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BACKGROUND: Phase III clinical trials have documented the efficacy of the SARS-CoV-2 vaccines in preventing symptomatic COVID-19. Nonetheless, it is imperative to continue analyzing the clinical response to different vaccines in real-life studies. Our objective was to evaluate the effectiveness of five different vaccines in hospitalized patients with COVID-19 during the third COVID-19 outbreak in Mexico dominated by the Delta variant. METHODS: A test-negative case-control study was performed in nine tertiary-care hospitals for COVID-19. We estimated odds ratios (OR) adjusted by variables related a priori with the likelihood of SARS-CoV-2 infection and its severity. RESULTS: We studied 761 subjects, 371 cases, and 390 controls with a mean age of 53 years (SD, 17 years). Overall, 51% had a complete vaccination scheme, and an incomplete scheme (one dose from a scheme of two), 14%. After adjustment for age, gender, obesity, and diabetes mellitus, we found that the effectiveness of avoiding a SARS-CoV-2 infection when hospitalized with at least one vaccination dose was 71% (OR 0.29, 95% CI 0.19-0.45), that of an incomplete vaccination scheme, 67% (OR 0.33, 95% CI 0.18-0.62), and that of any complete vaccination scheme, 73% (OR 0.27, 95% CI 0.17-0.43). CONCLUSIONS: The SARS-CoV-2 vaccination program showed effectiveness in preventing SARS-CoV-2 infection in hospitalized patients during a Delta variant outbreak.
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Fusarium species represent an opportunistic fungal pathogen. The data in Mexico about Fusarium infections in humans are scarce. Here, we present a retrospective series of patients with a confirmed diagnosis of fusariosis in eight different hospitals in Mexico from January 2010 to December 2019. The diagnosis of proven fusariosis was made according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORT/MSG) criteria. A total of 49 cases were identified in our series. Most patients had burn injuries (49%), and 37% had hematological malignancies. Most patients had fire injuries (40%), followed by electric injuries (8%), febrile neutropenia (10%), and pancytopenia (6%). Patients had skin and soft tissue involvement in 49%, followed by blood culture isolation and biopsies from different sites of the body (lung, sinuses, bone tissue, and eyes). Febrile neutropenia (10%) and fungemia (8%) were the most common clinical syndromes in immunosuppressed patients. Most patients received monotherapy (67%), where voriconazole was used in 30% of the cases, followed by conventional amphotericin B (16%), and lipidic formulations of amphotericin B in 10% (either liposomal amphotericin B or amphotericin B lipid complex). Combination therapy was used in 20% of the cases, and the most common combination therapy was triazole plus any lipidic formulation of amphotericin B (10%). Mortality related to Fusarium infection occurred in 22% of patients. Fusariosis is a serious threat. Burn injuries and hematologic malignancies represent the most common causes of infection in this small series from Mexico.
This study describes the epidemiological characteristics of patients with fusariosis from a multicenter cohort in Mexico. These findings provide information from this invasive fungal disease that threatens different countries in Latin America.
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Queimaduras , Neutropenia Febril , Fusariose , Fusarium , Neoplasias Hematológicas , Humanos , Fusariose/tratamento farmacológico , Fusariose/epidemiologia , Fusariose/veterinária , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Estudos Retrospectivos , México/epidemiologia , Voriconazol/uso terapêutico , Neoplasias Hematológicas/veterinária , Queimaduras/complicações , Queimaduras/epidemiologia , Queimaduras/veterinária , Neutropenia Febril/tratamento farmacológico , Neutropenia Febril/veterináriaRESUMO
One of the main causes of food spoilage is the lipid oxidation of its components, which generates the loss of nutrients and color, together with the invasion of pathogenic microorganisms. In order to minimize these effects, active packaging has played an important role in preservation in recent years. Therefore, in the present study, an active packaging film was developed using polylactic acid (PLA) and silicon dioxide (SiO2) nanoparticles (NPs) (0.1% w/w) chemically modified with cinnamon essential oil (CEO). For the modification of the NPs, two methods (M1 and M2) were tested, and their effects on the chemical, mechanical, and physical properties of the polymer matrix were evaluated. The results showed that CEO conferred to SiO2 NPs had a high percentage of 2,2-diphenyl-l-picrylhydrazyl (DPPH) free radical inhibition (>70%), cell viability (>80%), and strong inhibition to E. coli, at 45 and 11 µg/mL for M1 and M2, respectively, and thermal stability. Films were prepared with these NPs, and characterizations and evaluations on apple storage were performed for 21 days. The results show that the films with pristine SiO2 improved tensile strength (28.06 MPa), as well as Young's modulus (0.368 MPa) since PLA films only presented values of 27.06 MPa and 0.324 MPa, respectively; however, films with modified NPs decreased tensile strength values (26.22 and 25.13 MPa), but increased elongation at break (from 5.05% to 10.32-8.32%). The water solubility decreased from 15% to 6-8% for the films with NPs, as well as the contact angle, from 90.21° to 73° for the M2 film. The water vapor permeability increased for the M2 film, presenting a value of 9.50 × 10-8 g Pa-1 h-1 m-2. FTIR analysis indicated that the addition of NPs with and without CEO did not modify the molecular structure of pure PLA; however, DSC analysis indicated that the crystallinity of the films was improved. The packaging prepared with M1 (without Tween 80) showed good results at the end of storage: lower values in color difference (5.59), organic acid degradation (0.042), weight loss (24.24%), and pH (4.02), making CEO-SiO2 a good component to produce active packaging.
