Differential expression of biomarkers in saliva related to SARS-CoV-2 infection in patients with mild, moderate and severe COVID-19.

BACKGROUND: Severe COVID-19 is a disease characterized by profound dysregulation of the innate immune system. There is a need to identify highly reliable prognostic biomarkers that can be rapidly assessed in body fluids for early identification of patients at higher risk for hospitalization and/or death. This study aimed to assess whether differential gene expression of immune response molecules and cellular enzymes, detected in saliva samples of COVID-19 patients, occurs according to disease severity staging. METHODS: In this cross-sectional study, subjects with a COVID-19 diagnosis were classified as having mild, moderate, or severe disease based on clinical features. Transcripts of genes encoding 6 biomarkers, IL-1ß, IL-6, IL-10, C-reactive protein, IDO1 and ACE2, were measured by RT‒qPCR in saliva samples of patients and COVID-19-free individuals. RESULTS: The gene expression levels of all 6 biomarkers in saliva were significantly increased in severe disease patients compared to mild/moderate disease patients and healthy controls. A significant strong inverse relationship between oxemia and the level of expression of the 6 biomarkers (Spearman's correlation coefficient between -0.692 and -0.757; p < 0.001) was found. CONCLUSIONS: Biomarker gene expression determined in saliva samples still needs to be validated as a potentially valuable predictor of severe clinical outcomes early at the onset of COVID-19 symptoms.

Antimicrobial resistance and antibiotic consumption in Mexican hospitals.

OBJECTIVE: To establish the current situation of antimicrobial resistance and antibiotic consumption in Mexican hospitals. MATERIALS AND METHODS: Antimicrobial susceptibility data from blood and urine isolates were collected. Defined daily dose (DDD) of antibiotic consumption/100 occupied beds (OBD) was calculated. RESULTS: Study period: 2016 and 2017. Of 4 382 blood isolates, E. coli and K. pneumoniae were most frequently reported, with antimicrobial resistance >30% for most drugs tested, only for carbapenems and amikacin resistance were <20%. A. baumannii had antimicrobial resistance >20% to all drugs. Resistance to oxacillin in S. aureus was 20%. From 12 151 urine isolates, 90% corresponded to E. coli; resistance to ciprofloxacin, cephalosporins and trimethoprim/sulfamethoxazole was >50%, with good susceptibility to nitrofurantoin, amikacin and carbapenems. Global median antimicrobial consumption was 57.2 DDD/100 OB. CONCLUSIONS: s. This report shows a high antimicrobial resistance level in Gram-negative bacilli and provides an insight into the seriousness of the problem of antibiotic consumption.

OBJETIVO: Establecer la situación actual de la resistencia antimicrobiana y el consumo de antibióticos en hospitales mexicanos. MATERIAL Y MÉTODOS: Se colectaron datos de susceptibilidad antimicrobiana de aislamientos de sangre y orina. Se calculó la dosis diaria definida (DDD) del consumo de antibióticos/100 estancias. RESULTADOS: Periodo de estudio de 2016 a 2017. De 4 382 aislamientos en sangre, E. coli y K. pneumoniae fueron las más frecuentes, con resistencia >30% a la mayoría de las drogas evaluadas; sólo para carbapenémicos y amikacina la resistencia fue <20%. A. baumannii tuvo resistencia >20% a todos los fármacos. La resistencia a oxacilina en S. aureus fue de 20%. De 12 151 aislamientos en urocultivos, 90% correspondió a E. coli; la resistencia a ciprofloxacina, cefalosporinas y trimetoprima/sulfametoxazol fue >50%, con buena susceptibilidad a nitrofurantoína, amikacina y carbapenémicos. La mediana del consumo global de antibióticos en DDD/100 estancias fue de 57.2. CONCLUSIONES: Este reporte muestra el nivel elevado de resistencia en bacilos Gram-negativos y brinda una perspectiva de la gravedad del problema del consumo de antibióticos.

DISPERSION OF A NEW CORONAVIRUS SARS-COV-2 BY AIRLINES IN 2020: TEMPORAL ESTIMATES OF THE OUTBREAK IN MEXICO.

