Deported, homeless, and into the canal: Environmental structural violence in the binational Tijuana River.

INTRODUCTION: The US deports more Mexicans to Tijuana than any other borderland city. Returning involuntarily as members of a stigmatized underclass, many find themselves homeless and de-facto stateless. Subject to routinized police victimization, many take refuge in the Tijuana River Canal (El Bordo). Previous reports suggest Tijuana River water may be contaminated but prior studies have not accessed the health effects or contamination of the water closest to the river residents. METHODS: A binational, transdisciplinary team undertook a socio-environmental, mixed methods assessment to simultaneously characterize Tijuana River water quality with chemical testing, assess the frequency of El Bordo residents' water-related diseases, and trace water contacts with epidemiological survey methods (n = 85 adults, 18+) in 2019, and ethnographic methods in 2019-2021. Our analysis brings the structural violence framework into conversation with an environmental injustice perspective to documented how social forces drive poor health outcomes enacted through the environment. RESULTS: The Tijuana River water most proximate to its human inhabitants fails numerous water-quality standards, posing acute health risks. Escherichia coli values were ∼40,000 times the Mexican regulatory standard for directly contacted water. Skin infections (47%), dehydration (40%) and diarrhea (28%) were commonly reported among El Bordo residents. Residents are aware the water is contaminated and strive to minimize harm to their health by differentially using local water sources. Their numerous survival constraints, however, are exacerbated by routine police violence which propels residents and other people who inject drugs into involuntary contact with contaminated water. DISCUSSION: Human rights to drinking water, sanitation and hygiene are routinely violated among El Bordo inhabitants. This is exacerbated by violent policing practices that force unhoused deportees to seek refuge in waterways, and drive water contacts. Furthermore, US-Mexico 'free-trade' agreements drive rapid growth in Tijuana, restrict Mexican environmental regulation enforcement, and drive underinvestment in sewage systems and infrastructure.

The introduction of fentanyl on the US-Mexico border: An ethnographic account triangulated with drug checking data from Tijuana.

BACKGROUND: Illicitly-manufactured fentanyls (fentanyl) have changed the risk environment of people who use drugs (PWUD). In California and many western US states, the opioid overdose rate spiked from 2016 to 2021, driven largely by fentanyl. Mexican border cities act as transit through-points for the illicit drug supply and similar evolving health risks are likely to be present. Nevertheless, due to data gaps in surveillance infrastructure, little is known about fentanyl prevalence in Mexico. METHODS: We employ intensive ethnographic participant-observation among PWUD, as well as key informants including harm reduction professionals, EMTs, and physicians on the front lines in Tijuana, Mexico. We triangulate interview data and direct observations of consumption practices with n=652 immunoassay-based fentanyl tests of drug paraphernalia from mobile harm reduction clinics in various points throughout the city. RESULTS: PWUD informants described a sharp increase in the psychoactive potency and availability of powder heroin-referred to as "china white"-and concomitant increases in frequency of overdose, soft tissue infection, and polysubstance methamphetamine use. Fentanyl positivity was found among 52.8% (95%CI: 48.9-56.6%) of syringes collected at harm reduction spaces, and varied strongly across sites, from 2.7% (0.0-5.7%) to 76.5% (68.2-84.7%), implying strong market heterogeneity. Controlling for location of collection, syringe-based fentanyl positivity increased by 21.7% (10.1-42.3%) during eight months of testing. Key informants confirm numerous increased public health risks from fentanyl and describe the absence of a systematic or evidence-based governmental response; naloxone remains difficult to access and recent austerity measures have cut funding for harm reduction in Mexico. CONCLUSIONS: Fentanyl, linked to powder heroin, is changing the risk environment of PWUD on the US-Mexico border. Improved surveillance is needed to track the evolving street drug supply in Mexico and related health impacts for vulnerable populations. Structural factors limiting access to naloxone, harm reduction, substance use treatment, and healthcare, and minimal overdose surveillance, must be improved to provide an effective systemic response.

