Analysis of influenza data generated by four epidemiological surveillance laboratories in Mexico, 2010-2016.

The disease caused by the influenza virus is a global public health problem due to its high rates of morbidity and mortality. Thus, analysis of the information generated by epidemiological surveillance systems has vital importance for health decision making. A retrospective analysis was performed using data generated by the four molecular diagnostic laboratories of the Mexican Social Security Institute between 2010 and 2016. Demographics, influenza positivity, seasonality, treatment choices and vaccination status analyses were performed for the vaccine according to its composition for each season. In all cases, both the different influenza subtypes and different age groups were considered separately. The circulation of A/H1N1pdm09 (48.7%), influenza A/H3N2 (21.1%), influenza B (12.6%), influenza A not subtyped (11%) and influenza A/H1N1 (6.6%) exhibited well-defined annual seasonality between November and March, and there were significant increases in the number of cases every 2 years. An inadequate use of oseltamivir was determined in 38% of cases, and the vaccination status in general varied between 12.1 and 18.5% depending on the season. Our results provide current information about influenza in Mexico and demonstrate the need to update both operational case definitions and medical practice guidelines to reduce the inappropriate use of antibiotics and antivirals.

[A gender perspective analysis of perception and practices in coronary disease in women from northern México]. / Análisis con perspectiva de género sobre percepción y prácticas en enfermedad coronaria en mujeres en el norte de México.

OBJECTIVE: To analyze the perception of coronary risk and health care practices in a group of Mexican women, from a gendered perspective. MATERIALS AND METHODS: Mixed methods: survey of 140 women; nine in-depth interviews to women with coronary disease; eight semi-structured interviews to physicians. ANALYSIS: proportions contrast for quantitative data; and procedures of grounded theory for qualitative information. RESULTS: More than 50% of women don't know their coronary risk and how to reduce it. Despite having information about heart disease, vulnerable women with chest pain sought medical attendance less than non-vulnerable women (p=0.0l); and are blamed by physicians. Women consider they lack sufficient information about how to reduce the risk of coronary disease, and blame themselves when ill. CONCLUSIONS: There are vulnerability conditions in women that modulate a low perception of their being at risk, and the scarcity of health care practices.

Active Surveillance of Antimicrobial Resistance and Carbapenemase-Encoding Genes According to Sites of Care and Age Groups in Mexico: Results from the INVIFAR Network.

We analyzed the antimicrobial resistance (AMR) data of 6519 clinical isolates of Escherichia coli (n = 3985), Klebsiella pneumoniae (n = 775), Acinetobacter baumannii (n = 163), Pseudomonas aeruginosa (n = 781), Enterococcus faecium (n = 124), and Staphylococcus aureus (n = 691) from 43 centers in Mexico. AMR assays were performed using commercial microdilution systems (37/43) and the disk diffusion susceptibility method (6/43). The presence of carbapenemase-encoding genes was assessed using PCR. Data from centers regarding site of care, patient age, and clinical specimen were collected. According to the site of care, the highest AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from ICU patients. In contrast, in A. baumannii, higher AMR was observed in isolates from hospitalized non-ICU patients. According to age group, the highest AMR was observed in the ≥60 years age group for E. coli, E. faecium, and S. aureus, and in the 19-59 years age group for A. baumannii and P. aeruginosa. According to clinical specimen type, a higher AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from blood specimens. The most frequently detected carbapenemase-encoding gene in E. coli was blaNDM (84%).

Health-related quality of life in children and adults with respiratory allergy in Colombia: prospective study.

