ABCA1 variant rs9282541 is associated with metabolic syndrome in Maya children.

INTRODUCTION: Metabolic syndrome (MetS) is a metabolic disorder encompassing risk factors for cardiovascular disease and type 2 diabetes (T2D). In Mexico, the MetS is a national health problem in adults and children. Environmental and genetic factors condition the MetS. However, studies to elucidate the contribution of genetic factors to MetS in Mexico are scarce. A recent study showed that variant rs9282541 (A-allele) in ATP-binding cassette transporter A1 (ABCA1) was associated with T2D in the Maya population in addition to low levels of high-density lipoprotein cholesterol (HDL-C). Thus, this study aimed to determine whether the genetic variant of ABCA1 A-allele (rs9282541, NM_005502.4:c.688C > T, NP_005493.2:p.Arg230Cys) is associated with MetS and its components in Mexican Maya children. METHODS: The study was conducted in 508 children aged 9-13 from the Yucatán Peninsula. MetS was identified according to the de Ferranti criteria. Genotyping was performed using TaqMan assay by real-time PCR. Evaluation of genetic ancestry group was included. RESULTS: The frequency of MetS and overweight-obesity was 45.9% and 41.6%, respectively. The genetic variant rs9282541 was associated with low HDL-C and high glucose concentrations. Remarkably, for the first time, this study showed the association of ABCA1 rs9282541 with MetS in Maya children with an OR of 3.076 (95% CI = 1.16-8.13 p = 0.023). Finally, this study reveals a high prevalence of MetS and suggests that variant rs9282541 of the ABCA1 gene plays an important role in the developing risk of MetS in Maya children.

Resurgence of Vaccine-Preventable Diseases in Venezuela as a Regional Public Health Threat in the Americas.

Venezuela's tumbling economy and authoritarian rule have precipitated an unprecedented humanitarian crisis. Hyperinflation rates now exceed 45,000%, and Venezuela's health system is in free fall. The country is experiencing a massive exodus of biomedical scientists and qualified healthcare professionals. Reemergence of arthropod-borne and vaccine-preventable diseases has sparked serious epidemics that also affect neighboring countries. In this article, we discuss the ongoing epidemics of measles and diphtheria in Venezuela and their disproportionate impact on indigenous populations. We also discuss the potential for reemergence of poliomyelitis and conclude that action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. We further provide specific recommendations for addressing this crisis.

A Case about the Upgrade of Manufacturing Equipment for Insertion into an Industry 4.0 Environment.

Industry 4.0 is a synonym for the confluence of technologies that allows the integration of information technology, data science, and automated equipment, to produce smart industrial systems. The process of inserting new technologies into current conventional environments involves a wide range of disciplines and approaches. This article presents the process that was followed to identify and upgrade one station in an industrial workshop to make it compatible with the more extensive system as it evolves into the Industry 4.0 environment. An information processing kit was developed to upgrade the equipment from an automated machine to an Industry 4.0 station. The kit includes a structure to support the sensor and the data processing unit; this unit consisted of a minicomputer that records the data, graded the performance of the components, and sent the data to the cloud for storage, reporting, and further analysis. The information processing kit allowed the monitoring of the inspection system and improved the quality and speed of the inspection process.

Molecular and epidemiologic characterization of the diphtheria outbreak in Venezuela.

In 2016, Venezuela faced a large diphtheria outbreak that extended until 2019. Nasopharyngeal or oropharyngeal samples were prospectively collected from 51 suspected cases and retrospective data from 348 clinical records was retrieved from 14 hospitals between November 2017 and November 2018. Confirmed pathogenic Corynebactrium isolates were biotyped. Multilocus Sequence Typing (MLST) was performed followed by next-generation-based core genome-MLST and minimum spanning trees were generated. Subjects between 10 and 19 years of age were mostly affected (n = 95; 27.3%). Case fatality rates (CFR) were higher in males (19.4%), as compared to females (15.8%). The highest CFR (31.1%) was observed among those under 5, followed by the 40 to 49 age-group (25.0%). Nine samples corresponded to C. diphtheriae and 1 to C. ulcerans. Two Sequencing Types (ST), ST174 and ST697 (the latter not previously described) were identified among the eight C. diphtheriae isolates from Carabobo state. Cg-MLST revealed only one cluster also from Carabobo. The Whole Genome Sequencing analysis revealed that the outbreak seemed to be caused by different strains with C. diphtheriae and C. ulcerans coexisting. The reemergence and length of this outbreak suggest vaccination coverage problems and an inadequate control strategy.

