Spatial scales of COVID-19 transmission in Mexico.

During outbreaks of emerging infectious diseases, internationally connected cities often experience large and early outbreaks, while rural regions follow after some delay. This hierarchical structure of disease spread is influenced primarily by the multiscale structure of human mobility. However, during the COVID-19 epidemic, public health responses typically did not take into consideration the explicit spatial structure of human mobility when designing nonpharmaceutical interventions (NPIs). NPIs were applied primarily at national or regional scales. Here, we use weekly anonymized and aggregated human mobility data and spatially highly resolved data on COVID-19 cases at the municipality level in Mexico to investigate how behavioral changes in response to the pandemic have altered the spatial scales of transmission and interventions during its first wave (March-June 2020). We find that the epidemic dynamics in Mexico were initially driven by exports of COVID-19 cases from Mexico State and Mexico City, where early outbreaks occurred. The mobility network shifted after the implementation of interventions in late March 2020, and the mobility network communities became more disjointed while epidemics in these communities became increasingly synchronized. Our results provide dynamic insights into how to use network science and epidemiological modeling to inform the spatial scale at which interventions are most impactful in mitigating the spread of COVID-19 and infectious diseases in general.

Cooling Holstein cows for 60 days prepartum in summer: effects on prepartum physiology, postpartum productivity, and calf growth.

Heat stress (HS) during the dry period of dairy cows in hot and dry conditions compromises the physiological status and mammary gland development of dairy cows, thereby negatively affecting milk component yield in the subsequent lactation. Our objective was to evaluate the effects of cooling Holstein cows under moderate or higher HS conditions (i.e., ambient temperature higher than 30 °C, with a temperature-humidity index of 78.2 units) during the dry period on prepartum physiological status, postpartum productivity, and calf growth. Twenty-four multiparous Holstein cows were divided into two groups: one with a cooling system based on spray and fans under a pen shade (CL, n = 12) and the other not-cooled (NC, n = 12). The cooling system operated 10 h/d (09:00-19:00 h) for 60 d prepartum. During the morning, rectal temperature and respiration frequency were lower in CL cows, but not in the afternoon, which was attributed to higher (P < 0.01) dry matter intake by CL cows. Total serum protein was higher (P < 0.01) in CL cows, but hemoglobin was higher in NC cows (P < 0.01), with no differences in other electrolytes, hormones, hematological components, and metabolites. Milk fat and fat and fat-protein corrected milk were higher (P < 0.05) in CL cows. Female and birth weight trended (P = 0.08) to be higher in CL cows. Cooling cows during the dry period had a limited effect on physiology prepartum but increased postpartum productivity of Holstein cows under hot and dry conditions.

Convergent trends and spatiotemporal patterns of Aedes-borne arboviruses in Mexico and Central America.

BACKGROUND: Aedes-borne arboviruses cause both seasonal epidemics and emerging outbreaks with a significant impact on global health. These viruses share mosquito vector species, often infecting the same host population within overlapping geographic regions. Thus, comparative analyses of the virus evolutionary and epidemiological dynamics across spatial and temporal scales could reveal convergent trends. METHODOLOGY/PRINCIPAL FINDINGS: Focusing on Mexico as a case study, we generated novel chikungunya and dengue (CHIKV, DENV-1 and DENV-2) virus genomes from an epidemiological surveillance-derived historical sample collection, and analysed them together with longitudinally-collected genome and epidemiological data from the Americas. Aedes-borne arboviruses endemically circulating within the country were found to be introduced multiple times from lineages predominantly sampled from the Caribbean and Central America. For CHIKV, at least thirteen introductions were inferred over a year, with six of these leading to persistent transmission chains. For both DENV-1 and DENV-2, at least seven introductions were inferred over a decade. CONCLUSIONS/SIGNIFICANCE: Our results suggest that CHIKV, DENV-1 and DENV-2 in Mexico share evolutionary and epidemiological trajectories. The southwest region of the country was determined to be the most likely location for viral introductions from abroad, with a subsequent spread into the Pacific coast towards the north of Mexico. Virus diffusion patterns observed across the country are likely driven by multiple factors, including mobility linked to human migration from Central towards North America. Considering Mexico's geographic positioning displaying a high human mobility across borders, our results prompt the need to better understand the role of anthropogenic factors in the transmission dynamics of Aedes-borne arboviruses, particularly linked to land-based human migration.

