[Clinical competence measurement in Mexican resident physicians for diagnosis and treatment of Chagas disease]. / Evaluación de la competencia clínica en médicos residentes mexicanos para el diagnóstico y tratamiento de la enfermedad de Chagas.

OBJECTIVE: Evaluate clinical competence of a mexican resident physicians sample for diagnosis and treatment of Chagas disease. MATERIAL AND METHODS: Cross-sectional and analytic study in 122 resident physicians of epidemiology, family medicine and internal medicine specialty, assigned to a third level medical unit from Guadalajara, Jalisco, Mexico, taking a sample for convenience. An instrument was designed and validated for to evaluate clinical competence in five dimensions: risk factors identification, clinical data identification, diagnostic test interpretation, diagnostic integration and therapeutic resources utilization; that classified competence level in four strata: random defined, low, medium and high, with 89% of reliability accord to Kunder-Richardson test. Descriptive and no parametric inferential statistics were obtained. RESULTS: A total of 122 physicians, 55.7% males (n = 68) and 44.3% females (n = 54). Random defined clinical competence 4.9% (n = 6), low 49.2% (n = 60), medium 44.3% (n = 54) and high 1.6% (n = 2). Median significantly higher in epidemiologists (p = 0.03). CONCLUSIONS: Improve clinical competence level of resident physicians for diagnosis and treatment of Chagas disease is necessary. Intervention studies are required.

Frequency of urinary pesticides in children: a scoping review.

Pesticides are any mix of ingredients and substances used to eliminate or control unwanted vegetable or animal species recognized as plagues. Its use has been discussed in research due to the scarcity of strong scientific evidence about its health effects. International literature is still insufficient to establish a global recommendation through public policy. This study aims to explore international evidence of the presence of pesticides in urine samples from children and their effects on health through a scoping review based on the methodology described by Arksey and O'Malley. The number of articles resulting from the keyword combination was 454, and a total of 93 manuscripts were included in the results and 22 were complementary. Keywords included in the search were: urinary, pesticide, children, and childhood. Children are exposed to pesticide residues through a fruit and vegetable intake environment and household insecticide use. Behavioral effects of neural damage, diabetes, obesity, and pulmonary function are health outcomes for children that are commonly studied. Gas and liquid chromatography-tandem mass spectrometry methods are used predominantly for metabolite-pesticide detection in urine samples. Dialkylphosphates (DAP) are common in organophosphate (OP) metabolite studies. First-morning spot samples are recommended to most accurately characterize OP dose in children. International evidence in PubMed supports that organic diets in children are successful interventions that decrease the urinary levels of pesticides. Several urinary pesticide studies were found throughout the world's population. However, there is a knowledge gap that is important to address (public policy), due to farming activities that are predominant in these territories.

Social determinants and chronic kidney disease of undetermined origin in childhood: Its communication and understanding described by families in Lake Chapala, Mexico.

This work is based on the recognition of the existence of a complex relationship between social and environmental determinants and infants with chronic kidney disease of non-traditional etiology (CKDnT). The aim is to understand how the Social and Environmental Determinants are settled and its influence to the CKDnT in childhood, through knowledge built from the population that has lived the experience of this disease. This research was carried out with a narrative-conversational design. The experience of CKDnT was organized in stories focused on the experience of families in the social and environmental context where they live, get sick, suffer, and die from the disease. In the dialogue emerges the intersection of the social determinants of the disease, the different ways of life, and the relationship with the health services that attend them.

Seasonal Urinary Levels of Glyphosate in Children From Agricultural Communities.

BACKGROUND: Glyphosate is one of the most commonly used pesticides in agricultural activities worldwide. For the last 20 years, its use has increased rapidly becoming a public health concern. The IARC classified glyphosate as probably carcinogenic; however, the reported evidence is not enough to establish a statement. OBJECTIVE: This work aimed to measure glyphosate levels in the urine of children from a single rural community in an endemic region of chronic kidney disease and malnutrition. METHODS: A cross-sectional study was carried out in a rural community in western Mexico. The study included 95 children between the ages of 6 and 16. A urine sample (first-morning spot) was obtained from children and processed to measure glyphosate levels using high-performance liquid chromatography coupled with tandem mass spectrometry. RESULTS: All samples tested positive for glyphosate levels. Urine glyphosate levels were related to the season and the age of the children. CONCLUSION: Glyphosate is present in children of all ages in the community even if they were not in direct contact with it. No toxicity cases were reported, nor were there other health problems related to glyphosate. However, more long-term studies should be done that provide a statement regarding the harmful effects that glyphosate has on public health.

