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This is a case report of a young adult who died of COVID-19 twelve days after admission, with coronavirus nucleocapsid protein and lipofuscin found in the heart and kidney tissues, providing further evidence of the role of SARS-CoV-2 in cellular senescence.

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OBJECTIVES: We evaluated the VE and the mutations of the viruses present in the Mexican population at the beginning of 2018. METHODS: We diagnosed influenza in outpatients with a high-performance Rapid Influenza Diagnostic Test (RIDT) qRT-PCR. Descriptive statistics were used to describe the study population, while the chi-square test was used to determine clinical variables. VE was analyzed through a negative test design. We sequenced the hemagglutinin (HA) gene, performed a phylogenetic analysis, and analyzed the nonsynonymous substitutions both in and outside antigenic sites. RESULTS: Of the 240 patients analyzed, 42.5% received the trivalent vaccine, and 37.5% were positive for influenza. The VE for the general population for any influenza virus type or subtype was 37.0%, while the VE for the predominant influenza A(H3N2) subtype was the lowest (19.7%). The phylogenetic analysis of HA showed the co-circulation of clades and subclades 3C.2a1, 3C.2a1b, 3C.2a2, 3C.2a2re, 3C.2a3, and 3C.3a with identities approximately 97-98% similar to the vaccine composition. CONCLUSION: Low VE was related to the co-circulation of multiple clades and subclades of influenza A(H3N2), with sufficient genetic and phenotypic distance to allow for the infection of vaccinated individuals.

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Guatemala has a great diversity of butterflies, although there have been few intensive surveys on Lepidoptera in the country so far. We present an updated list of 218 species in 149 genera, 19 subfamilies, and six families of butterflies sampled at two seasonally dry forests in the Salamá and Motagua valleys in central and eastern Guatemala, by integrating new data from field surveys conducted in 2014-2021 into our previously published data (Yoshimoto et al. 2018, 2019), with Amblyscirteselissaelissa Godman, 1900, Repensflorus (Godman, 1900), and Niconiadesnikko Hayward, 1948 (Hesperiidae: Hesperiinae) as new country records. We collected a hairstreak species, Chalybshassan (Stoll, 1790) (Lycaenidae: Theclinae), at the Motagua Valley site, representing the second record for Guatemala since the early 20th century, after we rediscovered it at the Salamá Valley site in 2011 and 2012 (Yoshimoto and Salinas-Gutiérrez 2015). Nymphalidae and Hesperiidae had larger numbers of species than the other four families at both sites. In Pieridae and Nymphalidae, species composition was similar between the sites, whereas in Lycaenidae, Riodinidae, and Papilionidae it differed more greatly between the sites. These results confirm the relatively high lepidopteran diversity of Guatemalan dry forests, noteworthy for the small areas that comprise the study sites, and represent marked similarities and differences in butterfly fauna and phenology within these forests.

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Resumen: Introducción: Existen indicadores de calidad tanto generales como específicos en medicina crítica. Los indicadores para procesos propios de unidades de cuidados intensivos respiratorios (UCIRs) son necesarios. Material y métodos: Un grupo de trabajo de las UCIRs de los servicios de tórax de los principales hospitales de tercer y cuarto nivel de atención sanitaria en México, siguiendo la metodología de los grupos de trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias y la Fundación Avedis-Donabedian, identificó aspectos relevantes del proceso del cuidado con relación a volumen, riesgo y complejidad, recabando información de 10 años de actividad asistencial para ser correlacionados y finalmente diseñar indicadores. Resultados: Con información de 2,776 pacientes atendidos del 1o de noviembre de 2009 al 1o de noviembre de 2019, se delimitó el campo de actuación con aspectos importantes como broncoscopia, neumonía, paciente inmunocomprometido, hemoptisis masiva, embolización de arterias bronquiales, cirugía de resección segmentaria/lobar o pulmonar, pleurocentesis y ultrasonido fueron identificados y correlacionados en consenso por el grupo de expertos, llevando al diseño de cuatro indicadores. Conclusiones: Este es el primer reporte de desarrollo de indicadores de calidad para UCIRs de servicios de tórax que servirán para la mejora de la calidad en este tipo de unidades.

