New prophylaxis regimen for SARS-CoV-2 infection in health professionals with low doses of hydroxychloroquine and bromhexine: a randomised, double-blind placebo clinical trial (ELEVATE Trial).

INTRODUCTION: SARS-CoV-2 infection in Mexico has caused ~2.7 million confirmed cases; around 20%-25% of health workers will be infected by the virus at their workplace, with approximately 4.4% of mortality. High infectivity of SARS-CoV-2 is related with cell entry mechanism, through the ACE receptor. SARS-CoV-2 requires transmembrane protease serine 2 to cleave its spike glycoprotein and ensure fusion of host cell and virus membrane. We propose studying prophylactic treatment with hydroxychloroquine (HCQ) and bromhexine (BHH), which have been shown to be effective in preventing SARS-CoV-2 infection progression when administered in early stages. The aim of this study is to assess the efficacy of HCQ and BHH as prophylactic treatments for SARS-CoV-2 infection in healthy health workers exposed to the virus. METHODS AND ANALYSIS: Double-blind randomised clinical trial, with parallel allocation at a 1:1 ratio with placebo, of low doses of HCQ plus BHH, for 60 days. Study groups will be defined as follows: (1) HCQ 200 mg/day+BHH 8 mg/8 hours versus (2) HCQ placebo plus BHH placebo. Primary endpoint will be efficacy of both interventions for the prevention of SARS-CoV-2 infection, determined by the risk ratio of infected personnel and the absolute risk. At least a 16% reduction in absolute risk is expected between the intervention and placebo groups; a minimum of 20% infection is expected in the placebo group. The sample size calculation estimated a total of 214 patients assigned: two groups of 107 participants each. ETHICS AND DISSEMINATION: This protocol has been approved by the local Medical Ethics Committee (National Institute of Rehabilitation 'Luis Guillermo Ibarra Ibarra', approval number INRLGII/25/20) and by the Federal Commission for Protection against Sanitary Risks (COFEPRIS, approval number 203 300 410A0058/2020). The results of the study will be submitted for publication in peer-reviewed journals and disseminated through conferences. TRIAL REGISTRATION NUMBER: NCT04340349.

Predictive Factors for Returning to Work in Burn Adult Patients That Were Working Before Their Injury.

The goal of this study was to identify predictive factors that influence return to work in burn patients treated at the National Center for Burn Care and Research at the National Institute of Rehabilitation (CENIAQ) in México City. This is a retrospective case-control study that included all burn patients of working age (16-91 years old), treated between January 2011 and December 2013. Patients were divided into two groups: unemployed (no work group) and those who returned to work (RTW). The statistical analysis was performed by a logistic regression univariate and multivariate analysis. A total of 210 subjects were included in the study. The mean age was 38 ± 15 years and 66.7% of them were male. One hundred sixty-five patients (79.6%) were able to return to work after treatment. Through univariate analysis it was found that the predictive factors for not returning to work after injury were: education lower than elementary school (OR: 3.59; CI 95%: 1.79-7.32); history of epilepsy prior to burn injury (OR: 10.18; CI 95%: 1.9-54.43); total burned surface area (TBSA) ≥20% (OR: 2.87; CI 95%: 1.46-5.64); third-degree burns (OR: 2.64; CI 95%: 1.32-5.29); hospital stay ≥20 days (OR: 2.8; CI 95%: 1.47-5.68); length of stay in the burn intensive care unit (OR: 2.5; CI 95%: 1.25-4.97); secondary infection (OR: 2.24; CI 95%: 1.15-4.38); amputations (one or more regardless of amputation level; OR: 8; CI 95%: 2.52-25.30); burn of the upper extremity (shoulder; OR: 2.21; CI 95%: 0.97-5.03); thigh (OR: 2.41; CI 95%: 1.32-5.14); and knee (OR: 2.81; CI 95%: 1.21-6.55). Some of these factors have never been reported by other authors.

Microbiology and Infection Profile of Electric Burned Patients in a Referral Burn Hospital in Mexico City.

Electrical burn injuries are one of the most severe forms of trauma. This study aims to investigate the infection complications in electrical burn patients in a referral hospital in Mexico City. A longitudinal retrospective study was conducted, involving electrical burn patients admitted from April 2011 to December 2016. Demographic and clinical data including type of electric burns, infection complications, and mortality was sought. Data were collected at admission and daily until discharge. Number and type of infections and microorganism isolations were sought. Risk factors for death were analyzed. A total of 111 patients were included, of which 96.4% were males, mean age of 31.6±16.22, most injuries were high voltage associated. The total body surface area average was 27.8% ± 19.63. The overall infection rate was 72.9 cases per 100 patients. Mortality was observed in 4 (3.6%) patients. About 59.1% (443/749) had growth for Gram-negative bacteria. Multidrug-resistant Pseudomonas aeruginosa was the most frequent microorganism isolated. Fungi were present in 4.9% of cases. Electrical burn injuries occurred in young males in our study. Infection was frequent, most of them caused by Gram-negative rods with an important rate of antimicrobial resistance; however, an important microbial diversity was present.

High risk of lumbar spine osteoporosis with the RANK rs3018362 polymorphism.

Osteoporosis is characterized by reduced bone mineral density (BMD) and quality, increasing the risk of fractures. A large number of genes involved in bone metabolism have been implicated in the genesis of osteoporosis; these include RANK and RANKL. Polymorphisms of these genes have been implicated in osteoporosis. The aim of this study was to determine the association of the RANK rs3018362 and RANKL rs12585014 polymorphisms with risk of osteoporosis. Four hundred Mexican women aged 40 years old or above were genotyped by real-time PCR and several demographic and risk factors were explored. The GA and AA genotypes of the rs3018362 polymorphism were associated with a high risk of osteoporosis in the dominant model (p=.0062; OR = 2.16, 95% CI: 1.24-3.78). In summary, the rs3018362 polymorphism in the RANK gene seems to be associated with osteoporosis of the lumbar spine while the RANKL rs12585014 is not, although more studies are needed to confirm these results.