Demographic and climatic factors associated with dengue prevalence in a hyperendemic zone in Mexico: an empirical approach.

BACKGROUND: Many models for predicting dengue epidemics use incidence and short-term changes in climate variables, however, studies in real-life scenarios for correlations of seroprevalence (SP) with long-term climate variables and with integration of socio-economic factors are scarce. Our objective was to analyse the combined correlation between socio-economic and climate variables with the SP of dengue in Mexico. METHODS: We performed a seroepidemiological ecological study on the Mexican Pacific coast. Dengue SP was estimated by the presence of immunoglobulin G antibodies in 1278 inhabitants. We implemented multiple correlations with socio-economic, climatic and topographic characteristics using logistic regression, generalized linear models and non-linear regressions. RESULTS: Dengue SP was 58%. The age-adjusted correlation was positive with the male sex, while a negative correlation was seen with socio-economic status (SES) and scholl level (SL). The annual temperature showed a positive correlation, while the altitude was negative. It should be noted that these correlations showed a marked 'S' shape in the non-linear model, suggesting three clearly defined scenarios for dengue risk. CONCLUSION: Low SES and SL showed an unexpected paradoxical protective effect. Altitude above sea level and annual temperature are the main determinants for dengue in the long term. The identification of three clearly delineated scenarios for transmission could improve the accuracy of predictive models.

Erratum: Sierra-Diaz, E.; Celis-de la Rosa, A.J.; Lozano-Kasten, F.; Trasande, L.; Peregrina-Lucano, A.A.; Sandoval-Pinto, E.; Gonzalez-Chavez, H. Urinary Pesticide Levels in Children and Adolescents Residing in Two Agricultural Communities in Mexico. Int. J. Environ. Res. Public Health 2019, 16, 562.

The authors would like to update some important data in the manuscript. In Table 4, the pesticide means were reported in µg/mL, which is incorrect. The correct units are ng/mL (nanograms/milliliter). The same typographical inaccuracy applies for data in the fourth paragraph of the discussion (with minimal values of 0.0020 µg/mL and maximal values of 2.63 µg/mL), where the correct units are also ng/mL [1]. [...].

Urinary Pesticide Levels in Children and Adolescents Residing in Two Agricultural Communities in Mexico.

The use of pesticides in agricultural activities has increased significantly during the last decades. Several studies have reported the health damage that results from exposure to pesticides. In Mexico, hundreds of communities depend economically on agricultural activities. The participation of minors in this type of activity and their exposure to pesticides represents a potential public health problem. A cross-sectional study was conducted, in which urine samples (first-morning urine) were taken from children under 15 years of age in both communities. A total of 281 urine samples obtained in both communities were processed for the determination of pesticides with high-performance liquid chromatography together with tandem mass spectrometry. In 100% of the samples, at least two pesticides of the 17 reported in the total samples were detected. The presence of malathion, metoxuron, and glyphosate was remarkable in more than 70% of the cases. Substantial differences were detected regarding the other compounds. It is necessary to carry out long-term studies to determine the damage to health resulting from this constant exposure and to inform the health authorities about the problem in order to implement preventive measures.

[Epidemiologic knowledge and current situation of Chagas disease in the state of Jalisco, Mexico]. / Conocimiento epidemiológico y situación actual de la enfermedad de Chagas en el estado de Jalisco, México.

Chagas disease in the state of Jalisco, Mexico was described for the first time in 1967; however, knowledge on the disease remains in a slow process. Between 1967 and 2006, the disease was described in its acute and chronic forms. The vector species have been identified, and the parasite Trypanosoma cruzi has been isolated and genetically characterized. Also, the magnitude of the infection in humans has been determined through serological studies of different populations as well as of blood donors. The up-to-dateness of knowledge of the disease in the state of Jalisco, unveils a necessity of increased research on the epidemiology of Chagas disease as well as on clinical studies to assess the health of individuals and the populations.

Peridomicilary habitat and risk factors for Triatoma infestation in a rural community of the Mexican occident.