Abstract: Introduction: There are both general and specific quality indicators in critical care medicine. Indicators for respiratory intensive care units (RICUs) processes are needed. Material and methods: Following the methodology of the working groups of the Spanish Society of Intensive, Critical Care and Coronary Units and the Avedis-Donabedian Foundation, a working group of the RICUs belonging to departments of chest medicine of the main hospitals of third and fourth level of care in Mexico identified relevant aspects of the care process in relation to volume, risk and complexity, collecting information from ten years of clinical activity to be correlated and finally to design indicators. Results: Delimitation of the field of action was made accounting with information on 2,776 patients treated from November 1, 2009 to November 1, 2019. Important aspects such as bronchoscopy, pneumonia, immunocompromised patient, massive hemoptysis, bronchial artery embolization, segmental/lobar or pulmonary resection surgery, thoracentesis and ultrasound were identified and correlated in consensus by the group of experts leading to the design of four indicators. Conclusions: This is the first report on the development of quality indicators for RICUs belonging to departments of chest medicine that will serve to improve quality in this type of units.

Resumo: Introdução: Existen indicadores de qualidade tanto gerais como específicos em medicina crítica. São necessários os indicadores para procesos própios das unidades de terapias intensivas respiratórias (UTIRs). Material e métodos: Um grupo de trabalho das UTIRs dos serviço de tórax dos principais hospitais de tercero e quarto níveis de atenção sanitária no México, seguindo a metodologia dos grupos de trabalho da Sociedade Espanhola de Terapia Intensiva, Crítica e Unidades Coronárias e a Fundação Avedis-Donabedian, identificou aspectos relevantes do processo de cuidado com relação ao volume, risco e complexidade, reunindo informações de 10 anos de atividade assistencial para ser correlacionada e, finalmente, desenhar indicadores. Resultados: Com informações de 2,776 pacientes atendidos de 1o de novembro de 2009 a 1o de novembro de 2019, o campo de atuação foi definido com aspectos importantes como broncoscopia, pneumonia, paciente imunocomprometido, hemoptise maciça, embolização de artérias brônquicas, cirurgia de ressecção segmentar/lobar ou pulmonar, pleurocentese e ultrassom foram identificados e correlacionados em consenso pelo grupo de especialistas, resultando no desenho de quatro indicadores. Conclusão: Este é o primeiro relatório de desenvolvimento de indicadores de qualidade para UTIRs do serviço de tórax que servirão para melhorar a qualidade neste tipo de unidade.

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Objetivo: recopilar, resumir y analizar la producción científica actual sobre la violencia sexual infantil (VSI) en niños y adolescentes varones en el mundo entre el 2014 y el 2019. Método: se realizó una revisión integrativa de literatura mediante una búsqueda sistemática de estudios publicados entre el 2014 y el 2019 en PubMed, LILACS e IBECS. Resultados: se identificaron 990 referencias, de las cuales se seleccionaron 31 artículos para la revisión. La mayoría se realizaron en EE. UU. (n = 18) y otros países desarrollados; solo cinco provienen de países en desarrollo (Brasil, China, India, Jamaica y Suráfrica). Dieciocho estudios usaron metodologías cuantitativas; quince, de tipo transversal. Dos trabajos abordaron menores de 16 años como su población objetivo. Respecto a los objetivos y hallazgos principales, se identificaron cuatro temas recurrentes: caracterización de la VSI, efectos en salud de la VSI (salud mental, salud sexual, comportamientos de riesgo y violencia), revelación de la VSI y análisis de intervenciones terapéuticas. Entre los hallazgos más sobresalientes se refirió que la divulgación del evento constituye un factor protector en el fortalecimiento de la resiliencia frente al abuso. Conclusiones: la VSI genera un impacto negativo en diferentes dimensiones de la salud de la víctima, que trascienden a lo largo de su vida y se profundizan en la medida en que se prolonga el momento de la revelación de los hechos. Más investigaciones son necesarias, principalmente en regiones y países en vías de desarrollo.