BACKGROUND: On January 23, 2020, China imposed a quarantine on the city of Wuhan to contain the SARS-CoV-2 outbreak. Regardless of this measure, the new infection has spread to several countries around the world. OBJECTIVE: We developed a method to study the dissemination of this infection by airline routes and provide estimations of the time of arrival of the outbreak to different cities. METHODS: Using the Kermack and McKendrick model complemented with diffusion on a graph composed of nodes and edges, we made an analysis of COVID-19 dispersion to other cities by air travel. RESULTS: The estimation was accurate in that it was possible to predict in the middle of February 2020 the arrival of the first outbreak in Mexico, which eventually occurred between March 20 and 30. This estimation was robust with respect to small changes in epidemiological parameters at the other nodes. CONCLUSIONS: The estimation of the time of arrival of the outbreak from its epicenter, allows for a time period to implement and strengthen preventive measures aimed at the general population as well as to strengthen hospital infrastructure and training of human resources. In the present study, this estimation was accurate, as observed from the real data of the beginning of the outbreak in Mexico City up to April 6, 2020.

[Diagnóstico tardío de psoriasis: motivos y consecuencias]. / Late diagnosis of psoriasis: Reasons and consequences.

BACKGROUND: Psoriasis is an autoimmune skin disease that may be associated with articular manifestations, and the most common clinical presentation is the variety "in plaques". In Mexico, in the Centro Dermatológico Pascua, it is the eighth leading cause of consultation. The aim of this study was to determine the diagnostic process of patients in a reference center for diseases of the skin. METHODS: Performing an analytical cross-sectional study that included 100 patients where the diagnostic process was questioned, clinimetric scales were applied and evaluated anthropometric. RESULTS: It was found that 70% of patients had taken over a month to get medical care (median: 3 months; IQR: 11 months), having consulted in 61% to a general physician as a doctor of first contact and 89% being diagnosed by a dermatologist. Eighty-eight percent of the patients were overweight or obese. We found as a factor of delay, a partnership with the variable of having an Institutional Medical Service (p = 0.019; U = 695.5). CONCLUSION: it is necessary to design a system to shorten the diagnostic process, not only in psoriasis, in addition to emphasizing dermatological education.

The 2009 pandemic in Mexico: Experience and lessons regarding national preparedness policies for seasonal and epidemic influenza.

Influenza is a viral respiratory disease capable of causing epidemics that represent a threat for global security. Mexico was the first country to notify the WHO of an outbreak of what later became the first influenza pandemic of the 21st Century, caused by the virus A(H1N1)2009. Before this event Mexico had a national pandemic influenza preparedness plan, which included seasonal influenza vaccination, stockpiles of personal protection equipment and strategic drugs, and risk communication strategies. During the epidemic, the national public health laboratory network and case surveillance systems were strengthened together with surge capacities for intensive care and delivery of antiviral drugs. Risk communication was conducted for people to comply with implemented measures regarding social distancing (workplace and school closures, household quarantine). This report describes the Mexican experience during the 2009 influenza pandemic and the lessons that this experience provides to public health preparedness for future pandemics.

[Resistance to antibiotic: A serious global problem]. / La resistencia a los antibióticos: Un grave problema global.

An important piece of improvement in public health standards, medicine achievements, and development is based on the impressive effect of vaccines and antibiotics on infectious diseases. However, the last three or so decades have witnessed how an unsound use of antibiotics has resulted in antibiotic multi-resistant clones in hospitals and community environments. It also has been said that antibiotic research and the development pipeline has crashed, leading to no new antibiotic molecules to be tested at a time of treatment failure, manifest with unacceptable frequency as an increased economic and human cost in lives. Like the name of the series, antibiotic resistance is a global problem with clear evolutionary roots and a broad local impact. In that sense, this review explores the interaction among resistant mechanisms, underlying motives of expansion and actual trends in antibiotic resistance upgrade to limit the problem. Conceivably, only the involvement of players at every level, and coordinated actions accordingly constitute the necessary elements for effectively intervention.

The Real Practice Prescribing Antibiotics in Outpatients: A Failed Control Case Assessed through the Simulated Patient Method.

The first level of medical care provides the largest number of consultations for the most frequent diseases at the community level, including acute pharyngitis (AP), acute diarrhoea (AD) and uncomplicated acute urinary tract infections (UAUTIs). The inappropriate use of antibiotics in these diseases represents a high risk for the generation of antimicrobial resistance (AMR) in bacteria causing community infections. To evaluate the patterns of medical prescription for these diseases in medical offices adjacent to pharmacies, we used an adult simulated patient (SP) method representing the three diseases, AP, AD and UAUTI. Each person played a role in one of the three diseases, with the signs and symptoms described in the national clinical practice guidelines (CPGs). Diagnostic accuracy and therapeutic management were assessed. Information from 280 consultations in the Mexico City area was obtained. For the 101 AP consultations, in 90 cases (89.1%), one or more antibiotics or antivirals were prescribed; for the 127 AD, in 104 cases (81.8%), one or more antiparasitic drugs or intestinal antiseptics were prescribed; for the scenarios involving UAUTIs in adult women, in 51 of 52 cases (98.1%) one antibiotic was prescribed. The antibiotic group with the highest prescription pattern for AP, AD and UAUTIs was aminopenicillins and benzylpenicillins [27/90 (30%)], co-trimoxazole [35/104 (27.6%)] and quinolones [38/51 (73.1%)], respectively. Our findings reveal the highly inappropriate use of antibiotics for AP and AD in a sector of the first level of health care, which could be a widespread phenomenon at the regional and national level and highlights the urgent need to update antibiotic prescriptions for UAUTIs according to local resistance patterns. Supervision of adherence to the CPGs is needed, as well as raising awareness about the rational use of antibiotics and the threat posed by AMR at the first level of care.