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Within the framework of the current COVID-19 pandemic, there is a race against time to find therapies for the outbreak to be controlled. Since vaccines are still tedious to develop and partially available for low-income countries, passive immunity based on egg-yolk antibodies (IgY) is presented as a suitable approach to preclude potential death of infected patients, based on its high specificity/avidity/production yield, cost-effective manufacture, and ease of administration. In the present study, IgY antibodies against a recombinant RBD protein of SARS-CoV-2 were produced in specific-pathogen-free chickens and purified from eggs using a biocompatible method. In vitro immunoreactivity was tested, finding high recognition and neutralization values. Safety was also demonstrated prior to efficacy evaluation, in which body weight, kinematics, and histopathological assessments of hamsters challenged with SARS-CoV-2 were performed, showing a protective effect administering IgY intranasally both as a prophylactic treatment or a post-infection treatment. The results of this study showed that intranasally delivered IgY has the potential to both aid in prevention and in overcoming COVID-19 infection, which should be very useful to control the advance of the current pandemic and the associated mortality.
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COVID-19 , SARS-CoV-2 , Animais , Anticorpos , COVID-19/prevenção & controle , Galinhas , Humanos , Imunoglobulinas , PandemiasRESUMO
The coronavirus disease-19 (COVID-19) pandemic has already claimed millions of lives and remains one of the major catastrophes in the recorded history. While mitigation and control strategies provide short term solutions, vaccines play critical roles in long term control of the disease. Recent emergence of potentially vaccine-resistant and novel variants necessitated testing and deployment of novel technologies that are safe, effective, stable, easy to administer, and inexpensive to produce. Here we developed three recombinant Newcastle disease virus (rNDV) vectored vaccines and assessed their immunogenicity, safety, and protective efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in mice and hamsters. Intranasal administration of rNDV-based vaccine candidates elicited high levels of neutralizing antibodies. Importantly, the nasally administrated vaccine prevented lung damage, and significantly reduced viral load in the respiratory tract of vaccinated animal which was compounded by profound humoral immune responses. Taken together, the presented NDV-based vaccine candidates fully protected animals against SARS-CoV-2 challenge and warrants evaluation in a Phase I human clinical trial as a promising tool in the fight against COVID-19.
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COVID-19 , Vacinas Virais , Administração Intranasal , Animais , Anticorpos Neutralizantes , Anticorpos Antivirais , COVID-19/prevenção & controle , Cricetinae , Camundongos , Vírus da Doença de Newcastle/genética , SARS-CoV-2/genética , Vacinação , Vacinas Sintéticas/genéticaRESUMO
INTRODUCTION: The novel coronavirus pandemic (COVID-19) represents a major public health problem and it is key to find a treatment that reduces mortality. Our objective was to estimate whether treatment with 400 mg/day of Hydroxychloroquine for 10 days reduces in-hospital mortality in subjects with severe respiratory disease due to COVID-19 compared with placebo. MATERIAL AND METHODS: A double-blind, randomized, placebo-controlled trial to evaluate the safety and efficacy of Hydroxychloroquine for the treatment of severe disease by COVID-19 through an intention-to-treat analysis. Eligible for the study were adults aged more than 18 years with COVID-19 confirmed by RT-PCR and lung injury requiring hospitalization with or without mechanical ventilation. Primary outcome was 30-day mortality. Secondary outcomes: days of mechanical ventilation, days of hospitalization and cumulative incidence of serious adverse events. RESULTS: A total of 214 patients with COVID-19 were recruited, randomized and analyzed. They were hypoxemic with a mean SpO2 of 65% ± 20, tachycardic (pulse rate 108±17 min-1) and tachypneic (32 ±10 min-1); 162 were under mechanical ventilation at randomization. Thirty-day mortality was similar in both groups (38% in Hydroxychloroquine vs. 41% in placebo, hazard ratio [HR] 0.88, 95% Confidence Interval [95%CI] 0.51-1.53). In the surviving participants, no significant difference was found in secondary outcomes. CONCLUSION: No beneficial effect or significant harm could be demonstrated in our randomized controlled trial including 214 patients, using relatively low doses of Hydroxychloroquine compared with placebo in hospitalized patients with severe COVID-19.