Objective: Collect, summarize, and analyze current scientific publications on Child Sexual Violence (CSV) in male children and adolescents worldwide between 2014 and 2019. Method: An integrative review was conducted using a systematic search of studies published between 2014 and 2019 in PubMed, LILACS, and IBECS. Results: Nine hundred and ninety references were identified, from which thirty-one articles were selected for the review. Most of the studies were conducted in the USA (n=18) and other developed countries; only five were conducted in developing countries (Brazil, China, India, Jamaica, and South Africa). Eighteen studies used quantitative methodologies; fifteen were cross-sectional. In two articles, children under 16 years were chosen as the target population. Regarding the main objectives and findings, four recurrent themes were identified: CSV characteristics, effects of CSV on health (mental health, sexual health, risk behaviors, and violence), CSV disclosure, and analysis of therapeutic interventions. Among the findings, the most outstanding was that the disclosure of the event is a protective factor for strengthening resilience against abuse. Conclusions: CSV has a negative impact on different dimensions of the victim's health that transcends throughout his life, and it deepens as the moment of disclosure is delayed. Further research is needed, especially in regions of developing countries.

Objetivo: coletar, resumir e analisar a produção científica atual sobre violência sexual infantil (VSI) em crianças e adolescentes do sexo masculino no mundo entre 2014 e 2019. Método: foi realizada uma revisão integrativa da literatura por meio de uma busca sistemática de estudos publicados entre 2014 e 2019 no PubMed, LILACS e IBECS. Resultados: foram identificadas 990 referências, das quais 31 artigos foram selecionados para a revisão. A maioria foi conduzida nos Estados Unidos (n = 18) e em outros países desenvolvidos; apenas cinco provém de países em desenvolvimento (Brasil, China, Índia, Jamaica e África do Sul). Dezoito estudos utilizaram metodologias quantitativas; quinze, tipo transversal. Dois estudos abordaram crianças menores de 16 anos como população-alvo. Em relação aos objetivos e principais achados foram identificados quatro temas recorrentes: caracterização da VSI, efeitos da VSI na saúde (saúde mental, saúde sexual, comportamentos de risco e violência), revelação da VSI e análise das intervenções terapêuticas. Entre os achados mais destacados, foi colocado que a divulgação do evento constitui um fator de proteção no fortalecimento da resiliência contra o abuso. Conclusões: a VSI gera impacto negativo em diferentes dimensões da saúde da vítima, que transcendem ao longo de sua vida e se aprofundam à medida que se prolonga o momento da revelação dos fatos. Mais pesquisas são necessárias, principalmente em países e regiões em desenvolvimento

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PURPOSE: To determine the anatomical variations and morphology of the external carotid artery (ECA) and its anterior branches. METHODS: Using computed tomography angiography (CTA), the origin, internal diameter, and surface laterality emergence of the superior thyroid (STA), lingual (LA), and facial (FA) arteries were evaluated retrospectively evaluated and classified. The bifurcation level of the common carotid artery (CCA) in relation to the cervical vertebrae and disc was also determined. RESULTS: A total of 76 CTA were included in the study. STA originated from the carotid bifurcation (CB) (type I), CCA (type II) and ECA (type III) in 20.4 (31/152), 17.1 (26/152) and 50.7% (77/152) cases, respectively. Also 10.5% (16/152) arose from a shared trunk with LA as a thyrolingual trunk (TLT) (type IVa), and absent in 1.3% (2/152). LA originated in the CB in only one case. A linguofacial trunk (LFT) was present in 14.5% (22/152). Mean diameters of STA, LA and FA were 1.70, 1.95 and 2.45 mm, respectively. Meanwhile, surface laterality were predominately from anteromedial, medial, and anterior, respectively. CB was mainly on C3 or C3-C4 (55.9% of cases). CONCLUSIONS: STA origin below the ECA is a common finding. Our population presented the highest percentage of TLT (10.5%) and high CB (9.8%) in literature. Considering these variations are important to prevent complications in neck surgical procedures.

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With regards to the article "Workplace bullying during specialty training in a pediatric hospital in Mexico: a little-noticed phenomenon", this letter shows a reflection about the thin line between discipline and bullying in the teacher student relationships in medical education in Mexico.

En relación con el artículo "Acoso laboral durante la formación como especialista en un hospital de pediatría en México: un fenómeno poco percibido", el autor de esta carta reflexiona en torno a la delgada línea que hay entre la disciplina y el bullying en la relación profesor-estudiante en la educación médica en México.