An examination of peridomestic area organization and triatomine collection in an endemic village for Chagas disease (Jalisco State) identified the habitat of Triatoma longipennis (dominant species) and the risk factors of peridomestic infestation. In 100 visited peridomestic areas, 369 structures (permanent, temporary, and natural) were submitted to active manual research of triatomines. Storage shelters had a higher infestation of T. longipennis than piles of brick and tile; baked clay material had higher degrees of infestation than others. The secondary species Triatoma barberi shares a wide range of peridomicilary habitats with T. longipennis. Peridomestic area infestation risks (evaluated with multivariate logistic regression analysis) are number of closed storage shelters, number of brick and tile piles, number of houses per peridomestic areas, and distance of peridomicile from natural environment. Because both species present great adaptability to different artificial habitats, strategies of control must involved improving the overall management of peridomestic areas to prevent stable colonization.

Peridomestic colonization of Triatoma longipennis (Hemiptera, Reduviidae) and Triatoma barberi (Hemiptera, Reduviidae) in a rural community with active transmission of Trypanosoma cruzi in jalisco state, Mexico.

Infestation of peridomiciles is likely a major risk factor for Chagas disease transmission in Jalisco state, Mexico. An entomological and serological survey of a typical village was conducted between July and September 2003. The peridomestic areas of 100 dwellings were visited and triatomines were searched manually in 369 potential sites. A total of 1821 Triatoma longipennis (93.2%) or Triatoma barberi was captured. Both species frequently occurred in sympatry. The infestation index was 60% for T. longipennis and 16% for T. barberi. T. longipennis occurred throughout the village. Colonization indices were high for T. longipennis (93%) and T. barberi (75%), suggesting that both species have adapted to peridomestic habitats. The bug population size was larger for T. longipennis than for T. barberi. Five very large colonies of T. longipennis were recorded whereas only 1 or 2 bugs were observed in 38% of the positive sites, which suggests intense dispersal activity. Both species exhibited high infection prevalence with Trypanosoma cruzi (46%). Only T. cruzi lineage I was detected. Human seroprevalence was 1.8%. This study serves as an entomological overview of peridomiciliar triatomine colonization in a Mexican village and highlights the current risk of Chagas disease transmission.

Non-Traditional Risk Factors of Albuminuria in the Pediatric Population: A Scoping Review.

The presence of albumin in urine has been used for more than four decades as a marker of renal and cardiovascular damage. Most of the information on this marker is related to adults. The prevalence of albuminuria in the pediatric population has been reported as being 2.2-12.8% in some countries. Most research in this field is related to albuminuria and diseases, such as diabetes and hypertension. Using the methodology described by Arksey and O'Malley in 2005, a scoping review was carried out to show that the presence of albumin in urine in the pediatric population might be associated with environmental, demographic, congenital, infectious, and non-infectious factors. The information collected is supported by 74 references present in PubMed. The results reveal the multiple causes associated with albuminuria in the pediatric population. This information can be very useful for clinical practice by adding knowledge about albuminuria behavior in children.

Prevalence of Albuminuria in Children Living in a Rural Agricultural and Fishing Subsistence Community in Lake Chapala, Mexico.

The occurrence of Chronic Kidney Disease (CKD) of unknown etiology in autochthonous child populations residing along the Lake Chapala lakeshore is endemic (Jalisco, México). The objective of this study was to determine the prevalence of albuminuria in the pediatric population and to measure the glomerular filtration rate in children with two positive albuminuria tests. Urinary albumin was measured in 394 children. Subjects with two or more positive albuminuria test donated blood samples for the determination of serum biomarkers. From a rural community with 565 children under the age of 17 years, 394 (69.7%) participated with first morning urine samples. A total of 180 children were positive (with two or more positive albuminuria tests). The prevalence of albuminuria among the children participating in the study was 45.7%. Of the 180 children with persistent albuminuria, 160 (88.9%) were tested for serum creatinine, urea, and cystatin C. The 68.1% of the children studied, were found in stages 3a and 3b of the Kidney Disease Improving Global Outcomes (KDIGO) classification (mean glomerular filtration rate (GFR) 51.9 and 38.4 mL/min/1.73 m² respectively). The lowest frequencies were for classifications 1 and 4. None of the subjects was classified as grade 5. The prevalence of albuminuria in children from this rural community is 3-5 times higher than reported in international literature. Regarding GFR, more than 50% of children studied are under 60 mL/min/1.73 m². It is a priority to find the causes of albuminuria and CKD in this Mexican region.

Epidemiological risk for Trypanosoma cruzi transmission by species of Phyllosoma complex in the occidental part of Mexico.