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Tratamento Farmacológico da COVID-19 , Hidroxicloroquina/uso terapêutico , SARS-CoV-2/metabolismo , Adulto , Antivirais/uso terapêutico , COVID-19/metabolismo , COVID-19/mortalidade , Doenças Transmissíveis/epidemiologia , Método Duplo-Cego , Feminino , Hospitalização , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Respiração Artificial , Infecções Respiratórias/epidemiologia , SARS-CoV-2/patogenicidade , Resultado do TratamentoRESUMO
BACKGROUND: The progressive disseminated histoplasmosis (PDH) has been associated with severe disease and high risk of death among people living with HIV (PLWHIV). Therefore, the purpose of this multicenter, prospective, double-blinded study done in ten Mexican hospitals was to determine the diagnostic accuracy of detecting Histoplasma capsulatum antigen in urine using the IMMY ALPHA Histoplasma EIA kit (IAHE), clarus Histoplasma GM Enzyme Immunoassay (cHGEI IMMY) and MiraVista Histoplasma Urine Antigen LFA (MVHUALFA); as well as the Hcp100 and 1281-1283220SCAR nested PCRs in blood, bone-marrow, tissue biopsies and urine. METHODOLOGY/PRINCIPAL FINDINGS: We included 415 PLWHIV older than 18 years of age with suspicion of PDH. Using as diagnostic standard recovery of H. capsulatum in blood, bone marrow or tissue cultures, or histopathological exam compatible, detected 108 patients (26%, [95%CI, 21.78-30.22]) with proven-PDH. We analyzed 391 urine samples by the IAHE, cHGEI IMMY and MVHUALFA; the sensitivity/specificity values obtained were 67.3% (95% CI, 57.4-76.2) / 96.2% (95% CI, 93.2-98.0) for IAHE, 91.3% (95% CI, 84.2-96.0) / 90.9% (95% CI, 87.0-94.0) for cHGEI IMMY and 90.4% (95% CI, 83.0-95.3) / 92.3% (95% CI, 88.6-95.1) for MVHUALFA. The Hcp100 nested PCR was performed on 393, 343, 75 and 297, blood, bone marrow, tissue and urine samples respectively; the sensitivity/specificity values obtained were 62.9% (95%CI, 53.3-72.5)/ 89.5% (95%CI, 86.0-93.0), 65.9% (95%CI, 56.0-75.8)/ 89.0% (95%CI, 85.2-92.9), 62.1% (95%CI, 44.4-79.7)/ 82.6% (95%CI, 71.7-93.6) and 34.9% (95%CI, 24.8-46.2)/ 67.3% (95%CI, 60.6-73.5) respectively; and 1281-1283220SCAR nested PCR was performed on 392, 344, 75 and 291, respectively; the sensitivity/specificity values obtained were 65.3% (95% CI, 55.9-74.7)/ 58.8% (95%CI, 53.2-64.5), 70.8% (95%CI, 61.3-80.2)/ 52.9% (95%CI, 46.8-59.1), 71.4% (95%CI, 54.7-88.2)/ 40.4% (95%CI, 26.4-54.5) and 18.1% (95%CI, 10.5-28.1)/ 90.4% (95%CI, 85.5-94.0), respectively. CONCLUSIONS/SIGNIFICANCE: The cHGEI IMMY and MVHUALFA tests showed excellent performance for the diagnosis of PDH in PLWHIV. The integration of these tests in clinical laboratories will certainly impact on early diagnosis and treatment.
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Antígenos de Fungos/urina , Infecções por HIV/complicações , HIV-1 , Histoplasmose/complicações , Adulto , Feminino , Infecções por HIV/epidemiologia , Histoplasma/imunologia , Histoplasma/metabolismo , Histoplasmose/epidemiologia , Histoplasmose/urina , Humanos , Técnicas Imunoenzimáticas , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
Background: Nasal asymmetry is one of the most frequent characteristics of patients with cleft lip and palate. The anthropometric measurement (AM) is an accessible and reliable method that can be used by specialists to evaluate nasal asymmetry in patients with cleft lip and palate. The aim of this study was to evaluate the effectiveness of an educational intervention applied to cleft lip and palate specialists to increase the accuracy of AM in the evaluation of nasal asymmetry. Methods: Quasi-experimental study. Results: In the first phase of the study, five of the 13 AM reported a mean difference (MD) > 1.5 mm, and 12 of the 13 AM showed results greater than 2 SD (standard deviations). In the second phase, the results showed 11 of the 13 AM with MD < 1 mm, and 9 of the 13 AM were less than 2 SD. Conclusions: The intervention carried out with the manual of AMs increased the knowledge of the specialists on the anatomy points and AM that can be used to evaluate the nasal asymmetry in patients with cleft lip and palate. Educational intervention help to increase the agreement between examiners to perform a reliable evaluation of nasal asymmetry in patients with these conditions.
Introducción: La asimetría nasal es una de las características más frecuentes de los pacientes con labio y paladar hendido; la medición antropométrica (MA) es un método accesible y confiable que puede ser utilizado por los especialistas para evaluarlo. El objetivo de este estudio fue evaluar la efectividad de una intervención educativa aplicada a especialistas que tratan pacientes con labio y paladar hendido para incrementar la precisión en las MA en la evaluación de la asimetría nasal. Métodos: Estudio cuasiexperimental. Resultados: En la primera fase del estudio, 5 de las 13 medidas antropométricas reportaron una diferencia de medias (DM) > 1.5 mm, y 12 de las 13 MA mostraron resultados mayores a dos desviaciones estándar (DE). Los resultados en la segunda fase evidenciaron 11 de las 13 MA con DM < 1 mm, y 9 de las 13 MA fueron menores a dos DE. Conclusiones: La intervención realizada con el Manual de medidas antropométricas aumentó los conocimientos de los especialistas sobre la anatomía, puntos y MA que se pueden utilizar para evaluar la asimetría nasal en pacientes con labio y paladar hendido. La intervención educativa ayuda a aumentar el acuerdo entre los evaluadores para realizar una evaluación confiable de la asimetría nasal en pacientes con estos padecimientos.