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BACKGROUND: Early tuberculosis (TB) diagnostic is one of the critical steps to TB control. GeneXpert MTB/RIF has been widely proven for a prompt TB diagnosis. The use of GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy samples may increase diagnostic accuracy. We aim to assess the diagnostic of TB with GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy. METHODS: Patients with suspected diagnosis of TB and negative smear microscopies, with TB culture and GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy were included in this cross-sectional study. Participants were enrolled from 2016 to 2018 at National Institute of Respiratory Diseases, Mexico. RESULTS: We included 54 patients (77.8% males) aged 30 to 65 years. The sensitivity of the GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy was 81.3% (95% CI, 62.1-100%), with a specificity of 100% (95% CI, 100-100%) and a negative predictive value of 92.7% (95% CI, 84.7-100%). Twenty-two patients of the total population have HIV, the sensitivity of the test in these patients was 87.5% (95% CI, 64.6-100%). Also, 28 patients with a peripheral localized lesion which had a solid pattern were identified (51.9%). The sensitivity in patients with peripheral localized lesions was 88.9% (68.4-100%). CONCLUSIONS: The GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy test is as efficient as broncho alveolar lavage for TB diagnosis. Transbronchial lung cryobiopsy increases a major diagnostic opportunity when the nature of illness is malignant. Transbronchial lung cryobiopsy is efficient in HIV patients, especially in patients with peripheral localized lesion.

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Introduction: A reliable list of species and the analysis of diversity patterns of hyperdiverse taxa, like butterflies, are fundamental for monitoring and managing biological resources. Oaxaca is one of the most diverse states in Mexico for many groups including Lepidoptera and most of its diversity is unknown. Objective: To estimate and describe the species richness and diversity of Papilionidae and Pieridae along an altitudinal gradient and five vegetation types in the Loxicha Region, Oaxaca, Sierra Madre del Sur. Methods: Sampling effort comprised 222 collecting days during a period of seven years. We estimated the alpha diversity for 17 sites within an elevational gradient from 80 to 2 850 m, with five vegetation types: tropical deciduous forest (TDF), tropical sub-deciduous forest (TSDF), cloud forest (low and middle levels) (CF), oak-pine and cloud forest (high level) (OPCF) and oak-pine forest (OPF). Results: We obtained a list of 69 species (27 Papilionidae and 42 Pieridae), of 34 genera and five subfamilies, from literature records and fieldwork. These species are 60 % of the Pieridae and 48 % of the Papilionidae recorded for the state. The Loxicha Region has 36 % of the Pieridae and 30 % of the Papilionidae of Mexico. Both families present different species richness patterns by vegetation type. Papilionidae is richer in the TDF with 23 estimated species and most of the species of this family (84 %) occur below 500 m. Meanwhile, species richness of Pieridae has non-significant differences among vegetations types, except for OPF which has fewer species than the other types. The elevational gradient was divided into three levels (0-750, 750-1 800, 1 800-2 850 m) showing a reduction of species richness and diversity for both families at higher altitudes. Conclusions: Papilionidae species are more restricted to a vegetation type or elevational level than Pieridae species. Likely reasons are higher vagility (including migrations) and wider ecological tolerance of most Pieridae.

Introducción: Una lista de especies confiable y el análisis de los patrones de diversidad de taxones hiperdiversos, como las mariposas, son fundamentales para el monitoreo y manejo de recursos biológicos. Oaxaca es uno de los estados más diversos de México y mucha de su diversidad aun es desconocida. Objetivo: Estimar y describir la riqueza de especies y diversidad de Papilionidae y Pieridae en un gradiente altitudinal y cinco tipos de vegetación presentes en la Región Loxicha, Oaxaca, en la Sierra Madre del Sur. Métodos: El esfuerzo de muestreo comprendió 222 días a lo largo de siete años. Se estima la diversidad alfa para 17 sitios dentro de un gradiente altitudinal de 880 a 2 850 m con cinco tipos de vegetación: bosque tropical caducifolio, bosque tropical subcaducifolio, bosque mesófilo (nivel bajo y medio), bosque de pino-encino con bosque mesófilo (nivel alto) y bosque de pino-encino. Resultados: Se obtuvo una lista de 69 especies (27 Papilionidae y 42 Pieridae), de 34 géneros y cinco subfamilias, a partir de los registros en la literatura y el trabajo de campo. Estas especies representan el 60 % de los Pieridae y el 48 % de los Papilionidae registrados para el estado. A nivel nacional, la región Loxicha tiene el 36 % de las Pieridae y el 30 % de las Papilionidae del país. Las familias presentan patrones diferentes de riqueza de especies por tipo de vegetación. Papilionidae es más rica en el bosque tropical caducifolio con 23 especies estimadas y la mayoría de las especies de esta familia (84 %) están por debajo de los 500 m Mientras que la riqueza de especies de Pieridae no presenta diferencias significativas entre los tipos de vegetación, excepto por el bosque de pino-encino que tiene menos especies que los demás tipos. El gradiente altitudinal se dividió en tres pisos (0-750, 750-1 800, 1 800-2 850 m) con una reducción de la riqueza de especies y diversidad de ambas familias en altitudes mayores. Conclusiones: Las especies de Papilionidae están más restringidas a un tipo de vegetación o piso altitudinal que las especies de Pieridae. Probablemente por la gran vagilidad, valencia ecológica más amplia y capacidad de migraciones altitudinales de la mayoría de las Pieridae.

