RESUMO
HIV prevalence among transgender women (TW) in Tijuana, Mexico is estimated at 22%. Pre-exposure prophylaxis (PrEP) reduces the risk of HIV acquisition by > 90%, though uptake in Tijuana has been low due to limited availability. The interplay between PrEP and gender stigmas may also serve as a barrier to PrEP uptake among TW in Tijuana. Experiences of gender- and PrEP- stigmas were assessed quantitatively (Quan) among 110 HIV-negative TW and qualitatively (Qual) among 17 TW through semi-structured interviews guide by the Health Stigma and Discrimination Framework. Qual findings were triangulated with Quant data to identify factors that may support gender affirmation and reduce PrEP stigma in an explanatory sequential Quan â Qual fashion. Most participants were < 40 years of age (80%), while approximately half had at least a high school education (48.2%) and were accessing gender-affirming hormone therapy (56.4%). Mean expectations of gender stigma were greatest for endorsing negative future expectations from others (M = 17.69; possible range 0-36). PrEP stigma was prominent among those who associated negative stereotypes with PrEP users, such as poor judgment (M = 45.91; possible range 14-70) and high personal risk attributes (M = 28.61; possible range 12-60). While PrEP knowledge was low among the qualitative sample, participants identified gender-, PrEP-, and intersectional- stigmas as potential barriers to PrEP uptake. Participants suggested that resilience strategies used to combat gender stigma could also mitigate PrEP stigma. Enhancing resilience skills at the intersection of gender and PrEP stigma may reduce these barriers, facilitating greater PrEP uptake as it becomes more available in Mexico.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Profilaxia Pré-Exposição , Estigma Social , Pessoas Transgênero , Humanos , Pessoas Transgênero/psicologia , Pessoas Transgênero/estatística & dados numéricos , México/epidemiologia , Feminino , Infecções por HIV/prevenção & controle , Adulto , Masculino , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/administração & dosagem , Pesquisa Qualitativa , Entrevistas como Assunto , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Adulto JovemRESUMO
OBJECTIVE: To describe the characteristics, upon presentation, of a cohort of Hispanic patients with birdshot retinochoroidopathy. METHODS: A retrospective chart review of Hispanic patients with birdshot retinochoroidopathy of was performed. The demographic and clinical characteristics were analyzed. RESULTS: Nine patients who met the research criteria for a diagnosis of birdshot retinochoroidopathy were identified and included in the analysis, all of whom were HLA-A29 positive. The median age of the cohort upon presentation was 52 years; 89% of the patients were female, and all were Hispanics. Ninety-four percent of the eyes had an initial visual acuity of 20/50 or better, while 72% had measured 20/25 or better. Sixty-one percent of the eyes had retinal vasculitis, which was bilateral in 83% of the cases. Thirty-three percent of the patients had, upon presentation, evidence of cystoid macular edema, which was always bilateral. All the eyes had the typical birdshot lesions, at presentation. CONCLUSION: Birdshot retinochoroidopathy can be found in Hispanic patients. Our study suggests that the characteristics upon presentation in Hispanics may be similar to those of Caucasian cohorts.
Assuntos
Coriorretinopatia de Birdshot/diagnóstico , Hispânico ou Latino , Adulto , Coriorretinopatia de Birdshot/etnologia , Coriorretinopatia de Birdshot/imunologia , Estudos de Coortes , Feminino , Fundo de Olho , Antígenos HLA-A , Humanos , Edema Macular/diagnóstico , Edema Macular/etnologia , Masculino , Pessoa de Meia-Idade , Porto Rico , Vasculite Retiniana/diagnóstico , Vasculite Retiniana/etnologia , Estudos Retrospectivos , Avaliação de Sintomas , Acuidade VisualRESUMO
Tuberculous Meningitis (TBM) is the most common form of central nervous system Tuberculosis (TB), accounting for 5-6% of extrapulmonary TB cases. Nowadays, TBM continues to be a major topic in public health because of its high prevalence worldwide. This retrospective study aimed to describe the clinical, laboratory, and imaging characteristics at admission; and in-hospital outcome of adult Mexican patients with TBM. We collected data from medical records of patients aged ≥18 years diagnosed with TBM according to the uniform case definition for clinical research who were treated at Tijuana General Hospital between January 2015 and March 2018 and compared them according to the subtype of diagnosis. We included 41 cases (26 males, median age 28 years, range 18-57 years), 13 (31.7%) patients were HIV positive, and 21 (51.2%) were illicit drug users. At admission, 7 (17.1%) patients were in stage I, 22 (53.6%) in stage II, and 12 (29.3%) in stage III. A definitive diagnosis was established in 23 (56.1%) patients, probable in 14 (34.1%), and possible in four (9.8%). Molecular testing was positive in 83% of the cases, yielding significantly higher positive results than other microbiological studies. There were eight (19.5%) deaths, without statistical difference between mortality and not having a definitive diagnosis (p = 0.109). We found that the baseline characteristics of our population were similar to those described by other authors worldwide. In this series, molecular testing showed to be very useful when used in the early stages, particularly in subjects with subacute onset of headache, fever, weight loss, and altered mental status.