Lipids From Trypanosoma cruzi Amastigotes of RA and K98 Strains Generate a Pro-inflammatory Response via TLR2/6.

Lipids from microorganisms are ligands of Toll like receptors (TLRs) and modulate the innate immune response. Herein, we analyze in vitro the effect of total lipid extracts from Trypanosoma cruzi amastigotes of RA and K98 strains (with polar biological behavior) on the induction of the inflammatory response and the involvement of TLRs in this process. We demonstrated that total lipid extracts from both strains induced lipid body formation, cyclooxygenase-2 expression and TNF-α and nitric oxide release in macrophages, as well as NF-κB activation and IL-8 release in HEK cells specifically through a TLR2/6 dependent pathway. We also evaluated the inflammatory response induced by total lipid extracts obtained from lysed parasites that were overnight incubated to allow the action of parasite hydrolytic enzymes, such as Phospholipase A1, over endogenous phospholipids. After incubation, these total lipid extracts showed a significantly reduced pro-inflammatory response, which could be attributed to the changes in the content of known bioactive lipid molecules like lysophospholipids and fatty acids, here reported. Moreover, analyses of total fatty acids in each lipid extract were performed by gas chromatography-mass spectrometry. Our results indicate a relevant role of T. cruzi lipids in the induction of a pro-inflammatory response through the TLR2/6 pathway that could contribute to the modulation of the immune response and host survival.

[Clinical competences for human viral hepatitis treatment of primary healthcare physicians from the Guatemalan social security system]. / Competencia clínica de médicos de seguridad social guatemaltecos para manejar hepatitis virales en atención primaria.

OBJECTIVE: To measure the clinical competence for diagnosis and treatment of human viral hepatitis in primary health care physicians. METHODOLOGY: Cross-sectional study in which a previously validated instrument to measure competences was used, and subsequent comparison between physicians at various primary health care units (PHCT) from the Guatemalan Institute of Social Security (GISS). This information was analyzed using descriptive and non-parametrical statistics. 104 physicians, from 5 PHCT ascribed to GISS were analyzed. RESULTS: A low level of clinical competence for diagnosis and treatment of human viral hepatitis in this physicians group was found, within a range of 9 to 62 points obtained through an instrument with a maximum theoretical value of 88; no significant statistical difference between PHCT was found. CONCLUSIONS: PHCT physicians from require continuing education to improve their clinical competence on human viral hepatitis.

OBJETIVO: Medir la competencia clínica para el diagnóstico y manejo de hepatitis virales en médicos de primer nivel de atención a la salud. METODOLOGÍA: Se efectuó un estudio transversal en el que usando un instrumento previamente validado se midió la competencia y posteriormente se comparó entre médicos adscritos a diversas unidades médicas de atención primaria a la salud (UMAPS) del Instituto Guatemalteco de Seguridad Social (IGSS). La información fue analizada mediante estadística descriptiva e inferencial no paramétrica. Se evaluaron 104 médicos de 5 UMAPS del IGSS. RESULTADOS: Se encontró un nivel muy bajo de competencia clínica para el diagnóstico y tratamiento de las hepatitis virales, dentro de un intervalo de 9 a 62 puntos obtenidos en el instrumento que tiene un valor máximo teórico de 88, sin encontrar diferencias estadísticamente significativas entre UMAPS. Conclusiones: Se requiere educación continua en los médicos de las UMAPS del IGSS para mejorar sus competencias en hepatitis virales.