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BACKGROUND: Simultaneous infection in tuberculosis (TB) is rare. The mixed infection between Streptococcus anginosus group (SAG) and M. tuberculosis (MTB) has not been reported in children. The aim of this report was to describe a pediatric case with a pulmonary abscess caused by the duality SAG-MTB co-infection. CASE PRESENTATION: An 11-year-old boy with an acute onset of throbbing pain of two-day evolution located in the anterior chest wall. The patient reported a history of fever, cough and rhinorrhea during the last seven days. An anterior chest radiography revealed a heterogenic opacity at the lower right lobe while the lateral projection showed an obliteration at the anterior diaphragmatic insertion. Parenteral Ceftriaxone (100 mg/kg/day) and Dicloxacillin (200 mg/kg/day) was started. The abscess was subsequently drained and analyzed. After a year of follow-up, the patient remained asymptomatic. CONCLUSION: This case represents the first reported case of pulmonary co-infection involving MTB and SAG in an immunocompetent pediatric patient.

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Health is not only a biological condition; it is configured as a social, cultural and legal good that the state can´t promote, improve or protect without the participation of health professionals, states and educational and research institutions; but, above all, it must have the active intervention of all citizens. The aim is for services to be carried out with equity, quality and social protection.

La salud no es únicamente una condición biológica, sino que se configura como un bien social, cultural y jurídico que el Estado no puede promover, mejorar ni proteger sin la participación de los profesionales de la salud, las entidades federativas y las instituciones educativas y de investigación; pero, sobre todo, debe contar con la intervención activa de todos los ciudadanos. Se busca que los servicios de salud se realicen con equidad, calidad y protección social.

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El sismo ocurrido el 19 de septiembre del presente año en la ciudad de México, a 32 años del ocurrido en la misma fecha y en el mismo lugar, ha motivado una respuesta intensa de voluntariado en la generación llamada millenials; las redes sociales invitaron a participar y localizar las áreas geográ ficas más necesitadas de apoyo de brigadistas e insumos, y el poder de convocatoria y el espíritu de solidaridad fue ejemplar, incluso rebasando el número solicitado para dichas actividades. Analizando este fenómeno, es de considerar la respuesta a la siguiente pregunta: ¿la generación millenial es la más prepa rada para afrontar un desastre de esta magnitud?

The earthquake that occurred on September 19 of this year in Mexico City, 32 years after that occurred on the same date and in the same place, has motivated an intense volunteer response in the generation called millennials; Social networks invited people to participate and locate the geographic areas most in need of support from brigades and supplies, and the convening power and spirit of solidarity was exemplary, even exceeding the number requested for such activities. Analyzing this phenomenon, it is necessary to consider the answer to the following question: is the millennial generation the most prepared to face a disaster of this magnitude?

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It has been 50 years since the first description of the respiratory distress syndrome or acute respiratory distress syndrome (ARDS), advances from the physiopathological view are immense, unfortunately, the case fatality rate has had little variation, it is important to disseminate the knowledge to achieve the proper diagnosis and treatment.

Han pasado 50 años desde la descripción original del síndrome de distrés respiratorio o síndrome de dificultad respiratoria aguda (SDRA), los avances desde el punto de vista fisiopatológico son inmensos, desgraciadamente la letalidad ha tenido poca variación, por ello sigue siendo importante difundir el conocimiento requerido para lograr el diagnóstico y tratamiento adecuados.

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