Different epidemiological profiles in patients with Zika and dengue infection in Tapachula, Chiapas in Mexico (2016-2018): an observational, prospective cohort study.

BACKGROUND: The introduction of Zika and chikungunya to dengue hyperendemic regions increased interest in better understanding characteristics of these infections. We conducted a cohort study in Mexico to evaluate the natural history of Zika infection. We describe here the frequency of Zika, chikungunya and dengue virus infections immediately after Zika introduction in Mexico, and baseline characteristics of participants for each type of infection. METHODS: Prospective, observational cohort evaluating the natural history of Zika virus infection in the Mexico-Guatemala border area. Patients with fever, rash or both, meeting the modified criteria of PAHO for probable Zika cases were enrolled (June 2016-July 2018) and followed-up for 6 months. We collected data on sociodemographic, environmental exposure, clinical and laboratory characteristics. Diagnosis was established based on viral RNA identification in serum and urine samples using RT-PCR for Zika, chikungunya, and dengue. We describe the baseline sociodemographic and environmental exposure characteristics of participants according to diagnosis, and the frequency of these infections over a two-year period immediately after Zika introduction in Mexico. RESULTS: We enrolled 427 participants. Most patients (n = 307, 65.7%) had an acute illness episode with no identified pathogen (UIE), 37 (8%) Zika, 82 (17.6%) dengue, and 1 (0.2%) chikungunya. In 2016 Zika predominated, declined in 2017 and disappeared in 2018; while dengue increased after 2017. Patients with dengue were more likely to be men, younger, and with lower education than those with Zika and UIE. They also reported closer contact with water sources, and with other people diagnosed with dengue. Participants with Zika reported sexual exposure more frequently than people with dengue and UIE. Zika was more likely to be identified in urine while dengue was more likely found in blood in the first seven days of symptoms; but PCR results for both were similar at day 7-14 after symptom onset. CONCLUSIONS: During the first 2 years of Zika introduction to this dengue hyper-endemic region, frequency of Zika peaked and fell over a two-year period; while dengue progressively increased with a predominance in 2018. Different epidemiologic patterns between Zika, dengue and UIE were observed. Trial registration Clinical.Trials.gov (NCT02831699).

[First Mexican Consensus of Vaccination in Adults]. / 1º Consenso Mexicano de Vacunación en el Adulto.

For years our efforts have been focused on vaccination during childhood. Today we know that this is not enough to ensure health in the rest of the life. Childhood is as important as any other stage and, therefore, vaccination must be permanent and differentiated, according to our age, throughout life. Introducing a life course perspective in vaccination programs, with emphasis on adult vaccination, particularly in older adults, offers us the opportunity to review the performance of health programs, actions, and services in the field of immunization, as well as strengthening health promotion actions. In this context, the first Mexican Consensus on Adult Vaccination was carried out in a joint effort of the National Institute of Geriatrics, bringing together a group of specialists who worked on three central objectives: establishing vaccination guidelines throughout the life course, with emphasis on new vaccines; defining priority groups according to their risk factors; and contributing to the effort to promote healthy aging.

[Results of the First Mexican Consensus of Vaccination in the Adult]. / Resultados del Primer Consenso Mexicano de Vacunación en el Adulto.

For years our efforts have been focused on vaccination during childhood. Today we know that this is not enough to ensure health in the rest of the life. Childhood is as important as any other stage and, therefore, vaccination must be permanent and differentiated, according to our age, throughout life. Introducing a life course perspective in vaccination programs, with emphasis on adult vaccination, particularly in older adults, offers us the opportunity to review the performance of health programs, actions, and services in the field of immunization, as well as strengthening health promotion actions. In this context, the first Mexican Consensus on Adult Vaccination was carried out in a joint effort of the National Institute of Geriatrics, bringing together a group of specialists who worked on three central objectives: establishing vaccination guidelines throughout the life course, with emphasis on new vaccines; defining priority groups according to their risk factors; and contributing to the effort to promote healthy aging.

[Active tuberculosis in a cohort of HIV-infected inmates in a prison in Mexico City: clinical and epidemiological characteristics]. / Tuberculosis activa en una cohorte de reclusos infectados por VIH en una cárcel de la Ciudad de México: características clínicas y epidemiológicas.