Competencia clínica de médicos de seguridad social guatemaltecos para manejar hepatitis virales en atención primaria / Clinical competences for human viral hepatitis treatment of primary healthcare physicians from the Guatemalan social security system

RESUMEN Objetivo Medir la competencia clínica para el diagnóstico y manejo de hepatitis virales en médicos de primer nivel de atención a la salud. Metodología Se efectuó un estudio transversal en el que usando un instrumento previamente validado se midió la competencia y posteriormente se comparó entre médicos adscritos a diversas unidades médicas de atención primaria a la salud (UMAPS) del Instituto Guatemalteco de Seguridad Social (IGSS). La información fue analizada mediante estadística descriptiva e inferencial no paramétrica. Se evaluaron 104 médicos de 5 UMAPS del IGSS. Resultados Se encontró un nivel muy bajo de competencia clínica para el diagnóstico y tratamiento de las hepatitis virales, dentro de un intervalo de 9 a 62 puntos obtenidos en el instrumento que tiene un valor máximo teórico de 88, sin encontrar diferencias estadísticamente significativas entre UMAPS. Conclusiones: Se requiere educación continua en los médicos de las UMAPS del IGSS para mejorar sus competencias en hepatitis virales.(AU)

ABSTRACT Objective To measure the clinical competence for diagnosis and treatment of human viral hepatitis in primary health care physicians. Methodology Cross-sectional study in which a previously validated instrument to measure competences was used, and subsequent comparison between physicians at various primary health care units (PHCT) from the Guatemalan Institute of Social Security (GISS). This information was analyzed using descriptive and non-parametrical statistics. 104 physicians, from 5 PHCT ascribed to GISS were analyzed. Results A low level of clinical competence for diagnosis and treatment of human viral hepatitis in this physicians group was found, within a range of 9 to 62 points obtained through an instrument with a maximum theoretical value of 88; no significant statistical difference between PHCT was found. Conclusions PHCT physicians from require continuing education to improve their clinical competence on human viral hepatitis.(AU)

[Demographic characteristics, social inequality and inequity in Mexican childhood health]. / Contexto demográfico, desigualdad social e inequidad en salud de la niñez en México.

OBJECTIVES: Demographically describing the present and future for Mexican children to correlate aspects regarding demographic and social equity during childhood and describing the challenges these variables represent for Mexican children during the next few years. METHODS: The present and future scenario for Mexican childhood was evaluated using existing population projections. Mortality rates were estimated from avoidable causes during childhood per Mexican state, per state grouped by quartile depending on their marginalisation level and by municipality grouped according to their degree of marginalisation. The Gini coefficient was used for measuring inequality. RESULTS: Even though the absolute numbers of children in Mexico will tend to decrease in the future, the number will remain high until 2025. A greatest numbers of children were living in states having the highest degree of social marginalisation. Avoidable mortality was higher in these states compared to states having lower marginalisation. The Gini coefficient was highest concerning mortality rate caused by acute respiratory infection (0.34). Excess of avoidable mortality was evident in municipalities having high and extremely high marginalisation. CONCLUSIONS: Conditions related to demographic ageing and childhood diseases coexist in Mexico. Inequity in children's health is evident; it is related to high levels of social marginalisation. In-depth structural changes are needed to change this situation which will lead to reducing some Mexican populations' unjust social disadvantages.

[A socio-spatial analysis of social exclusion and inequity in health in Mexico]. / Exclusión Social e Inequidad en Salud en México: Un Análisis Socio-espacial.

OBJECTIVE: Determining the relationship between social exclusion and health inequity at state and municipal level in Mexico during recent years. METHODS: Adjusted mortality rates were calculated for 2005 (related to transmissible illnesses in childhood, pregnancy, childbirth and being produced by causes considered potentially avoidable); rates were calculated by states, for states grouped in quartiles according to marginalization level and for municipalities grouped according to degree of marginalization. Indicators such as rate ratio, Gini coefficient and the inequities in health index (IHI) were used for measuring such inequity. RESULTS: A clear excess of mortality was observed in the states grouped in the 4th quartile (highest marginalization) in relationship to the 1st quartile (lowest marginalization); conversely, resources and health services in the 1st quartile were evidently higher than those in the 4th quartile. The Gini coefficient reached its highest value in the mortality rate for nutritional anaemia (0.44). Excess mortality was evident in those municipalities considered as having very high marginalization; the highest IHI was observed in the states located in the 4th quartile (Chiapas, Oaxaca and Guerrero) when analysing mortality related to childhood, pregnancy, childbirth and potentially avoidable mortality. CONCLUSIONS: Notorious health inequality exists in Mexico, associated with high prevalent levels of social exclusion in different areas of the country. Deep structural changes are needed to modify this situation, promote social development and lead to reducing the unfair disadvantages to which important population groups are exposed.