Assuntos
Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Meníngea/epidemiologia , Tuberculose Meníngea/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Adulto JovemRESUMO
La histoplasmosis es una infección causada por el hongo Histoplasma capsulatum, la incidencia de la enfermedad oscila entre 0.1 a 0.29 casos por cada 100 000 habitantes y de estos 1 de cada 2 000 casos se presenta de forma diseminada, manifestándose en personas con inmunosupresión y de forma infrecuente en personas inmunocompetentes. Objetivo: mostrar la relación existente entre hipotiroidismo e histoplasmosis diseminada. Presentación del caso clínico: paciente de 33 años, procedente de Talanga, Francisco Morazán, Honduras, tratada por hipotiroidismo de 3 años de evolución con levotiroxina 100ug cada día, con tumoración en axila izquierda de hace 2 años, la cual 3 meses previos al ingreso fue tratada por adenitis aguda de forma ambulatoria sin mostrar mejoría. Al examen físico se encontró adenopatía de 2 sospecha de histoplasmosis confirmándose con tinción de Grocott; el examen para virus de inmunodeficiencia humana fue negativo y el perfil inmunológico resultó normal. Conclusión : En este caso la histoplasmosis diseminada se acompañó de hipotiroidismo, no se ha demostrado que conlleve a inmunosupresión, y aún faltan pruebas que establezcan el vínculo de hipotiroidismo como factor predisponente a esta enfermedad...(AU)
Assuntos
Humanos , Feminino , Adulto , Técnicas de Laboratório Clínico , Histoplasmose , Hipotireoidismo/diagnóstico , Terapia de Imunossupressão , Linfadenite/diagnósticoRESUMO
BACKGROUND: Pretreatment drug resistance (PDR) levels to NNRTI approaching 10% have recently been reported in Mexico. However, subnational differences may exist in PDR prevalence and transmission dynamics. OBJECTIVES: We longitudinally assessed HIV PDR in three geographic areas of Mexico. PATIENTS AND METHODS: HIV-infected, antiretroviral-naive individuals were recruited from 2008 to 2016, from the Central Metropolitan Zone (CMZ), Cancun and Tijuana (1194, 773 and 668 respectively). PDR was estimated using the Stanford HIVdb tool from plasma HIV pol sequences. RESULTS: A higher proportion of females, lower education and lower employment rate were observed in Tijuana, while a higher proportion of MSM was observed in the CMZ (P < 0.0001, all cases). For 2012-16, PDR was 13.4%, 8.9% and 11.2% in the CMZ, Tijuana and Cancun respectively. NNRTI PDR was highest in the three regions (8.7%, 4.8% and 8.1% respectively, P < 0.05); nevertheless, NNRTI PDR in Tijuana was lower than in the CMZ (P = 0.01). For 2008-16, we observed increasing efavirenz resistance trends in all regions (P < 0.05, all cases), reaching 11.8%, 6.1% and 8.3% respectively in 2016. Increasing efavirenz resistance was mostly associated with increasing K103N frequency (P = 0.007 CMZ, P = 0.03 Tijuana, not significant for Cancun). CONCLUSIONS: Our study suggests different NNRTI PDR prevalence and transmission dynamics in three geographical areas of Mexico. Even when increasing trends in efavirenz resistance were observed in the three areas, our observations support that, in a large country such as Mexico, subnational surveillance and locally tailored interventions to address drug resistance may be a reasonable option.
