the age of the patient. Among dyslipidemias, hypertriglyceridemia has the highest prevalence. The etiology of the dyslipidemia should be identified; it allows the proper selection of therapy for the patients and their family. The goal is the prevention of cardiovascular complications. Reduced caloric intake and a structured physical activity plan should be considered for initial treatment for all the overweight and obese patients. For adherence to treatment to be successful, the participation of the primary care physician and a multidisciplinary team is required. With treatment, the risks and complications can be reduced. The participation of a specialist in handling the pediatric obese patient with dyslipidemia should be limited to severe cases or those at risk for having pancreatitis.

En todos los niños o adolescentes con sobrepeso u obesidad debe buscarse de manera intencionada la presencia de dislipidemias que sean secundarias a la obesidad, con el fin de poder prevenir un evento cardiovascular. Las dislipidemias son un grupo de enfermedades asintomáticas que comúnmente son causadas por concentraciones anormales de las lipoproteínas sanguíneas; son una comorbilidad que es común en la obesidad, independientemente de la edad del paciente. De estas enfermedades, la que tiene mayor prevalencia es la hipertrigliceridemia. Identificar anormalidades en el perfil de lípidos de la población pediátrica permite seleccionar la intensidad y el tipo de tratamiento para el paciente y su familia. El manejo inicial que debe recibir todo niño y adolescente con obesidad y dislipidemia debe basarse en la promoción de un estilo de vida saludable con la dieta y el ejercicio. Para que la adherencia al tratamiento sea exitosa, es fundamental la participación del médico en combinación con un equipo multidisciplinario. Con el tratamiento se pueden reducir los riesgos de complicaciones. La participación del especialista en el manejo del paciente pediátrico obeso con dislipidemias debe limitarse a los casos con dislipidemias severas o a aquellos en los que se busque prevenir una pancreatitis.

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OBJECTIVE: to develop a guideline available to the staff of the second and third level of medical care, that includes recommendations based on the best available evidence about diagnosis and management of diabetic retinopathy (DR). METHODS: clinical questions were formulated and structured. A standardized sequence was established to search for practice guidelines from the clinical questions raised on diagnosis and treatment of DR. The working group searched clinical practice guidelines and found eleven on this topic. For recommendations not included in the reference guide, the search process was conducted in PubMed and Cochrane Library. The results were expressed as levels of evidence and grade of recommendation. CONCLUSIONS: in Mexico diabetic retinopathy is a main cause of blindness in the active working population. It is necessary to establish a program for detection of at-risk population that allow make early diagnosis and opportune management for reducing blindness in patients. It is equally important to be aware of the need for long-term good metabolic control, which is associated with better quality of life.

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The need to solve a clinical problem leads us to establish a starting point to address (risk, prognosis or treatment studies), all these cases seek to attribute causality. Clinical reasoning described in the book Clinical Epidemiology. The architecture of clinical research, offers a simple guide to understanding this phenomenon. And proposes three basic components: baseline, maneuver and outcome. In this model, different systematic errors (bias) are described, which may be favored by omitting characteristics of the three basic components. Thus, omissions in the baseline characteristics cause an improper assembly of the population and susceptibility bias, omissions in the application or evaluation of the maneuver provoke performance bias, and omissions in the assessment of out-come cause detection bias and transfer bias. Importantly, if this way of thinking facilitates understanding of the causal phenomenon, the appropriateness of the variables to be selected in the studies to which attribute or not causality, require additional arguments for evaluate clinical relevance.

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A diagnosis test is carried out to establish the presence of health or illness. In the latter it could grade the severity. Due to its importance in clinical decisions, the diagnosis test is evaluated by mathematical strategies. We estimate the sensitivity and specificity once we know the existence or not of the disease, but we act in the reverse direction; with the presence "X" test positive or negative we estimate the presence of the disease, therefore, we use the positive and negative predictive values. Mathematical strategy allow us to quantify the observation, but it requires judgment to determine the quality making use of a minimum of features: a) selection under the same criteria for cases and controls; b) the inclusion of the full spectrum of disease severity (from mild to the most serious, ensuring that all levels have an enough number of subjects); c) the interpretation of both, the gold standard and the new tool of diagnosis, it must be blind and conducted by experts; d) the interpretation of results should show us what is their application in everyday clinical practice; e) the reproducibility must be checked. Do not forget that usually, we treat only one patient at once, what enforce us to have full knowledge of the performance of the diagnostic test, and to consider all clinical aspects for its proper implementation.

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Para evaluar la incidencia de delirium en pacientes hospitalizados en el Servicio de Medicina e identificar la comorbilidad asociada al trastorno, se aplicó el CAM (Método de Evaluación de la Confusión), el MMSE (Exámen Mínimo del Estado Mental de Folstein) y el subtest de dígitos de WAIS (Escala de Inteligencia Wechsler para el adulto). En los primeros 7 días de internación se identificó que el 15,9 por ciento de los pacientes internados en la Unidad de Medicina Interna desarrollaron delirium. La comorbilidad que se encontró más asociada al delirium fué la diabetes mellitus (p menor 0,02); la hipertensión arterial no alcanzó significación estadística (p menor 0,10)

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Para evaluar la incidencia de delirium en pacientes hospitalizados en el Servicio de Medicina e identificar la comorbilidad asociada al trastorno, se aplicó el CAM (Método de Evaluación de la Confusión), el MMSE (Exámen Mínimo del Estado Mental de Folstein) y el subtest de dígitos de WAIS (Escala de Inteligencia Wechsler para el adulto). En los primeros 7 días de internación se identificó que el 15,9 por ciento de los pacientes internados en la Unidad de Medicina Interna desarrollaron delirium. La comorbilidad que se encontró más asociada al delirium fué la diabetes mellitus (p menor 0,02); la hipertensión arterial no alcanzó significación estadística (p menor 0,10)

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Con frecuencia los datos que usamos en los proyectos de investigación en medicina, provienen de apreciaciones y juicios que hacen los pacientes o los médicos. Las enfermedades se caracterizan por síntomas, que son sensaciones subjetivas para las cuales no hay un estándar de comparación. Las características de una medición son la consistencia y la validez; a su vez la calidad de los resultados de un trabajo de investigación depende de la calidad de sus datos. Por ello se discuten los conceptos de medición, consistencia y validez en la clínica y se proponen algunos métodos para evaluar la consistencia: la prueba Kappa, el coeficiente de correlación intraclase y el método de Bland Altman. Estos métodos no substituyen al juicio del clínico, quien será el que decida si la medición es creíble y si realmente refleja lo que se pretende medir

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