Domestic and peridomestic triatomine populations were collected in three rural Mexican communities of Jalisco, Nayarit and Zacatecas states. Triatoma longipennis and T. picturata (Phyllosoma complex) were the principal species unequally distributed in the villages: T. longipennis was the main species in two communities and T. picturata in the third one. Peridomestic infestation and colonization indexes were remarkably high ranging from 26.1% to 50% and from 58.3% to 85.7%, respectively. Moreover, domestic (indoor) infestation was observed in only one of the communities infested by T. longipennis. The preliminary study of temporal variation indicates increasing trend of the triatomine population and infestation rates during the dry season. Triatomine infection rates ranged from 41.2% to 60.2% and all the flagellate isolates were assigned to T. cruzi I. The majority of the dwellings were built with modern building materials and the sanitary conditions were generally good. High peridomestic infestations must be considered as a risk factor of Chagas disease transmission and further studies are needed to better understand the peridomestic conditions favoring the establishment of the triatomines. The contribution of such study to enlarger knowledge of epidemiological features of Chagas disease in Mexico is considered.

Colonization of rock pile boundary walls in fields by sylvatic triatomines (Hemiptera: Reduviidae) in Jalisco State, Mexico.

Granite rocks is a very abundant material in Mexico because they are used habitually as borders for fields. The current work established the significance of this ecotype as a colonization site for triatomines of the Phyllosoma complex. Seven sites, arbitrary selected, in San Martin de Hidalgo municipality (Mexico) were investigated in April 2002 by using 210 mouse bait-traps left during the night in wall hollows. One hundred and seventy-two triatomines of all life stages were collected from the seven sites. Triatomines adhered to the tape that covered the traps or were found near them, and 36.6% of the traps collected triatomines. The principal species was Triatomia longipennis Usinger (1939) and low numbers of Triatoma picturata Usinger (1939) were found. The nymphal population was very young, probably corresponding to the reproductive period in April (end of the dry season). The infection rate of the triatomines for Trypanosoma cruzi was 49%. Because collecting triatomines in the field is laborious and time-consuming, the mouse bait-trap method found to be practical to assess the population of triatomines within a sylvatic habitat.

Population genetic structure of Meccus longipennis (Hemiptera, Reduviidae, Triatominae), vector of Chagas disease in West Mexico.

The originally wild species of the Meccus complex are important vectors of Chagas disease in Mexico. In West Mexico, Meccus longipennis plays an important epidemiological role. To understand the genetic structure of the domestic and wild populations of this species, a preliminary study with five polymorphic microsatellite loci was conducted. The population genetics analysis showed high structuring between peridomestic biotopes, with breeding subunits detected in a single peridomestic structure. In the wild environment, two genetic patterns were observed according to the biotope, possible breeding subunits in large rocky formations and a larger panmictic unit in agropastoral areas, suggesting considerable dispersal of bugs in this biotope. Moreover, the discovery of two foci of wild populations at the edge of Guadalajara city raises the question of new urban areas where the phenomenon of bug incursions into households could constitute a risk of transmission of Chagas disease.

Community participation and domiciliary occurrence of infected Meccus longipennis in two Mexican villages in Jalisco state.

The entomological features of Chagas disease in two western Mexican villages were analyzed through triatomines collection by the inhabitants and active research in the peridomicile. The inhabitant collections have the following comparable characteristics: 1) Meccus longipennis was the dominant species (> 91%), 2) around 43% of the insects were collected indoors, 3) about 70% of triatomines were adults, 4) cumulated rates of infestation of the dwellings reached 40-50%, 5) the triatomine infection rate by Trypanosoma cruzi was > 50%, and 6) the indoor triatomines frequently feed on humans (range 38.5-56.2%). However, the collection was twice as abundant in the first village and the peridomicile infestation, evaluated by the active collection, reached up to 60% and only 4.9% in the other village. Furthermore, females predominated in the first village, whereas males in the other. The current results allow discussing the course of action to prevent Chagas disease in this region.

Preliminary results of random amplification of polymorphic DNA among Triatominae of the phyllosoma complex (Hemiptera, Reduviidae).