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Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Pessoal de Saúde/educação , Nariz/anatomia & histologia , Adulto , Idoso , Antropometria , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , EspecializaçãoRESUMO
Resumen Introducción: La asimetría nasal es una de las características más frecuentes de los pacientes con labio y paladar hendido; la medición antropométrica (MA) es un método accesible y confiable que puede ser utilizado por los especialistas para evaluarlo. El objetivo de este estudio fue evaluar la efectividad de una intervención educativa aplicada a especialistas que tratan pacientes con labio y paladar hendido para incrementar la precisión en las MA en la evaluación de la asimetría nasal. Métodos: Estudio cuasiexperimental. Resultados: En la primera fase del estudio, 5 de las 13 medidas antropométricas reportaron una diferencia de medias (DM) > 1.5 mm, y 12 de las 13 MA mostraron resultados mayores a dos desviaciones estándar (DE). Los resultados en la segunda fase evidenciaron 11 de las 13 MA con DM < 1 mm, y 9 de las 13 MA fueron menores a dos DE. Conclusiones: La intervención realizada con el Manual de medidas antropométricas aumentó los conocimientos de los especialistas sobre la anatomía, puntos y MA que se pueden utilizar para evaluar la asimetría nasal en pacientes con labio y paladar hendido. La intervención educativa ayuda a aumentar el acuerdo entre los evaluadores para realizar una evaluación confiable de la asimetría nasal en pacientes con estos padecimientos.
Abstract Background: Nasal asymmetry is one of the most frequent characteristics of patients with cleft lip and palate. The anthropometric measurement (AM) is an accessible and reliable method that can be used by specialists to evaluate nasal asymmetry in patients with cleft lip and palate. The aim of this study was to evaluate the effectiveness of an educational intervention applied to cleft lip and palate specialists to increase the accuracy of AM in the evaluation of nasal asymmetry. Methods: Quasi-experimental study. Results: In the first phase of the study, five of the 13 AM reported a mean difference (MD) > 1.5 mm, and 12 of the 13 AM showed results greater than 2 SD (standard deviations). In the second phase, the results showed 11 of the 13 AM with MD < 1 mm, and 9 of the 13 AM were less than 2 SD. Conclusions: The intervention carried out with the manual of AMs increased the knowledge of the specialists on the anatomy points and AM that can be used to evaluate the nasal asymmetry in patients with cleft lip and palate. Educational intervention help to increase the agreement between examiners to perform a reliable evaluation of nasal asymmetry in patients with these conditions.
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz/anatomia & histologia , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Pessoal de Saúde/educação , Especialização , Antropometria , Reprodutibilidade dos TestesRESUMO
Los niños con trastorno por déficit de atención con hiperactividad (TDAH) presentan fallas en diversos componentes de las funciones ejecutivas (FE) como en el control inhibitorio y la memoria de trabajo (MT), las cuales además pueden predecir alteraciones en la regulación emocional (RE). Estas alteraciones son comunes en los niños con TDAH y pueden manifestarse mediante fallas en la conducta social (CS). El presente estudio tiene un diseño de investigación no experimental, transeccional correlacional-causal. El objetivo fue determinar qué componente de las FE media la interacción entre la RE y la CS en niños con TDAH. Participaron 234 niños de ambos sexos entre 6 y 12 años distribuidos en dos grupos: 138 niños con desarrollo típico y 96 niños con TDAH. Los resultados muestran que la MT fue el componente de las FE que medió de manera significativa la relación entre la RE y la CS principalmente para el grupo con TDAH en presentación combinada (ß = -.16; IC 95% [-0.30, -0.01], p < .001). Se concluye que, para comprender las fallas en la RE en los niños con TDAH, es importante evaluar la MT y tomar en cuenta el tipo de presentación predominante del trastorno, lo cual pudiera predecir el impacto que tienen dichos déficits sobre la CS.
Children with attention deficit/hyperactivity disorder (ADHD) present failures in various components of the executive functioning (EF) such as inhibitory control and working memory (WM), which can also predict alterations in emotional regulation (ER). These deficits are common in children with ADHD and it can be manifested through failures in social behavior (SB). The present study has a non-experimental, transectional correlational-causal research design. The aim was to determine which component of EF mediates the interaction between ER and SB in children with ADHD. 234 male and female children between 6 and 12 years old participated, divided in two groups: 138 children with typical development and 96 children with ADHD. The results show that WM was the component of EF that significantly mediated the relationship between ER and SB, mainly for the group with ADHD in combined presentation (ß = -.16; 95% CI [-0.30, -0.01], p <.001). It is concluded that, to understand ER failures in children with ADHD, it is important to evaluate WM and take into account the type of predominant presentation in the disorder, which could predict the impact that these deficits have on SC.