Biogénesis y mecanismo de acción de los MicroARN como biomarcadores séricos en las enfermedades cardiovasculares / Biogenesis and mechanism of action of MicroRNAs as serum biomarkers in cardiovascular diseases

Las enfermedades cardiovasculares constituyen la principal causa de mortalidad y morbilidad en el mundo actualmente, lo que obliga a la realización de los continuos avances en las estrategias diagnóstico precoz y tratamiento con el fin de mejorar el pronóstico y disminuir la mortalidad. Sin duda esto abre las puertas al campo de la investigación y en los últimos años aparecen los llamados biomarcadores séricos y entre ellos los microARN (miARN) que juegan un papel fundamental tanto en el desarrollo y como en la regulación del sistema cardiovascular. Los microARN tienen un tamaño de 19-25 nucleótidos, son el grupo de ARN de pequeño tamaño que ha atraído mayor atención durante los últimos años. Hasta la fecha, se han identificado aproximadamente unos 2500 miARN en el genoma humano. Los miARN desempeñan un papel en la regulación de diversos procesos biológicos, como la embriogénesis, la proliferación y diferenciación celular, la apoptosis o la tumorogénesis. En el sistema cardiovascular, los miARN controlan el crecimiento y la contractilidad de los cardiomiocitos, el desarrollo y mantenimiento del ritmo cardíaco, la formación de la placa arterioesclerótica, el metabolismo de los lípidos y la angiogénesis. Además están vinculados en la fisiopatología de varias enfermedades cardiovasculares, fundamentalmente la insuficiencia cardiaca, el infarto de miocardio, la enfermedad coronaria, la ateroesclerosis, y las cardiomiopatías de diversas etiologías, de allí que su determinación en la circulación podría ser de utilidad en la práctica clínica como potencial biomarcador diagnóstico y pronóstico de las enfermedades cardiovasculares. Palabras clave: Micro RNA; Enfermedades cardiovasculares; Biomarcadores séricos.

Cardiovascular diseases are the main cause of mortality and morbidity in the world today, which forces the continuous progress in early diagnosis and treatment strategies in order to improve the prognosis and decrease mortality. Undoubtedly this opens the doors to the field of research and in recent years there are the so-called serum biomarkers and among them microRNAs (miRNAs) that play a fundamental role both in the development and in the regulation of the cardiovascular system. The microRNAs are 19 to 25 nucleotides in size, they are the small group of RNA that has attracted the most attention in recent years. To date, approximately 2,500 miRNAs have been identified in the human genome. The miRNAs play a role in the regulation of various biological processes, such as embryogenesis, cell proliferation and differentiation, apoptosis or oncogenesis. In the cardiovascular system, miRNAs control the growth and contractility of cardiomyocytes, the development and maintenance of heart rhythm, the formation of atherosclerotic plaque, lipid metabolism and angiogenesis. They are also linked in the pathophysiology of several cardiovascular diseases, mainly heart failure, myocardial infarction, coronary heart disease, atherosclerosis, and cardiomyopathies of various etiologies, hence their determination in circulation could be useful in clinical practice as a potential biomarker in the diagnosis and prognosis of cardiovascular diseases. Keywords: Micro RNA; Cardiovascular diseases; Serum biomarkers.

Fentanyl is used in Mexico's northern border: current challenges for drug health policies.

BACKGROUND AND AIMS: Results from a recent study among 750 heroin users in three Mexico's northern border cities revealed an increase in white powder availability (also known as China white) and preference for this product among heroin users, as well as a general perception of increased overdose cases among this population. Here, we questioned whether those findings reflect an increased presence of heroin laced with fentanyl, which is associated with greater risks of overdose but that, until now, has not been described in Mexico. DESIGN: We tested fentanyl using highly sensitive test strips in syringe plungers, metal cookers and drug wrappings associated with heroin use. SETTING: Three injection sites in Tijuana, Baja California, México. PARTICIPANTS: Eighty-nine heroin users who interchanged paraphernalia for new syringes. MEASUREMENTS: We tested 59 residues of 'pure' white powder. The rest were white powder with black tar (n = 5) or white powder with crystal meth (n = 9), black tar with crystal meth (n = 1), black tar only (n = 13) and crystal meth only (n = 2). FINDINGS: Users believed that they consumed either white powder heroin, white powder heroin with crystal meth, white powder with black tar heroin or black tar heroin only. Analyses revealed that 93% (n = 55) of the 'pure' white powder samples had fentanyl. All (n = 9) the white powder samples mixed with crystal meth and 40% (n = 2) of the white powder with black tar were also laced with fentanyl. CONCLUSIONS: In a sample of 89 heroin users in Mexico, most white powder heroin users were unknowingly exposed to fentanyl, with fentanyl detected in 93% of white powder samples.