Predicting carcass tissue composition in Blackbelly sheep using ultrasound measurements and machine learning methods.

This study aimed to predict Blackbelly sheep carcass tissue composition using ultrasound measurements and machine learning models. The models evaluated were decision trees, random forests, support vector machines, and multi-layer perceptrons and were used to predict the total carcass bone (TCB), total carcass fat (TCF), and total carcass muscle (TCM). The best model for predicting the three parameters, TCB, TCF, and TCM was random forests, with mean squared error (MSE) of 0.31, 0.33, and 0.53; mean absolute error (MAE) of 0.26, 0.29, and 0.53; and the coefficient of determination (R2) of 0.67, 0.69, and 0.76, respectively. The results showed that machine learning methods from in vivo ultrasound measurements can be used as determinants of carcass tissue composition, resulting in reliable results.

Enseñanza aprendizaje del contenido "familia" en la formación del Médico General desde la educación en el trabajo

Fundamento el contenido "familia" es de vital importancia en la formación del Médico General en Cuba porque la familia se constituye como grupo objeto de la atención médica. Objetivo elaborar una estrategia didáctica para perfeccionar la enseñanza aprendizaje del contenido "familia". Métodos: investigación de desarrollo con enfoque dialéctico materialista, realizada en la Universidad de Ciencias Médicas de Cienfuegos, entre julio de 2021 y marzo de 2022. Se trabajó desde la visita a la familia como modalidad de la educación en el trabajo. Se aplicaron métodos en los niveles empíricos, teóricos y estadísticos matemáticos que en su conjunto permitieron dar salida al objetivo previsto. La propuesta se organizó en las etapas de diagnóstico, diseño y evaluación. Resultados fueron identificadas potencialidades y limitaciones en el proceso de enseñanza aprendizaje del contenido "familia" que permitieron diseñar la estrategia; los objetivos constituyen la categoría rectora, en función de los cuales se organiza el sistema de conocimientos, habilidades y valores, estructurados desde las etapas de la visita a la familia, visto de manera sistémica, por lo cual se tratan aspectos del método, la forma, los medios y el sistema de evaluación, en estrecha relación con lo académico, lo laboral atencional y lo investigativo. Conclusiones: la estrategia diseñada se deriva de los resultados obtenidos en el diagnóstico y fue valorada por especialistas como útil, integradora, sistémica y aplicable, todo lo cual avala su pertinencia.

Background: the "family" content is of vital importance in the General Physician's training in Cuba because the family is constituted as a group that is the objective of medical care. Objective: to develop a didactic strategy to improve the teaching-learning of the "family" content. Methods: development research with a materialistic dialectical approach, carried out at the Cienfuegos University of Medical Sciences, between July 2021 and March 2022, working from the visit to the family as an education at work modality. Methods were applied at the empirical, theoretical and mathematical statistical levels that as a whole allowed achieving the expected objective. The proposal was organized in the diagnostic, design and evaluation stages. Results: potentialities and limitations were identified in the teaching-learning process of the "family" content that allowed designing the strategy where the objectives constitute the guiding category, based on which the system of knowledge, skills and values is organized, structured from the stages of the visit to the family, seen in a systemic way, for which aspects of the method, the form, the means and the evaluation system are dealt with, in close relation with the academic, the attentional labor and the research aspects. Conclusions: the designed strategy is derived from the results obtained in the diagnosis and was valued by specialists as useful, inclusive, systemic and applicable, all of which supports its relevance.

Vibrio parahaemolyticus Is Associated with Diarrhea Cases in Mexico, with a Dominance of Pandemic O3:K6 Clones.