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Humanos , Masculino , Feminino , Criança , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Comportamento Social , Regulação Emocional/fisiologia , Memória de Curto Prazo/fisiologia , AtençãoRESUMO
Dengue virus is the most prevalent arbovirus in Mexico, and although the diversity of this virus has been studied, the vast majority of sequences have been derived from viruses isolated from the human host. In this work, we aimed to sequence and to analyze DENVs derived from wild mosquitoes captured in Acapulco Guerrero, Mexico. We succeeded in determining three full genome sequences of such viruses and were able to compare them with other reported sequences from human and mosquito-derived DENVs. We found 15 nonsynonymous and 88 synonymous substitutions that were present more frequently in mosquito viruses than what would be expected by chance, although the limited number of genomes reported so far puts a constraint on the conclusions that can be derived from these analyses. Also, given the high depth of coverage attained in one of the genomes a variant analysis was carried out, finding 68 polymorphic sites in this genome. Interestingly, six of them corresponded to SNV that were detected as potentially differential between mosquitoes and humans, indicating that a that at least some positions may be maintained as polymorphic, which may facilitate host transmission.
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Aedes/virologia , Vírus da Dengue/genética , Dengue/transmissão , Mosquitos Vetores/virologia , Animais , Genoma Viral/genética , Técnicas de Genotipagem , Humanos , México , Filogenia , Polimorfismo Genético , Sequenciamento Completo do GenomaRESUMO
BACKGROUND: The Histoplasma urine antigen (HUAg) is the preferred method to diagnose progressive disseminated histoplasmosis (PDH) in HIV patients. In 2007, IMMY ALPHA Histoplasma EIA was approved for clinical for on-site use, and therefore useful for regions outside the United States. However, ALPHA-HUAg is considered inferior to the MVista-HUAg which is only available on referral. We aim to evaluate the diagnostic accuracy of ALPHA-HUAg. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a multicenter, prospective, diagnostic test study in two secondary and eight tertiary-care facilities in Mexico. We included HIV patient with PDH suspicion and evaluated ALPHA-HUAg diagnostic accuracy using as reference standard the Histoplasma capsulatum growth on blood, bone marrow, and tissue cultures or compatible histopathologic exam (PDH-proven). We evaluated the results of 288 patients, 29.5% (85/288; 95% confidence interval [CI], 24.3-35.1) had PDH. The sensitivity of ALPHA-HUAg was 67.1% (95% CI, 56-76.8%) and the specificity was 97.5% (95% CI, 94.3%-99.1%). The positive likelihood ratio was 27.2 (95% CI; 11.6-74.4). In 10.5% of the PDH-proven patients, a co-existing opportunistic infection was diagnosed, mostly disseminated Mycobacterium avium complex infection. CONCLUSIONS/SIGNIFICANCE: We observed a high specificity but low sensitivity of IMMY-HUAg. The test may be useful to start early antifungals, but a culture-based approach is necessary since co-infections are frequent and a negative IMMY-HUAg result does not rule out PDH.
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Testes Diagnósticos de Rotina/métodos , Infecções por HIV/complicações , Histoplasmose/diagnóstico , Adulto , Antígenos de Fungos , Feminino , Histoplasma , Histoplasmose/etiologia , Humanos , Masculino , México , Estudos ProspectivosRESUMO
BACKGROUND: Invasive fungal infections (IFIs) affect >1.5 million people per year. Nevertheless, IFIs are usually neglected and underdiagnosed. IFIs should be considered as a public-health problem and major actions should be taken to tackle them and their associated costs. Aim To report the incidence of IFIs in four Mexican hospitals, to describe the economic cost associated with IFIs therapy and the impact of adverse events such as acute kidney injury (AKI), liver damage (LD), and ICU stay. METHODS: This was a retrospective, transversal study carried-out in four Mexican hospitals. All IFIs occurring during 2016 were included. Incidence rates and estimation of antifungal therapy's expenditure for one year were calculated. Adjustments for costs of AKI were done. An analysis of factors associated with death, AKI, and LD was performed. RESULTS: Two-hundred thirty-eight cases were included. Among all cases, AKI was diagnosed in 16%, LD in 25%, 35% required ICU stay, with a 23% overall mortality rate. AKI and LD showed higher mortality rates (39% vs 9% and 44% vs 18%, respectively, p<0.0001). The overall incidence of IFIs was 4.8 cases (95% CI=0.72-8.92) per 1000 discharges and 0.7 cases (95% CI=0.03-1.16) per 1000 patients-days. Invasive candidiasis showed the highest incidence rate (1.93 per 1000 discharges, 95% CI=-1.01 to 2.84), followed by endemic IFIs (1.53 per 1000 discharges 95% CI=-3.36 to 6.4) and IA (1.25 per 1000 discharges, 95% CI=-0.90 to 3.45). AKI increased the cost of antifungal therapy 4.3-fold. The total expenditure in antifungal therapy for all IFIs, adjusting for AKI, was $233,435,536 USD (95% CI $6,224,993 to $773,810,330). CONCLUSIONS: IFIs are as frequent as HIV asymptomatic infection and tuberculosis. Costs estimations allow to assess cost-avoidance strategies to increase targeted driven therapy and decrease adverse events and their costs.