OBJECTIVE: To determine the clinical and epidemiological characteristics of prison inmates with active tuberculosis in HIV-positive prison populations. MATERIALS AND METHODS: We conducted a cohort study in HIV-infected subjects in a prison in Mexico City, with the aim of determining clinical and epidemiological characteristics of cases with active TB. RESULTS: We detected 172 HIV infected inmates and TB in 28 of them (16.3%) - 21 (12.2) with pulmonary TB--with an incidence rate of 7.7/100 persons/year for active TB and 4.7/100 persons/year for pulmonary TB. No drug resistance was found. Two clusters (4 and 2 subjects) were observed after RFLP-typing of 18 isolates, with a transmission rate of 11% by molecular and clinical analysis. CONCLUSIONS: The prevalence of active TB was found to be a thousand times greater than in the general population. Evidence of transmission inside the prison was also found.

[The clinical tests used to determine the position of the central venous catheter]. / Validez de las pruebas clínicas para determinar posición del catéter venoso central.

BACKGROUND: Chest x-ray (Rx) is the standard test to assess correct placement of a central venous catheter (CVC). Our objective was to validate the use of four clinical measures (CMs) to assess the proper placement of the line. METHODS: During a period of eight month, at the Intensive Care Unit a prospective study was done. A chest Rx was always obtained to assess the position of the catheter. The CMs were: venous return; waveform of the central venous pressure (CVP); arrhythmias while advancing the guide wire and the difference between planned length in cm to be introduced and the length of the catheter introduced. RESULTS: For each parameter alone the sensitivity and specificity found were: for venous return 97% and 22%, for CVP waveform changes 86% and 40%, for arrhythmias 97% and 60%, for difference between planned and real length introduced into the patient 97% and 50% respectively. According to chest x-ray, 78% of the catheters were located at a central position. Using the four CMs, we obtained 86% sensitivity and 90% specificity of the placement of the CVC. CONCLUSIONS: The use of each parameter alone is highly sensitive but poorly specific.

Tuberculosis activa en una cohorte de reclusos infectados por VIH en una cárcel de la Ciudad de México: características clínicas y epidemiológicas / Active tuberculosis in a cohort of HIV-infected inmates in a prison in Mexico City: clinical and epidemiological characteristics

OBJETIVO: Determinar las características clínicas y epidemiológicas de los casos con tuberculosis (TB) activa en población de cárceles con VIH, que se ve especialmente afectada por ambas epidemias. La infección por VIH incrementa significativamente la probabilidad del desarrollo de TB. MATERIAL Y MÉTODOS: Se realizó un estudio de cohorte en sujetos infectados por VIH e internados en un reclusorio de la Ciudad de México. RESULTADOS: Se encontraron 172 pacientes con VIH, 28 con TB activa (16.3%) - 21 (12.2%) con afección pulmonar - con una tasa de incidencia de 7.7 por 100 sujetos/año para TB activa y de 4.7 por 100 sujetos/ año para TB pulmonar. No se encontró drogorresistencia. Dieciocho aislados fueron tipificados por RFLP, con una tasa de transmisión calculada de 11%. CONCLUSIÓN: Se encontró una prevalencia de TB en esta población mil veces superior a la observada en la población general y datos sugerentes de transmisión al interior de la cárcel.

OBJECTIVE: To determine the clinical and epidemiological characteristics of prison inmates with active tuberculosis in HIV-positive prison populations. MATERIALS AND METHODS: We conducted a cohort study in HIV-infected subjects in a prison in Mexico City, with the aim of determining clinical and epidemiological characteristics of cases with active TB. RESULTS: We detected 172 HIV infected inmates and TB in 28 of them (16.3%) - 21 (12.2) with pulmonary TB - with an incidence rate of 7.7/100 persons/year for active TB and 4.7/100 persons/year for pulmonary TB. No drug resistance was found. Two clusters (4 and 2 subjects) were observed after RFLP-typing of 18 isolates, with a transmission rate of 11% by molecular and clinical analysis. CONCLUSIONS: The prevalence of active TB was found to be a thousand times greater than in the general population. Evidence of transmission inside the prison was also found.