In the present study, we conducted surveillance of the V. parahaemolyticus strains present in clinical samples from six geographical regions of Mexico (22 states) from 2004 to 2011. The serotype dominance, virulence genes, presence of pandemic O3:K6 strains, and antibiotic resistance of the isolates were investigated. In total, 144 strains were isolated from the clinical samples. Seven different O serogroups and twenty-five serovars were identified. Most clinical isolates (66%, 95/144) belonged to the pandemic clone O3:K6 (tdh+, toxRS/new+ and/or orf8+) and were detected in 20 of the 22 states. Among the pandemic clones, approximately 17.8% (17/95) of the strains cross-reacted with the antisera for the K6 and K59 antigens (O3:K6, K59 serotype). Other pathogenic strains (tdh+ and/or trh+, toxRS/new-, orf8-) accounted for 26.3%, and the nonpathogenic strains (tdh- and/or trh-) accounted for 7.6%. Antimicrobial susceptibility testing showed that most of the strains were resistant to ampicillin (99.3%) but were sensitive to most tested antibiotics. The level of multidrug resistance was 1.3%. Our results indicate that pandemic O3:K6 is present in most Mexican states, thus, constant surveillance of V. parahaemolyticus strains in diarrhea patients is a public health priority and is useful for conducting risk assessments of foodborne illnesses to prevent V. parahaemolyticus outbreaks. Overall, our observations indicate that the pandemic O3:K6 clone of V. parahaemolyticus has become a relatively stable subpopulation and may be endemically established in Mexico; therefore, constant surveillance is needed to avoid new outbreaks of this pathogen.

Estimation of Carcass Tissue Composition from the Neck and Shoulder Composition in Growing Blackbelly Male Lambs.

This study was designed to develop predictive equations estimating carcass tissue composition in growing Blackbelly male lambs using as predictor variables for tissue composition of wholesale cuts of low economic value (i.e., neck and shoulder). For that, 40 lambs with 29.9 ± 3.18 kg of body weight were slaughtered and then the left half carcasses were weighed and divided in wholesale cuts, which were dissected to record weights of fat, muscle, and bone from leg, loin, neck, rib, and shoulder. Total weights of muscle (CM), bone (CB) and fat (CF) in carcass were recorded by adding the weights of each tissue from cuts. The CM, CF and CB positively correlated (p < 0.05; 0.36 ≤ r ≤ 0.86), from moderate to high, with most of the shoulder tissue components, but it was less evident (p ≤ 0.05; 0.32≤ r ≤0.63) with the neck tissue composition. In fact, CM did not correlate with neck fat and bone weights. Final models explained (p < 0.01) 94, 92 and 88% of the variation observed for CM, CF and CB, respectively. Overall, results showed that prediction of carcass composition from shoulder (shoulder) tissue composition is a viable option over the more accurate method of analyzing the whole carcass.

Epidemiological surveillance of chikungunya fever in Mexico since its introduction in 2014-2016 and identification of circulating genotypes.

In 2014, the chikungunya virus (CHIKV) was detected for the first time in Mexico, the identified strain was the one corresponding to the Asian genotype which was phylogenetically grouped with the strains that circulated in the British Virgin Islands outbreak and was later classified with lineages of Caribbean strains. In three years, 13,569 cases of chikungunya were registered in Mexico. Although the transmission and spread of the virus are now considered a moderate risk, the danger that the virus reemerges is not ruled out due to the infestation of Aedes mosquitoes. In this study, we reviewed the chikungunya fever (CHIKF) cases reported between 2014 and 2016 to reanalyze the data. Seventeen cases were selected from different states where the circulation of the virus had been reported. Statistical data were analyzed and a retrospective analysis was carried out. Nucleic acid sequences were determined of these 17 samples. 2015 was the year with the highest number of cases (92.8%) and they were detected in 28 states of the country. There is a predominance of females, and the most affected age group was between 25 and 44 years. In 2016, CHIKV genotypes were not known, in this study the presence of the Asian genotype of Caribbean lineage was confirmed. The presence of the West African and ECSA genotypes was phylogenetically ruled out. The sequences obtained were deposited in GeneBank.

From ISET to InDRE. V. Institute of Epidemiological Diagnosis and Reference. Global strategic position, 2012-2019.