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Injúria Renal Aguda/economia , Efeitos Psicossociais da Doença , Unidades de Terapia Intensiva/economia , Infecções Fúngicas Invasivas/economia , Hepatopatias/economia , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Adulto , Antifúngicos/economia , Estudos Transversais , Gerenciamento Clínico , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Infecções Fúngicas Invasivas/complicações , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/epidemiologia , Hepatopatias/epidemiologia , Hepatopatias/etiologia , Hepatopatias/terapia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Estatísticas não Paramétricas , Análise de Sobrevida , Fatores de TempoRESUMO
ABSTRACT Background: Invasive fungal infections (IFIs) affect >1.5 million people per year. Nevertheless, IFIs are usually neglected and underdiagnosed. IFIs should be considered as a public-health problem and major actions should be taken to tackle them and their associated costs. Aim To report the incidence of IFIs in four Mexican hospitals, to describe the economic cost associated with IFIs therapy and the impact of adverse events such as acute kidney injury (AKI), liver damage (LD), and ICU stay. Methods: This was a retrospective, transversal study carried-out in four Mexican hospitals. All IFIs occurring during 2016 were included. Incidence rates and estimation of antifungal therapy's expenditure for one year were calculated. Adjustments for costs of AKI were done. An analysis of factors associated with death, AKI, and LD was performed. Results: Two-hundred thirty-eight cases were included. Among all cases, AKI was diagnosed in 16%, LD in 25%, 35% required ICU stay, with a 23% overall mortality rate. AKI and LD showed higher mortality rates (39% vs 9% and 44% vs 18%, respectively, p < 0.0001). The overall incidence of IFIs was 4.8 cases (95% CI = 0.72-8.92) per 1000 discharges and 0.7 cases (95% CI = 0.03-1.16) per 1000 patients-days. Invasive candidiasis showed the highest incidence rate (1.93 per 1000 discharges, 95% CI = −1.01 to 2.84), followed by endemic IFIs (1.53 per 1000 discharges 95% CI = −3.36 to 6.4) and IA (1.25 per 1000 discharges, 95% CI = −0.90 to 3.45). AKI increased the cost of antifungal therapy 4.3-fold. The total expenditure in antifungal therapy for all IFIs, adjusting for AKI, was $233,435,536 USD (95% CI $6,224,993 to $773,810,330). Conclusions: IFIs are as frequent as HIV asymptomatic infection and tuberculosis. Costs estimations allow to assess cost-avoidance strategies to increase targeted driven therapy and decrease adverse events and their costs.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Efeitos Psicossociais da Doença , Injúria Renal Aguda/economia , Infecções Fúngicas Invasivas/economia , Unidades de Terapia Intensiva/economia , Hepatopatias/economia , Incidência , Estudos Transversais , Análise Multivariada , Estudos Retrospectivos , Gerenciamento Clínico , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Injúria Renal Aguda/epidemiologia , Infecções Fúngicas Invasivas/complicações , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/epidemiologia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , México/epidemiologia , Antifúngicos/economiaRESUMO
In individuals with HIV/AIDS, 47% of the deaths are attributed to invasive fungal infections (IFIs), despite antiretroviral (ARV) therapy. This is a retrospective study carried out in the Hospital Regional de Alta Especialidad Oaxaca (HRAEO), southwest Mexico, where IFIs that occurred during 2016â»2017 are described. A total of 55 individuals were included. Histoplasmosis (36%) and possible-IFIs in neutropenic fever (20%) were the most frequent cases, followed by cryptococcosis (14%). The HIV/AIDS subpopulation corresponded with 26 cases (47%), all from an indigenous origin. The incidence of IFIs among them was 24% (95% CI = 15â»33%). The CD4+ T cells median was 35 cells/mL (IQR 12â»58). Four cases (15%) of unmasking IRIS were identified, three of histoplasmosis and one coccidioidomycosis. Co-infections were found in 52% (12/23), and tuberculosis in 50% (6/12) was the most frequent. The mortality rate was 48%. The general characteristics of the HIV individuals who died were atypical pneumonia (70% vs. 9%, p = 0.01), acute kidney injury, (70% vs. 9%, p = 0.008) and ICU stay (80% vs. 9%, p = 0.002). In conclusion, IFIs are diagnosed in one out of four individuals with HIV/AIDS along with other complicated infectious conditions, leading to major complications and a high mortality rate.