In Mexico, Triatoma longipennis (Usinger), Triatoma picturata (Usinger), and Triatoma pallidipennis (Stal), primary Chagas disease vector species of the phyllosoma complex, were analyzed by randomly amplified polymorphic DNA (RAPD). Sixteen decametric primers resolved individual profiles not identical, but partially discriminative between species. Analysis based on pairwise presence/absence comparisons between the three species was performed using three primers and two outgroup species Triatoma infestans (Klug) and Triatoma barberi (Usinger). Fifty-three bands in total were scored, although only two bands were constant among the three phyllosoma complex species. Two other bands were constant only for T. longipennis and T. picturata together, and not present in T. pallidipennis. Neighbor Joining tree and the multiple correspondence analysis discriminated T. pallidipennis clearly from the other two species, although there was overlap between T. longipennis and T. picturata. The results indicate a close relationship between the studied species and support the hypothesis of their recent evolution. The suitability of RAPD to discern populations within the species is discussed.

Predominance of Trypanosoma cruzi lineage I in Mexico.

Randomly amplified polymorphic DNA (RAPD) has emerged as an effective genetic marker for analysis of Trypanosoma cruzi population variability. This method has been used to study the genetic variability of Mexican T. cruzi stocks and to relate these results to previous classifications. High clonal diversity was observed among the Mexican populations: 24 RAPD types were scored among 56 stocks analyzed. Only two stocks (3.6%) belonged to the T. cruzi II lineage, while all others belonged to T. cruzi I. The robustness of these clusters was statistically highly significant. Mexican T. cruzi I stocks formed a homogeneous group with reduced genetic distances among its members. Parasites from this group were isolated from both domestic and sylvatic cycles over a broad geographic area in Mexico. The two Mexican stocks classified as T. cruzi II (isolated from sylvatic cycles) were of the same RAPD type, although they were not closely related to the three reference T. cruzi II stocks circulating in domestic cycles in Argentina, Brazil, Bolivia, and Chile. These stocks were also unrelated to the formerly named Zymodeme III.

Conocimiento epidemiológico y situación actual de la enfermedad de Chagas en el estado de Jalisco, México / Epidemiologic knowledge and current situation of Chagas disease in the state of Jalisco, Mexico

La enfermedad de Chagas en el estado de Jalisco, México, apareció por primera vez en 1967, aunque su conocimiento ha seguido un proceso lento. Entre los años de 1967 y 2006 se describió la enfermedad en sus formas agudas y crónicas; se identificaron las especies de vectores y se aisló el parásito Trypanosoma cruzi, que luego se caracterizó en el plano genético. La magnitud de la infección en el hombre se determinó con estudios serológicos en diversas poblaciones, así como en donadores de sangre. En la actualización presente del conocimiento de la enfermedad en el estado de Jalisco se mostró la necesidad de incrementar las investigaciones sobre la epidemiología de la enfermedad de Chagas, así como los estudios clínicos para determinar la salud de los individuos y las poblaciones.

Chagas disease in the state of Jalisco, Mexico was described for the first time in 1967; however, knowledge on the disease remains in a slow process. Between 1967 and 2006, the disease was described in its acute and chronic forms. The vector species have been identified, and the parasite Trypanosoma cruzi has been isolated and genetically characterized. Also, the magnitude of the infection in humans has been determined through serological studies of different populations as well as of blood donors. The up-to-dateness of knowledge of the disease in the state of Jalisco, unveils a necessity of increased research on the epidemiology of Chagas disease as well as on clinical studies to assess the health of individuals and the populations.

Preliminary results of random amplification of polymorphic DNA among Triatominae of the phyllosoma complex (Hemiptera, Reduviidae)

In Mexico, Triatoma longipennis (Usinger), Triatoma picturata (Usinger), and Triatoma pallidipennis (Stal), primary Chagas disease vector species of the phyllosoma complex, were analyzed by randomly amplified polymorphic DNA (RAPD). Sixteen decametric primers resolved individual profiles not identical, but partially discriminative between species. Analysis based on pairwise presence/absence comparisons between the three species was performed using three primers and two outgroup species Triatoma infestans (Klug) and Triatoma barberi (Usinger). Fifty-three bands in total were scored, although only two bands were constant among the three phyllosoma complex species. Two other bands were constant only for T. longipennis and T. picturata together, and not present in T. pallidipennis. Neighbor Joining tree and the multiple correspondence analysis discriminated T. pallidipennis clearly from the other two species, although there was overlap between T. longipennis and T. picturata. The results indicate a close relationship between the studied species and support the hypothesis of their recent evolution. The suitability of RAPD to discern populations within the species is discussed.