[Knowledge, attitudes and practices about influenza A(H1N1) 2009, and influenza vaccine in Mexico: results of a population survey]. / Conocimientos, actitudes y prácticas sobre la influenza A(H1N1) 2009 y la vacunación contra influenza pandémica: resultados de una encuesta poblacional.

OBJECTIVE: To assess knowledge, attitudes and practices regarding influenza pandemic, with special emphasis on issues related to influenza vaccine, seasonal and pandemic. MATERIALS AND METHODS: Cross-sectional study, probabilistic multistage sampling in patients over 18 years, residents of Mexico City (and metropolitan area), Monterrey, Guadalajara and Merida in December 2009. RESULTS: A total of 1.600 subjects (48.9% male) were interviewed, 34% had previously received seasonal flu vaccine, 90.6% were willing to be vaccinated against A(H1N1), 46.5% of those who would not receive the vaccine was because they did not trust A (H1N1), 68% considered influenza A (H1N1) as a risk for their family. Hand washing was the preventive measure most commonly reported (47.5%), secondly influenza vaccine (28%). Schooling (1.7, p=0.006) and age (1.02, p<0.001) influence rejection to get vaccine. 82.9% of respondents rate the federal government's management as good or very good. CONCLUSIONS: There was a high acceptance rate for the pandemic influenza vaccine in Mexico when compared to similar studies in other countries, the main reason for those who reject the vaccine was distrust in it.

Limited Therapeutic Options in Mexico for the Treatment of Urinary Tract Infections.

The rise in antimicrobial resistance (AMR) has complicated the management of urinary tract infections (UTIs). The objective of this study was to evaluate the antimicrobial susceptibility patterns of Escherichia coli and Klebsiella pneumoniae. Design: prospective observational study. Bacteria were classified as susceptible or resistant to ampicillin-sulbactam, amikacin, gentamicin, ciprofloxacin, norfloxacin, nitrofurantoin, trimethoprim-sulfamethoxazole (TMP/SMZ), ertapenem, meropenem, and fosfomycin. The sensitivity to fosfomycin and chloramphenicol was evaluated by the disk diffusion method. Statistical analysis: the chi-square test and Fisher's exact test were used to compare differences between categories. A p value < 0.05 was considered statistically significant. Isolates were collected from January 2019 to November 2020 from 21 hospitals and laboratories. A total of 238 isolates were received: a total of 156 E. coli isolates and 82 K. pneumoniae isolates. The majority were community-acquired infections (64.1%). Resistance was >20% for beta-lactams, aminoglycosides, fluoroquinolones, and TMP/SMZ. For E. coli isolates, resistance was <20% for amikacin, fosfomycin, and nitrofurantoin; for K. pneumoniae, amikacin, fosfomycin, chloramphenicol, and norfloxacin. All were susceptible to carbapenems. K. pneumoniae isolates registered a higher proportion of extensively drug-resistant bacteria in comparison with E. coli (p = 0.0004). In total, multidrug-resistant bacteria represented 61% of all isolates. Isolates demonstrated high resistance to beta-lactams, fluoro-quinolones, and TMP/SMZ.

COVID-19: Clouds Over the Antimicrobial Resistance Landscape.

In recent years, the increase in antimicrobial resistance (AMR) has been recognized as a real threat to human and animal health. It is a problem that has been given the highest priority, uniting nations in the fight against its causes and effects. Among the actions that have been implemented are: clinical and microbiological surveillance, promotion of rational and controlled use of antibiotics, AMR stewardship programs in hospitals, development of tools for rapid diagnosis of infectious diseases to establish prompt and adequate treatment, and radically improving vaccination strategies. The current COVID-19 pandemic has placed disproportionate demands on the healthcare infrastructure and economy worldwide, which will negatively impact on the availability of materials as well as the technical capacity for diagnosis, patient care, and treatment of both COVID-19 and non-COVID-19 patients. Disruptions to production and distribution chains will hamper the availability and usage of antibiotics, also interrupting several of the activities that have been implemented thus far to combat AMR, including detailed laboratory monitoring and reinforced vaccination programs. Here, we discuss the main aspects that should be considered with regard to AMR, that may be affected by the pandemic and propose some actions to counter them.