RESUMO
Las galletas son actualmente productos de gran demanda, constituyendo un sector sustancial de la industria alimentaria. Considerando la importancia de la buena alimentación y la oportunidad de incorporar leguminosas a productos de panificación como alternativa saludable logrando un mejor balance proteico, se planteó la propuesta de elaborar galletas a base de harina de trigo, sorgo y frijol. El objetivo del presente trabajo fue elaborar y evaluar galletas de harina de trigo sustituidas al 10%, 30% y 100% de harina de sorgo y frijol. Se diseñaron tres formulaciones para la elaboración de galletas al 10%, 30%, 100% de harina de sorgo y harina de frijol y la muestra control 100% trigo. Se realizó la evaluación proximal y perfil instrumental de textura a cada uno de las formulaciones; así mismo, el análisis sensorial para evaluar los atributos de color, olor, sabor y textura por medio de una escala hedónica de siete puntos. El reemplazo parcial de trigo por sorgo 10% - 30% y frijol al 10% fueron las formulaciones más acertadas con un porcentaje promedio de proteínas de 19 a 23%, además de presentar una alta puntuación en la evaluación sensorial. Estas combinaciones de harinas podrían ser utilizadas por la industria alimentaria para producir galletas de buena calidad nutricional, con características físicas y sensoriales aceptables para la población en general(AU)
Nowadays, cookies are in a real high demand, constituting a substantial sector of the food industry. Considering the importance of a good nutrition and the opportunity to incorporate legumes into baking products as a healthy alternative achieving a better protein balance, it was made a proposal to make cookies based on wheat flour, sorghum and beans. The objective of the current work was to elaborate and evaluate wheat flour cookies substituted to 10%, 30% and a 100% of sorghum and bean flour. Three formulations were prepared for the making of the cookies at 10%, 30% and a 100% of sorghum and bean flour and the control sample at a 100% of wheat. The proximal evaluation was made to each of the treatments, as well as the sensorial analysis for the evaluation of color attributes, odor, taste and texture through a hedonic scale of 7 points. The partial replacement of wheat by sorghum 10% - 30% and 10% of bean were the most successful formulations with a protein percentage average of 19 to 23% besides presenting a high score in sensory evaluation. These flour combinations could be used in the food industry for the making of cookies with a well nutritional quality, with physical and sensory qualities acceptable for the general population(AU)
Assuntos
Humanos , Masculino , Feminino , Triticum , Sorghum , Biscoitos , Fabaceae , Alimentos, Dieta e Nutrição , Tecnologia de Alimentos , Valor NutritivoRESUMO
Psoriasis is a chronic inflammatory disease with a worldwide prevalence between 6 and 39% in moderate to severe forms. In European countries like Germany and England was identified that only one third of patients with moderate to severe forms will receive systemic management, this fact motivated to integrate into Europe an international consensus on treatment goals with the aim of providing support to the dermatologist by algorithms that serve as a therapeutic guide that allows you to gain control short and long term effects of this disease. The European group met to develop the definitions of severity of psoriasis, treatment goals for moderate to severe disease, and optimization options and / or therapeutic transition than a paper published in 2011 was obtained. In Mexico a working group of experts on biological therapy (GTEB), made up of 10 members and an extended group of 150 dermatologists' voters in the country for the purpose of issuing Mexico's position on the proposals of the European group was formed. In this document the findings of the Working Group of Experts on Biological Therapy in Mexico are listed.
La psoriasis es una enfermedad crónica inflamatoria, con una prevalencia mundial entre 6 y 39% en las formas moderadas a severas. En países europeos como Alemania e Inglaterra se identificó que solo la tercera parte de los pacientes que padecen formas moderadas a severas reciben manejo sistémico; este hecho motivó la integración en Europa de un consenso internacional sobre metas de tratamiento con el objetivo de brindar apoyo al dermatólogo con algoritmos que sirvan como guía terapéutica para lograr el control a corto y largo plazo de esta enfermedad. El grupo europeo se reunió para elaborar las definiciones de severidad de la psoriasis, las metas de tratamiento en la enfermedad moderada a severa, entre otros temas, de lo que se obtuvo un documento publicado en el 2011. En México se conformó un grupo de trabajo de expertos en terapia biológica (GTEB), formado por 10 integrantes y un grupo extendido de 150 dermatólogos votantes del país, con la finalidad de emitir la posición de México sobre las propuestas del grupo europeo. En el presente documento se enumeran las conclusiones del grupo de trabajo de expertos en terapia biológica en México.