BACKGROUND: Allergic diseases are very common, with the estimated cumulative prevalence in Colombia for asthma and allergic rhinitis being 22.7% and 31.3% respectively, and with a clear upward trend. A major social as well as economic impact associated with allergic disease has been described. Because in Colombia there are no studies that assess the Health-Related Quality of Life (HRQOL) in allergic respiratory diseases, our aim is to describe the HRQOL in subjects with respiratory allergy and its association with clinical control variables. METHODS: A prospective descriptive study was conducted among 76 Colombian subjects with rhinitis and asthma/allergic rhinitis. In order to evaluate the HRQOL, the instruments Kidscreen-27 and SF-36 were applied. The scores obtained in the HRQOL fields were correlated with the following clinical variables: peak expiratory flow (PEF) and peak nasal inspiratory flow (PNIF). RESULTS: In children, the better HRQL domain is present in the school environment (55.9) and the worst in psychological well-being (39.9). For adults the worst HRQL was found in the emotional function domain (55.6) while the physical function (81.7) had the best. There were no statistical differences between groups of asthma/allergic rhinitis and allergic rhinitis. Subjects with allergic asthma showed a strong correlation between the mental health domain and PEF values (r=-0717, p=0.046). CONCLUSION: Mental health is more affected than physical health in Colombian subjects with respiratory allergy. There was a strong correlation between the mental health domain and the values of PEF in patients with asthma/allergic rhinitis.

Increment Antimicrobial Resistance During the COVID-19 Pandemic: Results from the Invifar Network.

Aim: This study aims to assess the changes in antimicrobial resistance among some critical and high-priority microorganisms collected previously and during the coronavirus disease 2019 (COVID-19) pandemic in Mexico. Methods: We collected antimicrobial susceptibility data for critical and high-priority microorganisms from blood, urine, respiratory samples, and from all specimens, in which the pathogen may be considered a causative agent. Data were stratified and compared for two periods: 2019 versus 2020 and second semester 2019 (prepandemic) versus the second semester 2020 (pandemic). Results: In the analysis of second semester 2019 versus the second semester 2020, in blood samples, increased resistance to oxacillin (15.2% vs. 36.9%), erythromycin (25.7% vs. 42.8%), and clindamycin (24.8% vs. 43.3%) (p ≤ 0.01) was detected for Staphylococcus aureus, to imipenem (13% vs. 23.4%) and meropenem (11.2% vs. 21.4) (p ≤ 0.01), for Klebsiella pneumoniae. In all specimens, increased ampicillin and tetracycline resistance was detected for Enterococcus faecium (p ≤ 0.01). In cefepime, meropenem, levofloxacin, and gentamicin (p ≤ 0.01), resistance was detected for Escherichia coli; and in piperacillin-tazobactam, cefepime, imipenem, meropenem, ciprofloxacin, levofloxacin, and gentamicin (p ≤ 0.01), resistance was detected for Pseudomonas aeruginosa. Conclusion: Antimicrobial resistance increased in Mexico during the COVID-19 pandemic. The increase in oxacillin resistance for S. aureus and carbapenem resistance for K. pneumoniae recovered from blood specimens deserves special attention. In addition, an increase in erythromycin resistance in S. aureus was detected, which may be associated with high azithromycin use. In general, for Acinetobacter baumannii and P. aeruginosa, increasing resistance rates were detected.

The fourth Mexican consensus on Helicobacter pylori. / IV consenso mexicano sobre Helicobacter pylori.

Important advances have been made since the last Mexican consensus on the diagnosis and treatment of Helicobacter pylori (H. pylori) infection was published in 2007. Therefore, the Asociación Mexicana de Gastroenterología summoned 20 experts to produce "The Fourth Mexican Consensus on Helicobacter pylori". From February to June 2017, 4 working groups were organized, a literature review was performed, and 3 voting rounds were carried out, resulting in the formulation of 32 statements for discussion and consensus. From the ensuing recommendations, it was striking that Mexico is a country with an intermediate-to-low risk for gastric cancer, despite having a high prevalence of H. pylori infection. It was also corroborated that peptic ulcer disease, premalignant lesions, and histories of gastric cancer and mucosa-associated lymphoid tissue lymphoma should be considered clear indications for eradication. The relation of H. pylori to dyspeptic symptoms continues to be controversial. Eradication triple therapy with amoxicillin, clarithromycin, and a proton pump inhibitor should no longer be considered first-line treatment, with the following 2 options proposed to take its place: quadruple therapy with bismuth (proton pump inhibitor, bismuth subcitrate, tetracycline, and metronidazole) and quadruple therapy without bismuth (proton pump inhibitor, amoxicillin, clarithromycin, and metronidazole). The need for antimicrobial sensitivity testing when 2 eradication treatments have failed was also established. Finally, the promotion of educational campaigns on the diagnosis and treatment of H. pylori for both primary care physicians and the general population were proposed.