Surveillance of nosocomial infections in a Mexican community hospital. How are we doing?

OBJECTIVE: To compare the nosocomial infection (NI) rate obtained from a retrospective review of clinical charts with that from the routine nosocomial infection surveillance system in a community hospital. MATERIAL AND METHODS: Retrospective review of a randomized sample of clinical charts.Results were compared to standard surveillance using crude and adjusted analyses. RESULTS: A total of 440 discharges were reviewed, there were 27 episodes of NIs among 22 patients. Cumulated incidence was 6.13 NI per 100 discharges. Diarrhea, pneumonia and peritonitis were the most common infections. Predictors of NI by Cox regression analysis included pleural catheter (HR 16.38), entry through the emergency ward, hospitalization in the intensive care unit (HR 7.19), and placement of orotracheal tube (HR 5.54). CONCLUSIONS: Frequency of NIs in this community hospital was high and underestimated. We identified urgent needs in the areas of training and monitoring.

[Current situation of HIV/AIDS in the world]. / La situación actual del VIH/SIDA en el mundo.

The pandemic of HIV and AIDS has existed for almost 30 years in the clinical setting. Although there was a surprising reaction during the early years in global public health, for the last 14 years, mainly due to the creation of the Joint United Nations Programme on HIV/AIDS (UNAIDS), a systematic epidemiological surveillance of this disease has refined the available data and has allowed the evolution of the epidemic to be monitored more or less in detail. In Mexico, something similar has occurred. In addition to programs of assistance for persons with HIV/AIDS, epidemiological surveillance systems now have robust software platforms that provide data to define the incidence and prevalence of this epidemic reliably. This article presents the most current official information, and a review of the behavior and current situation of HIV/AIDS in the world and in Mexico.

Developing and assessing a density surface model in a Bayesian hierarchical framework with a focus on uncertainty: insights from simulations and an application to fin whales (Balaenoptera physalus).

Density surface models (DSMs) are an important tool in the conservation and management of cetaceans. Most previous applications of DSMs have adopted a two-step approach to model fitting (hereafter referred to as the Two-Stage Method), whereby detection probabilities are first estimated using distance sampling detection functions and subsequently used as an offset when fitting a density-habitat model. Although variance propagation techniques have recently become available for the Two-Stage Method, most previous applications have not propagated detection probability uncertainty into final density estimates. In this paper, we describe an alternative approach for fitting DSMs based on Bayesian hierarchical inference (hereafter referred to as the Bayesian Method), which is a natural framework for simultaneously propagating multiple sources of uncertainty into final estimates. Our framework includes (1) a mark-recapture distance sampling observation model that can accommodate two team line transect data, (2) an informed prior for the probability a group of animals is at the surface and available for detection (i.e. surface availability) (3) a density-habitat model incorporating spatial smoothers and (4) a flexible compound Poisson-gamma model for count data that incorporates overdispersion and zero-inflation. We evaluate our method and compare its performance to the Two-Stage Method with simulations and an application to line transect data of fin whales (Balaenoptera physalus) off the east coast of the USA. Simulations showed that both methods had low bias (<1.5%) and confidence interval coverage close to the nominal 95% rate when variance was propagated from the first step. Results from the fin whale analysis showed that density estimates and predicted distribution patterns were largely similar among methods; however, the coefficient of variation of the final abundance estimate more than doubled (0.14 vs 0.31) when detection variance was correctly propagated into final estimates. An analysis of the variance components demonstrated that overall detectability as well as surface availability contributed substantial amounts of variance in the final abundance estimates whereas uncertainty in mean group size contributed a negligible amount. Our method provides a Bayesian alternative to DSMs that incorporates much of the flexibility available in the Two-Stage Method. In addition, these results demonstrate the degree to which uncertainty can be underestimated if certain components of a DSM are assumed fixed.

Mucosal Microbiome Profiles Polygenic Irritable Bowel Syndrome in Mestizo Individuals.