Assuntos
Fármacos Anti-HIV/farmacologia , Farmacorresistência Viral Múltipla , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , Inibidores da Transcriptase Reversa/farmacologia , Adulto , Alcinos , Fármacos Anti-HIV/uso terapêutico , Benzoxazinas/farmacologia , Estudos Transversais , Ciclopropanos , Monitoramento Epidemiológico , Feminino , Genótipo , Geografia , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , HIV-1/genética , Humanos , Masculino , México/epidemiologia , Mutação , Prevalência , Estudos Retrospectivos , Inibidores da Transcriptase Reversa/uso terapêutico , Análise de Sequência de DNA , Adulto JovemRESUMO
BACKGROUND: Invasive meningococcal disease (IMD) has been reported to be endemic in children from Tijuana, Mexico and the risk of an outbreak was always a threat. OBJECTIVES: To describe all clinical, epidemiological and microbiological features of a meningococcal outbreak that occurred in Tijuana, Mexico. METHODS: All cases with IMD were admitted at different emergency departments within the city and diagnosed by culture and agglutination tests. Further restriction fragment length polymorphism pulse field gel electrophoresis (RFLP-PFGE) and multi locus sequence typing (MLST) were performed. All clinical and epidemiological characteristics and interventions were evaluated, as well as risk factors associated with mortality. RESULTS: From 30 January 2013 to 30 March 2013 there were 19 cases of IMD all caused by Neisseria meningitidis serogroup C. The median age was 16 years (2-47), with higher frequency among individuals at least 13 years old (73.7%). At admission, meningitis was the main clinical presentation (94.7%), followed by purpura (78.9%), septic shock (42.1%) and disseminated intravascular coagulation (DIC, 36.8%). Overall mortality was seven (36.8%). Variables associated with higher mortality were, at admission, presence of septic shock, DIC and thrombocytopenia less than 70,000. All 19 cases had no identifiable site or cluster as the source of the outbreak. RFLP-PFGE showed a discriminatory power for only one profile on all N. meningitidis strains analyzed and a clone ST-11 was identified in all strains. Public health interventions were continuous case reporting of all suspected cases of IMD, an increase in active surveillance in all hospitals, training of medical and laboratory personnel, massive and rapid chemoprophylaxis to all close contacts as indicated, and promotion of good health habits. CONCLUSIONS: An outbreak with high mortality of IMD occurred in Tijuana, Mexico. This event and evidence of endemicity should encourage health authorities to evaluate meningococcal vaccination in the region.
RESUMO
INTRODUCTION: Mexico was the country to initiate massive vaccination with heptavalent pneumococcal conjugate vaccine (PCV-7) in children. There is no information regarding pneumococcal invasive disease (PID) in children before and after implementation of PCV-7 in Mexico or elsewhere in Latin America. METHODOLOGY: During October 2005 to September 2010, active surveillance for pediatric PID was initiated at Tijuana General Hospital. Only culture-confirmed cases from sterile fluids were included in the study. Serotype identification was also performed. RESULTS: Twenty-eight pediatric PID cases were confirmed. Streptococcus pneumoniae was the main cause of pleural empyema (n = 13). It was also the second most common cause of confirmed bacterial meningitis (n = 10), followed by Neisseria meningitidis (n = ?), and the only cause of otomastoiditis with bacterial isolation (n = 5). Vaccine-associated serotypes decreased from 54% before PCV-7 introduction to the vaccination schedule, to only 5.6% after PCV-7 implementation. Serotypes 19A and 7F (47% and 33% respectively were predominant following PCV-7 vaccination. CONCLUSIONS: Serotype substitution in PID is present in the northern border of Mexico following PCV-7 vaccination in children.
Assuntos
Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/classificação , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Criança , Pré-Escolar , Empiema/epidemiologia , Empiema/microbiologia , Vacina Pneumocócica Conjugada Heptavalente , Hospitais Pediátricos , Humanos , Lactente , Masculino , Mastoidite/epidemiologia , Mastoidite/microbiologia , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/microbiologia , México/epidemiologia , SorotipagemRESUMO
BACKGROUND: Transmitted drug resistance (TDR) remains an important concern for the management of HIV infection, especially in countries that have recently scaled-up antiretroviral treatment (ART) access. METHODOLOGY/PRINCIPAL FINDINGS: We designed a study to assess HIV diversity and transmitted drug resistance (TDR) prevalence and trends in Mexico. 1655 ART-naïve patients from 12 Mexican states were enrolled from 2005 to 2010. TDR was assessed from plasma HIV pol sequences using Stanford scores and the WHO TDR surveillance mutation list. TDR prevalence fluctuations over back-projected dates of infection were tested. HIV subtype B was highly prevalent in Mexico (99.9%). TDR prevalence (Stanford score>15) in the country for the study period was 7.4% (95% CI, 6.2â¶8.8) and 6.8% (95% CI, 5.7â¶8.2) based on the WHO TDR surveillance mutation list. NRTI TDR was the highest (4.2%), followed by NNRTI (2.5%) and PI (1.7%) TDR. Increasing trends for NNRTI (pâ=â0.0456) and PI (pâ=â0.0061) major TDR mutations were observed at the national level. Clustering of viruses containing minor TDR mutations was observed with some apparent transmission pairs and geographical effects. CONCLUSIONS: TDR prevalence in Mexico remains at the intermediate level and is slightly lower than that observed in industrialized countries. Whether regional variations in TDR trends are associated with differences in antiretroviral drug usage/ART efficacy or with local features of viral evolution remains to be further addressed.