Sex and Gender Interactions in the Lives of Patients with Spondyloarthritis in Spain: A Quantitative-qualitative Study.

OBJECTIVE: To illustrate the experiences and contextual support perceived by men and women with spondyloarthritis (SpA) in relation to their demanding productive and reproductive roles. METHODS: A quantitative-qualitative study of 96 men and 54 women with SpA was conducted at the Alicante University General Hospital, in a Spanish Mediterranean city, from March 2013 to February 2014. Descriptive and qualitative content analyses compared working lives and family/partner relationships of male and female patients. RESULTS: Working life: both women (55.6%) and men (51.04%) were similarly affected, but women had worse disease activity (5.4 vs 4.0, p = 0.01) and less antitumor necrosis factor-α therapy (56.7% vs 77.6%, p < 0.05). Different patterns were found by gender: women mostly practiced presenteeism whereas men practiced absenteeism, women took antiinflammatories prior to work and men after work, employers suggested more frequently the beneficial actions for men, and some women withdrew permanently from the labor market. Family/partner relationships: women were more affected (57.4%) than men (41.7%), with worse results for diagnostic delay (11.2 vs 6.4 yrs, p = 0.02), disease activity (5.8 vs 3.6, p < 0.001), and physical function (5.2 vs 3.8, p = 0.02). Gender role conflicts emerged, with women developing strategies to face compulsory housework whereas men avoided them; women regretted neglecting their children and men not sharing leisure activities with them. CONCLUSION: Our study highlights the vital complexity in which patients with SpA are immersed, especially for women in a country where a mix of new and traditional gender roles coexist. Awareness of its existence is crucial when professionals strive to provide healthcare focused on their well-being in addition to medical therapy.

Serologic IgG response to urease in Helicobacter pylori-infected persons from Mexico.

Helicobacter pylori urease is required to counteract acidity during colonization of the stomach, and has been suggested as a major immunodominant antigen. The aim of this study was to determine the anti-urease response in a representative national serologic survey in Mexico. The population surveyed included persons 1-90 years of age from all socioeconomic levels and geographic zones of the country. Helicobacter pylori status was determined by ELISA serology. The IgG anti-urease was studied by ELISA using a recombinant apoenzyme. We found that 2,930 of the 7,720 infected patients (38%) were seropositive for IgG urease. The rate of IgG anti-urease positivity increased with age; in children < 10 years old it was < 20% and in persons > 40 years old it was > 50%. Age and a region with a high level of development were risk factors for seropositivity, whereas gender, educational level, crowding, and socioeconomic level were not associated with seropositivity. In conclusion, in natural infection with H. pylori, the response to urease is poor, mainly during the first years of infection. This inconsistent immune response to the enzyme may favor persistence of infection. A vaccine eliciting a consistent anti-urease response might overcome immune evasion and enhance clearance of bacteria after exposure.

Influence of parental lead exposure on subsequent learning ability of offspring.

This study was designed to assess the learning ability of rat offspring following the exposure of one or both parents to lead acetate (Pb) from 30-90 days of age. At that time, parents were mated to yield four groups: Group Pb-Pb, both parents had received Pb; Group Pb-N, only the mother had received Pb; Group N-Pb, only the father had received Pb; Group N-N, the control parents. Mothers were continued on their respective treatments throughout gestation and nursing. Testing of offspring began at 30 days of age, employing a black-white discrimination water T maze. Analysis of results revealed that the three Pb groups made more errors than the controls, but did not differ from one another. However, offspring in Group Pb-Pb had longer swimming times than those in Groups Pb-N and N-Pb, who, in turn, had longer swimming times than Group N-N. Thus dual parental exposure was more severe than single parental exposure, which, however, still exerted a detrimental effect compared to control performance.