Mecanismos fisiopatológicos, neurohormonales y objetivos terapéuticos en la insuficiencia cardiaca aguda / Physiopathological, neurohormonal and therapeutic targets in acute heart failure

La insuficiencia cardiaca aguda (ICA) se define como la aparición rápida o el empeoramiento de los síntomas o signos de IC. Es una entidad potencialmente mortal que requiere evaluación y tratamiento urgentes y típicamente conlleva la hospitalización urgente. La descompensación de la insuficiencia cardiaca crónica puede ocurrir sin que existan factores desencadenantes conocidos. Se produce una disfunción endotelial que puede deberse a un desequilibrio en el medio neuro-hormonal, inflamatorio, y oxidativo en la circulación y en las células endoteliales. Se produce clínicamente hipoperfusión miocárdica, reducción del flujo coronario, disfunción isquémica, aumento de la rigidez vascular y deterioro de la distensibilidad arterial que agravan en mayor medida la lesión miocárdica. La evaluación inicial y la monitorización no invasiva continua de las funciones vitales cardiorrespiratorias son esenciales. Los diuréticos son la piedra angular del tratamiento de los pacientes con ICA y signos de sobrecarga de fluidos y congestión. La terapia de reemplazo renal se debe reservar para pacientes que no responden al tratamiento con diuréticos. Los vasodilatadores intravenosos son los segundos fármacos más utilizados en la ICA para el alivio de los síntomas; sin embargo, no existen pruebas definitivas que confirmen su efecto beneficioso. El uso de inotrópicos debería estar reservado a los pacientes con disfunción sistólica que afecta a la perfusión de órganos vitales. Los dispositivos de asistencia ventricular y otras formas de asistencia mecánica circulatoria pueden emplearse como tratamiento puente en pacientes seleccionados(AU)

Acute heart failure (AHF) is defined as the rapid onset or worsening of the symptoms or signs of heart failure. It is a potentially fatal entity that requires urgent evaluation and treatment and typically involves urgent hospitalization. Decompensation of chronic heart failure can occur without known triggers. An endothelial dysfunction occurs that may be due to an imbalance in the neuro-hormonal, inflammatory, and oxidative environment in the circulation and in the endothelial cells. Myocardial hypoperfusion is clinically produced, coronary flow reduction, ischemic dysfunction, increased vascular rigidity and deterioration of arterial compliance that aggravate myocardial injury to a greater extent. Initial evaluation and continuous non-invasive monitoring of vital cardiorespiratory functions are essential. Diuretics are the cornerstone of the treatment of patients with AHF and signs of fluid overload and congestion. Renal replacement therapy should be reserved for patients who do not respond to treatment with diuretics. Intravenous vasodilators are the second most used drugs in the AHF for the relief of symptoms; however, there is no definitive evidence to confirm its beneficial effect. The use of inotropics should be reserved for patients with systolic dysfunction that affects the perfusion of vital organs. Ventricular assist devices and other forms of mechanical circulatory assistance can be used as a bridge treatment in selected patients(AU)

Conceptos epidemiológicos, manejo diagnóstico y farmacológico de la insuficiencia cardiaca congestiva crónica