Impacto de la pandemia de nueva influenza A H1N1 en personal de salud del hospital de niños JM de los Ríos: Caracas, 2009 / Impact of the new pandemic H1N1 insluenza personal health Children's Hospital JM de los Rios: Caracas, 2009

La nueva influenza A H1N1 circuló como virus predominante desde marzo de 2009 con carácterizcas pandémicas, estando los trabajadores de la salud en mayor riesgo de exposición ocupacional. El objetivo es evaluar el impacto de la pandemia por nueva influenza A H1N1 en el personal de salud del Hospital de Niños J. M. de los Ríos. Trabajo descriptivo, prospectivo, donde se incluyó al personal de salud con influenza A H!N!, según los criterios del MPPS, quienes trabajaron en las áreas de atención a pacientes designadas del Hospital JM de los Ríos. Se evaluó la presencia de complicaciones, co-morbilidad e indicación de antivirales. Análisis estadístico: Medidas de tendencia central y prueba de Chi². De 273 trabajadores de la salud 3,29 % presentaron infección por influenza AH1N1; de estos 8,62 % fueron médicos y 2,27 % personal de enfermería (p<0,05). Todos recibieron antivirales. Se presentaron complicaciones en 22,22 %, la totalidad por sobre-infección bacteriana. Se reportó un caso de co-morbilidad (11,11 %). No hubo fallecimientos. Ninguno de los casos tenía esquema de inmunización para influenza estacional. La tasa de ataque de influenza AH1N1 se consideró baja probablemente debido al cumplimiento de las medidas de precaución estándar por parte del personal de salud. Los médicos adquirieron la infección en mayor porcentaje. La educación del personal de salud es crucial para garantizar el éxito y control de la transmisión nosocomial de infuenza AH1N1.

New Influenza Virus A H1N1, was circulating as a predominant virus since march 2009 with a pandemic pattern. Health-care workers wereat an elevated risk. Evaluation of the impact o pandemic influenza in health-care personnel at JM de los Ríos Children's Hospital. Prospective, descriptive study including health-care personnel infected with influenza AH1N1, according with the MPPS criteria, who were working in the areas of assessment of patients; evaluation complications, comorbidities and indications for antivirals. Statistical Analysys: Meassures of Central Tendency, and CHI2. Of 273 health-care workers, 3.29 % were infected, 8.62% physcians, and 2.27% nurses (P<0.05). All were treated with antivirals. Complications presented in 22.22 %; most frequent being bacterial superinfection. Comorbidity presented in 11.11 %. There were no deaths, and none of the cases had been vaccinated with the influenzas seasonal vaccine. Influenza AH1N1 attack rate was low, probably because of observance of standard precautions measures by personnel. Physicians acquired the illness more frequently. Education of health personnel is important to guarantee success in preventing nosocomial transmission of influenza AH1N1.

Contexto demográfico, desigualdad social e inequidad en salud de la niñez en México / Demographic characteristics, social inequality and inequity in Mexican childhood health

Objetivos Caracterizar demográficamente el presente y futuro de la población infantil en México; relacionar condiciones demográficas y equidad social en la niñez y delinear los desafíos que éstas representan para la población infantil mexicana en los próximos años. Métodos A partir de las proyecciones de población existentes se analizó el escenario presente y futuro de la población infantil en México. Se calcularon tasas de mortalidad por causas evitables en la infancia, por estados, por estados agrupados en cuartiles según nivel de marginación y por municipios agrupados según grado de marginación. Para medir la inequidad, se utilizó el coeficiente de Gini Resultados Aunque disminuirá a futuro, el número absoluto de niños en México seguirá siendo elevado hacia 2025; el mayor número de niños reside en los estados con mayor marginación social. Existe un claro exceso de mortalidad evitable en dichos estados en relación con los de menor marginación. El Coeficiente de Gini alcanza su valor más alto en la tasa de mortalidad por infecciones respiratorias agudas (0,34). El exceso de mortalidad evitable es evidente en los municipios de alta y muy alta marginación. Conclusiones Coexisten en México demandas relacionadas con el envejecimiento demográfico, pero también con el notable peso que mantendrá en los próximos años la población infantil; es notoria la inequidad en salud en la niñez, asociada a los altos niveles de marginación social; para modificar esta situación se necesitan profundos cambios estructurales que permitan reducir las desventajas injustas a las que están expuestos importantes núcleos poblacionales del país.