This document describes the changes at the Institute of Epidemiological Diagnosis and Reference (InDRE) from 2012 to 2019, the administrative and equipment modifications, the new headquarters and the National System of Epidemiological Surveillance legal modifications. The process of relocation is mentioned, especially the careful transfer of the biological material protected by the Institute, and the new way of studying epidemic outbreaks, endemic diseases and the negative network is analyzed. At the international level, the promotion of links with global networks of the Pan American Health Organization, the World Health Organization (WHO) and other international organizations is described. The assignation to InDRE of four WHO collaborating centres is also mentioned. The Global Health Security Initiative Laboratory Network acknowledged InDRE's leadership, which co-chaired the working group during the study period.

En este documento se describen los cambios en el Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE) de 2012 a 2019, las modificaciones administrativas y de equipamiento, la nueva sede y las modificaciones jurídicas al Sistema Nacional de Vigilancia Epidemiológica. Se menciona el proceso de mudanza, en especial el cuidadoso traslado del material biológico que resguarda el Instituto y se analiza la nueva forma de estudiar los brotes epidémicos, los padecimientos endémicos y la red negativa. Respecto al ámbito internacional, se describe el fomento de la vinculación con redes globales de la Organización Panamericana de la Salud, la Organización Mundial de la Salud (OMS) y otros organismos internacionales. También se menciona la designación en el InDRE de cuatro centros colaboradores de la OMS. La Red de Laboratorios de la Iniciativa Global para la Seguridad en Salud reconoció el liderazgo del InDRE, cuyo director ocupó la copresidencia del grupo de trabajo en el periodo de estudio.

Del ISET al InDRE. V. Instituto de Diagnóstico y Referencia Epidemiológicos. Posición estratégica global, 2012-2019 / From ISET to InDRE. V. Institute of Epidemiological Diagnosis and Reference. Global strategic position, 2012-2019

Resumen En este documento se describen los cambios en el Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE) de 2012 a 2019, las modificaciones administrativas y de equipamiento, la nueva sede y las modificaciones jurídicas al Sistema Nacional de Vigilancia Epidemiológica. Se menciona el proceso de mudanza, en especial el cuidadoso traslado del material biológico que resguarda el Instituto y se analiza la nueva forma de estudiar los brotes epidémicos, los padecimientos endémicos y la red negativa. Respecto al ámbito internacional, se describe el fomento de la vinculación con redes globales de la Organización Panamericana de la Salud, la Organización Mundial de la Salud (OMS) y otros organismos internacionales. También se menciona la designación en el InDRE de cuatro centros colaboradores de la OMS. La Red de Laboratorios de la Iniciativa Global para la Seguridad en Salud reconoció el liderazgo del InDRE, cuyo director ocupó la copresidencia del grupo de trabajo en el periodo de estudio.

Abstract This document describes the changes at the Institute of Epidemiological Diagnosis and Reference (InDRE) from 2012 to 2019, the administrative and equipment modifications, the new headquarters and the National System of Epidemiological Surveillance legal modifications. The process of relocation is mentioned, especially the careful transfer of the biological material protected by the Institute, and the new way of studying epidemic outbreaks, endemic diseases and the negative network is analyzed. At the international level, the promotion of links with global networks of the Pan American Health Organization, the World Health Organization (WHO) and other international organizations is described. The designation of four WHO collaborating centres granted to InDRE is also mentioned. The Global Health Security Initiative Laboratory Network acknowledged InDRE's leadership, which co-chaired the working group during the study period.

Antimicrobial resistance and recurrent bacterial urinary tract infections in hospitalized patients following kidney transplantation: A single-center experience.