Tendencia de las bacteremias y factores de riesgo de muerte en un hospital de tercer nivel de la Ciudad de México. 1981 a 1992 / Trends of bacteremia and analysis of the risk factors death in a tertiarycare center in Mexico City. 1981 a 1992

Objetivo: Describir la tendencia de las bacteremias y los factores de riesgo (FR) de muerte en adultos atendidos en un hospital de tercer nivel entre de 1981 a 1992. Material y métodos: Incluimos aleatoriamente el 20 por ciento de las bacteremias por año. Resultados: Se tomaron 47,618 hemocultivos de 19,530 pacientes, de ellos 3,428 (17.6 por ciento) con bacteremia (285 / año). Incluimos 600 pacientes (50 / año), 307 hombres; edad promedio 46 ñ 19.8 años; 88 por ciento mono microbiana y 61.3 por ciento de origen nosocomial (BN). Encontramos diabetes mellitus en 103 casos, cirrosis hepática en 98, y SIDA en 33. Los microorganismos aislados fueron: E. coli (177), K pneumoniae (53), Enterobacter (50), Salmonella (45) y P. aeruginosa (35), estafilococos coagulasa negativa (ECN) (116), S. aureus (56), enterococo (22) y Candida (20). Hubo disminución de ECN (p<0.01), y aumento de Candida, Stenotro-phomonas maltophilia y enterococo (p<0.01), mortalidad cruda por BN de 70.8 por ciento, y comunitaria fue de 29.2 por ciento, con mortalidad atribuible a BN de 41.6 por ciento. Se definieron los siguientes FR: enfermedad valvular cardiaca (p<0.001), estancia en la UTI (p<0.001), sepsis (p<0.001) y neumonía (p<0.001). Discusión: La bacteremia es una de las infecciones asociadas con mayor mortalidad que no se ha modificado con la terapia oportuna. Enterococo y candida emergen como patógenos relevantes.

Patrones de conducta médica en el tratamiento farmacológico del dolor posoperatorio en niños hospitalizados / Patterns of prescription in the pharmacological treatment of pain in hospitalized children

Introducción. El dolor es una manifestación clínica común en la práctica médica y una de las principales razones por la que los pacientes pediátricos solicitan y requieren atención médica. Por ello, el objetivo del presente trabajo fue el de describir la frecuencia con que se indican analgésicos y las características de dicha prescripción en el tratamiento del dolor posoperatorio en niños. Material y métodos. El diseño del estudio fue de cohortes comparativas retrolectivas y se llevó a cabo en un hospital pediátrico de tercer nivel de atención médica. Se estudiaron los expedientes clínicos de 125 niños, a quienes se les practicó una cirugía abdominal; en ellos se identificó la indicación de analgésico, el tipo, la dosis, la vía de administración y el número de dosis aplicadas. Resultados. Se prescribió analgésico en 107 pacientes (86 por ciento), el cual se aplicó en 92 (74 por ciento) y a dosis adecuadas en 28 (22 por ciento). El analgésico más utilizado fue la dimetilpirazolona (metamizol sódico) (87 por ciento), seguido de la nalbufina (12 por ciento) y el acetaminofén (1 por ciento). Se prescribió una dosis mayor a la recomendada en 77 casos (72 por ciento) y una dosis menor a los estándares en dos niños (2 por ciento). La sobredosificación ocurrió en todos los casos para la dimetilpirazolona (RM= 26.4, IC 95 por ciento = 4.7-90.9, P= 0.000002). La administración de los analgésicos ocurrió en el 44 por ciento de los neonatos y en 64 por ciento de los lactantes, comparados con el 88 por ciento de escolares y adolescentes (RM = 6.6,IC 95 por ciento = 1.7-27.3, P=0.002). Conclusiones. En niños posoperados de cirugía abdominal se administraron analgésicos en el 74 por ciento, los cuales se aplican correctamente en sólo el 22 por ciento de los mismos. Se observó una tendencia a una menor indicación y administración en los niños de menor edad