Assuntos
Psoríase/terapia , Assistência ao Convalescente , Terapia Combinada , Técnica Delphi , Fármacos Dermatológicos/uso terapêutico , Objetivos , Humanos , México , Fototerapia , Psoríase/diagnóstico , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: The 2009-2010 influenza A (H1N1pdm09) pandemic caused substantial morbidity and mortality among young patients; however, mortality estimates have been confounded by regional differences in eligibility criteria and inclusion of selected populations. In 2013-2014, H1N1pdm09 became North America's dominant seasonal influenza strain. Our objective was to compare the baseline characteristics, resources, and treatments with outcomes among critically ill patients with influenza A (H1N1pdm09) in Mexican and Canadian hospitals in 2014 using consistent eligibility criteria. DESIGN: Observational study and a survey of available healthcare setting resources. SETTING: Twenty-one hospitals, 13 in Mexico and eight in Canada. PATIENTS: Critically ill patients with confirmed H1N1pdm09 during 2013-2014 influenza season. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome measures were 90-day mortality and independent predictors of mortality. Among 165 adult patients with H1N1pdm09-related critical illness between September 2013 and March 2014, mean age was 48.3 years, 64% were males, and nearly all influenza was community acquired. Patients were severely hypoxic (median PaO2-to-FIO2 ratio, 83 mm Hg), 97% received mechanical ventilation, with mean positive end-expiratory pressure of 14 cm H2O at the onset of critical illness and 26.7% received rescue oxygenation therapy with prone ventilation, extracorporeal life support, high-frequency oscillatory ventilation, or inhaled nitric oxide. At 90 days, mortality was 34.6% (13.9% in Canada vs 50.5% in Mexico, p < 0.0001). Independent predictors of mortality included lower presenting PaO2-to-FIO2 ratio (odds ratio, 0.89 per 10-point increase [95% CI, 0.80-0.99]), age (odds ratio, 1.49 per 10 yr increment [95% CI, 1.10-2.02]), and requiring critical care in Mexico (odds ratio, 7.76 [95% CI, 2.02-27.35]). ICUs in Canada generally had more beds, ventilators, healthcare personnel, and rescue oxygenation therapies. CONCLUSIONS: Influenza A (H1N1pdm09)-related critical illness still predominantly affects relatively young to middle-aged patients and is associated with severe hypoxemic respiratory failure. The local critical care system and available resources may be influential determinants of patient outcome.
Assuntos
Estado Terminal/terapia , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/fisiopatologia , Influenza Humana/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Corticosteroides/economia , Corticosteroides/uso terapêutico , Adulto , Idoso , Antivirais/economia , Antivirais/uso terapêutico , Canadá/epidemiologia , Estado Terminal/epidemiologia , Oxigenação por Membrana Extracorpórea/economia , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Gastos em Saúde , Humanos , Influenza Humana/economia , Influenza Humana/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Respiração Artificial/economia , Respiração Artificial/métodos , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapiaRESUMO
BACKGROUND: We report results of the entomo-virological surveillance system in Aedes aegypti local populations performed by the Ministry of Health of Guerrero. METHODS: Indoor-adult Ae. aegypti collected at Acapulco, Zihuatanejo, Coyuca de Benitez and Atoyac de Alvarez (dry season, 2015) were processed for dengue virus (DENV) and chikungunya virus (CHIKV) using RT-PCR. RESULTS: We identified different seroptypes of DENV (2, 3 and 4), CHIKV and their co-circulation in field-caught mosquitoes across a significant geographic area. Pools of males were positive for CHIKV and DENV 3 and 4 suggesting vertical transmission. CONCLUSIONS: Entomo-virological surveillance in Guerrero has identified early circulation of CHIKV and DENV and provided a trigger for timely and focalized vector control actions.
Assuntos
Febre de Chikungunya/transmissão , Vírus Chikungunya/isolamento & purificação , Vírus da Dengue/isolamento & purificação , Dengue/transmissão , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Aedes/virologia , Animais , Febre de Chikungunya/epidemiologia , Febre de Chikungunya/genética , Vírus Chikungunya/genética , Estudos Transversais , Dengue/epidemiologia , Dengue/genética , Vírus da Dengue/genética , Humanos , Insetos Vetores , México/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real , Vigilância de Evento SentinelaRESUMO
BACKGROUND: Mycetoma is a neglected, chronic, and deforming infectious disease caused by fungi and actinomycetes. In Mexico, N. brasiliensis is the predominant etiologic agent. Therapeutic alternatives are necessary because the current drug regimens have several disadvantages. Benzothiazinones (BTZ) are a new class of candidate drugs that inhibit decaprenyl-phosphoribose-epimerase (DprE1), an essential enzyme involved in the cell wall biosynthesis of Corynebacterineae. METHODOLOGY/PRINCIPAL FINDINGS: In this study, the in vitro activity of the next generation BTZ, PBTZ169, was tested against thirty Nocardia brasiliensis isolates. The MIC50 and MIC90 values for PBTZ169 were 0.0075 and 0.03 µg/mL, respectively. Because Nocardia is a potential intracellular bacterium, a THP-1 macrophage monolayer was infected with N. brasiliensis HUJEG-1 and then treated with PBTZ169, resulting in a decrease in the number of colony-forming units (CFUs) at a concentration of 0.25X the in vitro value. The in vivo activity was evaluated after infecting female BALB/c mice in the right hind food-pad. After 6 weeks, treatment was initiated with PBTZ169 and its activity was compared with the first generation compound, BTZ043. Both BTZ compounds were administered at 100 mg/kg twice daily by gavage, and sulfamethoxazole/trimethoprim (SXT), at 100 mg/kg sulfamethoxazole, was used as a positive control. After 22 weeks of therapy, only PBTZ169 and SXT displayed statistically significant activity. CONCLUSION: These results indicate that DprE1 inhibitors may be useful for treating infections of Nocardia and may therefore be active against other actinomycetoma agents. We must test combinations of these compounds with other antimicrobial agents, such as linezolid, tedizolid or SXT, that have good to excellent in vivo activity, as well as new DprE1 inhibitors that can achieve higher plasma levels.