PURPOSE: The burden of urinary tract infections (UTIs) and risk factors for developing infections with multidrug resistant organisms (MDROs) post-kidney transplantation (KT) are poorly understood. METHODS: Single-center retrospective cohort study (January 2015-December 2017) evaluating first and recurrent episodes of bacteriuria and subsequent analysis of episodes caused by MDROs up to 6 months post-KT. Donor and recipient variables were reviewed. RESULTS: A total of 743 adults underwent single KT during the study period, and 106 patients were hospitalized with bacteriuria. 45% were asymptomatic in their first episode. 73.6% had a single episode, and 26.4% had 2 or more episodes. A total of 28 patients had recurrent episodes; 64.3% had an MDRO on the first episode and 78.6% on the second episode. Escherichia coli was the most common organism isolated, 88.5% were resistant to trimethoprim-sulfamethoxazole (TMP-SMX), 9.3% were extended-spectrum beta-lactamase (ESBL) producers, and 38.1% were MDROs. Body mass index ≥30 was significantly associated with the presence of MDROs in both univariate and multivariate analyses (RR 1.37, 95% CI 1.01-1.88; OR 3.26, CI 1.29-8.25). A total of 12 donors had bacteremia or bacteriuria and 6 (50%) with E coli. A total of 10 KT recipients received antibiotic prophylaxis to prevent donor-derived infections. CONCLUSIONS: Our results suggest that a significant proportion of patients develop recurrent bacteriuria post-transplantation; of those, more than half caused by MDROs. There is a possible association between obesity and MDROs in KT recipients that merits further investigation. With the global crisis in antimicrobial resistance, innovative strategies are needed to prevent and treat UTIs in KT patients.

From ISET to InDRE. IV. Institute of Epidemiological Diagnosis and Reference: new orientation, 1990-2012.

From 1990 to 2012, the Sanitary and Tropical Diseases Institute experienced the most important changes. In 1989, its name and orientation were modified to become the National Institute of Epidemiological Diagnosis and Reference. Shortly before, it had been formalized as the apex of the National Network of Public Health Laboratories and had incorporated laboratories for preventive programs such as exfoliative cytology and rabies, malaria and tuberculosis diagnosis; subsequently, it would incorporate other networks that emerged as part of the response to major epidemic outbreaks and to the new epidemiological outlook. In this period, 27 priority diagnostic algorithms were defined, organized in 18 networks, some of which began to collaborate with global networks. In 2001, the Institute started working with pathogens related to bioterrorism. By then, space restrictions of the headquarter's building were evident; in 2008, starting the construction of new facilities was decided. The Institute and its diagnostic networks constitute a milestone in Latin American public health of the 21st century.

De 1990 a 2012, el Instituto de Salubridad y Enfermedades Tropicales experimentó los cambios más importantes desde su origen. En 1989 modificó su nombre y orientación a Instituto Nacional de Diagnóstico y Referencia Epidemiológicos. Poco antes se había formalizado como cúspide de la organización piramidal denominada Red Nacional de Laboratorios en Salud Pública y había incorporado los laboratorios de programas preventivos como el de citología exfoliativa y los de diagnóstico de rabia, paludismo, tuberculosis; posteriormente incorporaría otras redes que surgieron como parte de la respuesta a brotes epidémicos importantes (cólera, VIH-sida, sarampión, influenza) y al nuevo panorama epidemiológico (dengue, Chagas, rotavirus). En este periodo se definieron 27 algoritmos diagnósticos prioritarios organizados en 18 redes, algunas de las cuales comenzaron a colaborar con redes globales. En 2001, en el Instituto se empezó a trabajar con patógenos relacionados con el bioterrorismo. Para entonces, las severas restricciones de espacio del edificio construido en 1935 fueron evidentes; en 2008, las autoridades decidieron iniciar el diseño y construcción de las nuevas instalaciones. En conjunto, el InDRE y sus redes diagnósticas constituyen un hito en la salud pública latinoamericana del siglo XXI.

From the handling of an outbreak by an unknown pathogen in Wuhan to the preparedness and response in the face of the emergence of Covid-19 in Mexico.