RESUMEN La insuficiencia cardiaca (IC) es un síndrome clínico complejo que resulta de cualquier deterioro estructural o funcional del llenado ventricular o gasto cardiaco. Las manifestaciones clínicas típicas de la insuficiencia cardiaca son disnea y fatiga, que pueden limitar la tolerancia al ejercicio, y retención de líquidos, lo que pueden conducir a la congestión pulmonar y esplácnica, y edema periférico. La prevalencia de la IC se sitúa aproximadamente en el 1-2% de la población adulta en países desarrollados, y aumenta a más del 10% entre personas de 70 o más años de edad. El riesgo de IC a los 55 años es del 33% para los varones y el 28% para las mujeres. Es categórico el hecho de la existencia de una tendencia demográfica hacia el aumento de la longevidad de la población en general, lo cual implica a su vez un aumento en la incidencia de la insuficiencia cardiaca. Por lo tanto, las investigaciones científicas se deben dirigir al estudio del manejo diagnóstico y terapéutico de esta población con edad avanzada. Normalmente, la miocardiopatía es la causa de la disfunción ventricular sistólica o diastólica. No obstante, las anomalías de válvulas, pericardio, endocardio, ritmo cardiaco y conducción también pueden causar IC, en algunas ocasiones se puede deber a la combinación de más de una de ellas. Los objetivos del tratamiento para los pacientes con IC son mejorar el estado clínico, la capacidad funcional y la calidad de vida, prevenir las hospitalizaciones y reducir la mortalidad. Los estudios experimentales y clínicos deben enfocarse a seguir aportando datos sobre la fisiopatología, la influencia de la edad, los criterios diagnósticos, la caracterización de subgrupos especiales, y la identificación de nuevos agentes farmacológicos para mejorar la estrategia terapéutica preventiva y curativa en pacientes con insuficiencia cardiaca congestiva crónica.

ABSTRACT Heart failure (HF) is a complex clinical syndrome that results from any structural or functional deterioration of the ventricular filling or cardiac output. The typical clinical manifestations of heart failure are dyspnea and fatigue, which can limit exercise tolerance, and fluid retention leading to pulmonary and splanchnic congestion, and peripheral edema. The prevalence of HF is approximately 1-2% of the adult population in developed countries, and increases to more than 10% among people 70 years or older. The risk of HF at age 55 is 33% for men and 28% for women. There is a categorical tendency towards an increase in life expectancy in the world population, which consequently results in an increased incidence of heart failure. Therefore, scientific research should focus on searching for better diagnostic and treatment strategies in this elderly population. Frequently, cardiomyopathy is the cause of systolic or diastolic ventricular dysfunction. However, the heart valves diseases, pericardium, endocardium, cardiac conduction and rhythm disorders can also cause HF, in some cases it can be caused by a combination of more than one of them. Treatment goals for patients with HF are aimed on optimizing clinical status, improving functional capacity and quality of life, preventing hospitalizations and reducing mortality. Experimental and clinical studies should focus on continuing to provide data on the pathophysiology of heart failure, on diagnostic criteria, the characterization of special subgroups, and the identification of new pharmacological agents to improve the preventive and curative therapeutic strategy in patients with chronic congestive heart failure.

Síndrome de Boerhaave / Boerhaave's syndrome

El síndrome de Boerhaave es la rotura esofágica espontánea secundaria al aumento de presión intraesofágica, generalmente por un cuadro repetitivo e intenso de emesis que provoca perforación transmural del esófago. Semeja, clínicamente, un infarto agudo al miocardio, pancreatitis o perforación de víscera hueca, cuya manifestación principal es hematemesis masiva. En este artículo comunicamos el caso de un paciente masculino de 38 años de edad con antecedente de alcoholismo crónico, quien inició su padecimiento cuatro días previos al ingreso con dolor abdominal, distensión y vómito gastrobiliar; a los tres días tuvo hematemesis y melena. Con deterioro progresivo del estado de alerta, la exploración pulmonar reveló estertores gruesos diseminados, con disminución del ruido respiratorio en ambas bases. La telerradiografía de tórax mostró aire subdiafragmático y ensanchamiento mediastinal. El paciente falleció y el reporte histopatológico indicó perforación longitudinal, de aproximadamente 8.5 cm, en todas las capas del esófago en el tercio medio.