Análisis con perspectiva de género sobre percepción y prácticas en enfermedad coronaria en mujeres en el norte de México / A gender perspective analysis of perception and practices in coronary disease in women from northern México

Resumen: Objetivo: Analizar la percepción de riesgo coronario y prácticas de cuidados de un grupo de mujeres mexicanas, desde una perspectiva de género. Material y métodos: Estudio realizado de septiembre de 2013 a diciembre de 2014 en el estado de Sonora, México. Diseño mixto: encuesta a 140 mujeres. Análisis: contraste de proporciones; nueve entrevistas en profundidad a mujeres con enfermedad coronaria; ocho entrevistas semiestructuradas a médicos. Aplicación de técnicas de la teoría fundamentada. Resultados: Más de 50% desconoce su riesgo y cómo reducirlo. Mujeres informadas vulnerables con dolor de pecho buscan menos atención médica que las no vulnerables p=0.01 y son responsabilizadas por parte del personal médico sobre su enfermedad. Las mujeres consideran que están desinformadas sobre cómo reducir el riesgo de enfermedad coronaria; sin embargo, se culpabilizan por enfermar. Conclusiones: Las condiciones de vulnerabilidad de las mujeres modulan una baja percepción de riesgo coronario y mínimas prácticas de cuidados.

Abstract: Objective: To analyze the perception of coronary risk and health care practices in a group of Mexican women, from a gendered perspective. Materials and methods: Mixed methods: survey of 140 women; nine in-depth interviews to women with coronary disease; eight semi-structured interviews to physicians. Analysis: proportions contrast for quantitative data; and procedures of grounded theory for qualitative information. Results: More than 50% of women don't know their coronary risk and how to reduce it. Despite having information about heart disease, vulnerable women with chest pain sought medical attendance less than non-vulnerable women (p=0.0l); and are blamed by physicians. Women consider they lack sufficient information about how to reduce the risk of coronary disease, and blame themselves when ill. Conclusions: There are vulnerability conditions in women that modulate a low perception of their being at risk, and the scarcity of health care practices.

Infection with CagA+ Helicobacter pylori strains as a possible predictor of risk in the development of gastric adenocarcinoma in Mexico.

Helicobacter pylori strains possessing the Cag pathogenicity island have been associated with increased gastric inflammation and with duodenal ulcer. In contrast, studies on the association of cagA+ H. pylori infections and gastric cancer have shown conflicting results. The aim of our study was to determine whether H. pylori and CagA status are associated with gastric cancer in Mexico. We selected serum samples from 3 geographic areas with gastric cancer mortality rates per 100,000 inhabitants of 2.5 (low risk), 4.5 (medium risk) and 6.4 (high risk). H. pylori infection was determined by the detection of antibodies to H. pylori whole cell antigen by an enzyme-linked immunosorbent assay (ELISA). To study the prevalence of infection with cagA+ strains, serum IgG antibodies to CagA were determined by ELISA using a recombinant CagA antigen. Of the 2,775 individuals studied, 1,931 were H. pylori seropositive and 1,710 had antibodies against CagA. The risk for gastric cancer in the 3 populations studied increased proportionally as infection with cagA+ strains increased (p < 0.001 for trend). H. pylori infection also showed association with gastric cancer (p < 0.05). Individuals seropositive for CagA, but seronegative for H. pylori whole cell antigen, were more frequent in areas with higher gastric cancer rates (p < 0.01). These results support the possible role of CagA(+) status as predictor of risk for gastric adenocarcinoma in Mexico; this is in agreement with results in European and American populations, but contrary to studies in some Asian countries.

Validation of a serologic test for the diagnosis of Helicobacter pylori infection and the immune response to urease and CagA in children.