On December 31, 2019, the Chinese health authorities informed the international community, through the mechanisms established by the World Health Organization (WHO), of a pneumonia epidemic of unknown etiology in Wuhan, Hubei Province. The first cases were reported early in that month and were linked to a history of having visited a market where food and live animals are sold. On January 7, 2020, isolation and identification of the culprit pathogen was achieved using next-generation sequencing, while the number of affected subjects continued to rise. The publication of full-genomes of the newly identified coronavirus (initially called 2019-nCoV, now called SARS-CoV2) in public and private databases, of standardized diagnostic protocols and of the clinical-epidemiological information generated will allow addressing the Public Health Emergency of International Concern (PHEIC), declared on January 30 by the WHO. With this document, we intend to contribute to the characterization of the pneumonia epidemic, now designated coronavirus disease (Covid-19) review the strengths Mexico has in the global health concert and invite health professionals to join the preparedness and response activities in the face of this emergency.

El 31 de diciembre de 2019, las autoridades chinas de salud informaron a la comunidad internacional, a través de los mecanismos establecidos por la Organización Mundial de la Salud (OMS), de una epidemia de neumonía con etiología desconocida en Wuhan, provincia de Hubei. Los primeros casos se notificaron a inicios de ese mes y se vincularon al antecedente de visitar un mercado de comida y animales vivos. El 7 de enero de 2020 se logró el aislamiento y reconocimiento del patógeno responsable mediante secuenciación de siguiente generación, mientras el número de afectados continuaba en ascenso. La publicación de genomas completos del nuevo coronavirus identificado (inicialmente denominado 2019-nCoV, ahora designado SARS-CoV2) en bases de datos públicas y privadas, de protocolos diagnósticos estandarizados y de la información clínica epidemiológica generada permitirá atender la Emergencia de Salud Pública de Importancia Internacional (ESPII) declarada el 30 de enero por la OMS. Con este documento pretendemos aportar a la caracterización de la epidemia de neumonía, ahora llamada enfermedad por coronavirus (Covid-19), revisar las fortalezas que tiene México en el concierto de la salud global e invitar a los profesionales de la salud a incorporarse a las actividades de preparación y respuesta ante esta emergencia.

Desde el ISET al InDRE. IV. Instituto de Diagnóstico y Referencia Epidemiológicos: nueva orientación, 1990-2012 / From ISET to InDRE. IV. Institute of Epidemiological Diagnosis and Reference: new orientation, 1990-2012

Resumen De 1990 a 2012, el Instituto de Salubridad y Enfermedades Tropicales experimentó los cambios más importantes. En 1989 modificó su nombre y orientación a Instituto Nacional de Diagnóstico y Referencia Epidemiológicos. Poco antes se había formalizado como cúspide de la Red Nacional de Laboratorios en Salud Pública y había incorporado los laboratorios de programas preventivos como el de citología exfoliativa y los de diagnóstico de rabia, paludismo, tuberculosis; posteriormente incorporaría otras redes que surgieron como parte de la respuesta a brotes epidémicos y al nuevo panorama epidemiológico. En este periodo, 27 algoritmos diagnósticos se definieron y organizaron en 18 redes, algunas de las cuales comenzaron a colaborar con redes globales. En 2001, en el Instituto se empezó a trabajar con patógenos relacionados con el bioterrorismo. Para entonces, las restricciones del edificio sede fueron evidentes; en 2008, se decidió construir nuevas instalaciones. El Instituto y sus redes diagnósticas constituyen un hito en la salud pública latinoamericana del siglo XXI.

Abstract From 1990 to 2012, the Sanitary and Tropical Diseases Institute experienced the most important changes. In 1989, its name and orientation were modified to become the National Institute of Epidemiological Diagnosis and Reference (InDRE). Shortly before, it had been formalized as the apex of the National Network of Public Health Laboratories and had incorporated laboratories for preventive programs such as exfoliative cytology and rabies, malaria and tuberculosis diagnosis; subsequently, it would incorporate other networks that emerged as part of the response to major epidemic outbreaks and to the new epidemiological outlook. In this period, 27 priority diagnostic algorithms were defined and organized in 18 networks, some of which began to collaborate with global networks. In 2001, the Institute started working with pathogens related to bioterrorism. By then, space restrictions of the headquarters’ building were evident; in 2008, starting the construction of new facilities was decided. The institute and its diagnostic networks constitute a milestone in Latin American public health of the 21st century.