Irritable bowel syndrome (IBS) is the most frequent functional gastrointestinal disorder, worldwide, with a high prevalence among Mestizo Latin Americans. Because several inflammatory disorders appear to affect this population, a further understanding of host genomic background variants, in conjunction with colonic mucosa dysbiosis, is necessary to determine IBS physiopathology and the effects of environmental pressures. Using a simple polygenic model, host single nucleotide polymorphisms (SNPs) and the taxonomic compositions of microbiota were compared between IBS patients and healthy subjects. As proof of concept, five IBS-Rome III patients and five healthy controls (HCs) were systematically studied. The human and bacterial intestinal metagenome of each subject was taxonomically annotated and screened for previously annotated IBS, ulcerative colitis, and Crohn's disease-associated SNPs or taxon abundance. Dietary data and fecal markers were collected and associated with the intestinal microbiome. However, more than 1,000 variants were found, and at least 76 SNPs differentiated IBS patients from HCs, as did associations with 4 phyla and 10 bacterial genera. In this study, we found elements supporting a polygenic background, with frequent variants, among the Mestizo population, and the colonic mucosal enrichment of Bacteroides, Alteromonas, Neisseria, Streptococcus, and Microbacterium, may serve as a hallmark for IBS.

Environmental predictors of habitat suitability and occurrence of cetaceans in the western North Atlantic Ocean.

The objective of this study was to identify the main environmental covariates related to the abundance of 17 cetacean species/groups in the western North Atlantic Ocean based on generalized additive models, to establish a current habitat suitability baseline, and to estimate abundance that incorporates habitat characteristics. Habitat models were developed from dedicated sighting survey data collected by NOAA- Northeast and Southeast Fisheries Science Centers during July 2010 to August 2013. A group of 7 static physiographic characteristics and 9 dynamic environmental covariates were included in the models. For the small cetacean models, the explained deviance ranged from 16% to 69%. For the large whale models, the explained deviance ranged from 32% to 52.5%. Latitude, sea surface temperature, bottom temperature, primary productivity and distance to the coast were the most common covariates included and their individual contribution to the deviance explained ranged from 5.9% to 18.5%. The habitat-density models were used to produce seasonal average abundance estimates and habitat suitability maps that provided a good correspondence with observed sighting locations and historical sightings for each species in the study area. Thus, these models, maps and abundance estimates established a current habitat characterization of cetacean species in these waters and have the potential to be used to support management decisions and conservation measures in a marine spatial planning context.

Guillain-Barré Syndrome Associated With Zika Virus Infection: A Prospective Case Series From Mexico.

Background: On May 2016, anticipating the rainy season from June to October in Mexico, we expected an increase in cases of Zika virus (ZIKV) infections. With the goal of identifying cases of GBS associated with ZIKV infection, a prospective joint study was conducted by a reference center for neurological patients and the Secretary of Health in Mexico City from July 2016 to November 2016. Methods: Serum, cerebrospinal fluid, urine, and saliva were tested by RT-PCR for ZIKV, dengue virus, and chikungunya virus in patients referred from states with reported transmissions of ZIKV infection, and with clinical symptoms of GBS according to the Brighton Collaboration criteria. Clinical, electrophysiological, and long-term disability data were collected. Results: In the year 2016 twenty-eight patients with GBS were diagnosed at our institute. In five hospitalized patients with GBS, RT-PCR was positive to ZIKV in any collected specimen. Dengue and chikungunya RT-PCR results were negative. All five patients had areflexic flaccid weakness, and cranial nerves affected in three. Electrophysiological patterns were demyelinating in two patients and axonal in three. Three patients were discharged improved in 10 days or less, and two patients required intensive care unit admission, and completely recovered during follow-up. Conclusion: Our results are similar to those reported from the state of Veracruz, Mexico, in which out of 33 samples of urine of patients with GBS two had a positive RT-PCR for ZIKV. Simultaneous processing of serum, CSF, urine, and saliva by RT-PCR may increase the success of diagnosis of GBS associated to ZIKV.

Clostridium Difficile Infection: An Immunological Conundrum.

The lack of comprehensive understanding of the way immunity backfires on incidence and complications has made Clostridium difficile infection (CDI), the infectious disease of our times, as evidenced by in the parallel course it follows along epidemic of chronic degenerative diseases. Within these ailments, if as suspected the main effect of Clostridium difficile A and B toxins depends on inflammation, then aberrant immune function due to antibiotics would explain IBD triggering after treatment but also, the higher incidence and mortality surrounding disorders that are inflammatory and/or that show abatement of neutrophils. This review will discuss severity of the disease in terms of challenges to immunity during the progression of acute illness. We will identify the common signals in the communication between microbiota and inflammatory cells, as well as the sequestration of the regulatory network by Clostridium difficile, which leads to tissue damage and prevents its elimination from intestinal lumen.