OBJECTIVE: Little is known about Helicobacter pylori infections and the immune response to urease and CagA in pediatric populations. Our aims were: 1) to validate serological assays for antibodies against whole cell extract, CagA, and urease of H. pylori; 2) to examine their role in diagnosis of infection in children with recurrent abdominal pain (RAP); and 3) to examine the antibody responses to CagA and urease in children. METHODS: An enzyme-linked immunosorbent assay (ELISA) for diagnosis of H. pylori infection using whole cell extracts was validated in 50 children with biopsy-confirmed infection. The IgG and IgA antibody responses against recombinant CagA and urease were compared by ELISA in 82 children with RAP and in 246 age- and sex-matched healthy children. RESULTS: The whole-cell extract ELISA had a sensitivity of 85 % and specificity of 87%. Children with RAP were more infected with H. pylori than were healthy control subjects; however, IgG and IgA CagA seropositivity was lower among those with RAP than among asymptomatic children (34% and 23% vs 76% and 55%, respectively; p < 0.0001). In both groups of children, the immune response to urease was low. CONCLUSION: A serodiagnosis of H. pylori infection using native strains was developed. The difference in the immune response between children with RAP and control subjects suggests that RAP occurs during the acute phase of H. pylori infection. Our results also suggest that urease is a poor immunogen.

A community-based seroepidemiologic study of Helicobacter pylori infection in Mexico.

A nationwide community-based survey for Helicobacter pylori infection had not been done. This study sought to determine the seroprevalence of infection in Mexico, and the socioeconomic and demographic variables that are risk factors for infection. The survey assessed 11,605 sera from a sample population representing persons ages 1-90 years from all socioeconomic and demographic levels and from all regions of Mexico. Antibodies against H. pylori were studied by ELISA using whole cell antigen. Among the findings were that 66% of the population was infected and that age was the strongest risk factor for infection. By age 1 year, 20% were infected and by age 10 years, 50% were infected. Crowding (odds ratio [OR], 1.4), low educational level (OR, 2.42), and low socioeconomic level (OR, 1.43) were risk factors for infection. Prevalence was similar in urban and in rural communities (OR, 0.95). This study is the largest community-based seroepidemiologic study of H. pylori to date.

Cambios en la población de protozoarios ruminales por efecto de la inclusión de Canavalia ensiformis a la dieta de bovinos / Changes on rumen protozooa population induced by the inclusión of Canavalia ensiformis in cattle diets

Introducción. Canavalia ensiformis es una leguminosa que destaca por su contenido de nutrimentos. Sin embargo, posee numerosos compuestos tóxicos que pueden limitar su utilización. Se ha reportado efecto de estos compuestos in vitro sobre fauna ruminal, pero se desconoce su efecto tóxico in vivo. Objetivo. El objetivo del presente trabajo fue analizar los cambios en la población de protozoarios ruminales como respuesta al consumo de canavalia. Materiales y Métodos. Se emplearon cuatro bovinos con un peso de 264.5 Kg en un diseño doble conmutativo con arreglo factorial 2x2. Los animales fueron alimentados con pasto Taiwán ad libitum y canavalia o sorgo como suplemento (c. 27 por ciento de la dieta en base seca). Se colectó líquido ruminal después de tres semanas de adaptación a la dieta y se contaron las poblaciones de protozoarios ruminales. Los datos normalizados utilizando su log10 y fueron analizados mediante un modelo lineal general. Las medias fueron comparadas mediante la prueba de mínima diferencia significativa. Resultados. Se observó un incremento (p<0.05) en los conteos de protozoarios flagelados en las dietas que contenían canavalia (106.345 vs 105.247), pero los holotricos y entodinomorfos disminuyeron (103.717 vs 104.364 y 104.407 vs 104.933 respectivamente p<0.05). Las cuentas totales de protozoarios fueron mayores en dietas con canavalia si el total incluía flagelados (106.369 vs 105.575) y menores si los excluía (104.505 vs 105.093) (p<0.05).Discusión. Los cambios en las diferentes poblaciones de protozoarios son una respuesta de adaptación al consumo de canavalia. Los diferentes grupos de protozoarios ruminales parecen tener diferente respuesta y/o capacidad de adaptación a los tóxicos de la canavalia.