Objectives Demographically describing the present and future for Mexican children to correlate aspects regarding demographic and social equity during childhood and describing the challenges these variables represent for Mexican children during the next few years. Methods The present and future scenario for Mexican childhood was evaluated using existing population projections. Mortality rates were estimated from avoidable causes during childhood per Mexican state, per state grouped by quartile depending on their marginalisation level and by municipality grouped according to their degree of marginalisation. The Gini coefficient was used for measuring inequality. Results Even though the absolute numbers of children in Mexico will tend to decrease in the future, the number will remain high until 2025. A greatest numbers of children were living in states having the highest degree of social marginalisation. Avoidable mortality was higher in these states compared to states having lower marginalisation. The Gini coefficient was highest concerning mortality rate caused by acute respiratory infection (0.34). Excess of avoidable mortality was evident in municipalities having high and extremely high marginalisation. Conclusions Conditions related to demographic ageing and childhood diseases coexist in Mexico. Inequity in children's health is evident; it is related to high levels of social marginalisation. In-depth structural changes are needed to change this situation which will lead to reducing some Mexican populations' unjust social disadvantages.

Exclusión social e inequidad en salud en México: un análisis socio-espacial / A socio-spatial analysis of social exclusion and inequity in health in Mexico

Objetivo Determinar la relación existente entre exclusión social e inequidad en salud a nivel estatal y municipal en México en años recientes. Métodos Se calcularon tasas estandarizadas de mortalidad relacionadas con enfermedades trasmisibles en la infancia, el embarazo y el parto así como producto de causas que podrían considerarse potencialmente evitables; estas tasas se calcularon por estados, por estados agrupados en cuartiles según nivel de marginación y por municipios agrupados según grado de marginación. Para medir la inequidad, se utilizaron indicadores como la razón de tasa, el coeficiente de Gini y el índice de inequidades en salud (INIQUIS) Resultados Se observa un claro exceso de mortalidad en los Estados agrupados en el Cuartil IV (mayor marginación) en relación con el Cuartil I (menor marginación) y a la inversa, los recursos y servicios disponibles en el Cuartil I son mayores que los existentes en el Cuartil IV. El Coeficiente de Gini alcanza su valor más alto en la tasa de mortalidad por anemias nutricionales (0,44). El exceso de mortalidad es evidente en los municipios considerados como de muy alta marginación; el INIQUIS más elevado se observa en los Estados ubicados en el Cuartil IV, sobre todo Chiapas, Oaxaca y Guerrero. Conclusiones Existe en México una notoria inequidad en salud, asociada a los altos niveles de exclusión social; para modificar esta situación se necesitan profundos cambios estructurales que impulsen el desarrollo social, y permitan reducir las desventajas injustas a las que están expuestos importantes núcleos poblacionales del país.

Objective Determining the relationship between social exclusion and health inequity at state and municipal level in Mexico during recent years. Methods Adjusted mortality rates were calculated for 2005 (related to transmissible illnesses in childhood, pregnancy, childbirth and being produced by causes considered potentially avoidable); rates were calculated by states, for states grouped in quartiles according to marginalisation level and for municipalities grouped according to degree of marginalisation. Indicators such as rate ratio, Gini coefficient and the inequities in health index (IHI) were used for measuring such inequity, Results A clear excess of mortality was observed in the states grouped in the 4th quartile (highest marginalisation) in relationship to the 1st quartile (lowest marginalisation); conversely, resources and health services in the 1st quartile were evidently higher than those in the 4th quartile. The Gini coefficient reached its highest value in the mortality rate for nutritional anaemia (0.44). Excess mortality was evident in those municipalities considered as having very high marginalisation; the highest IHI was observed in the states located in the 4th quartile (Chiapas, Oaxaca and Guerrero) when analysing mortality related to childhood, pregnancy, childbirth and potentially avoidable mortality. Conclusions Notorious health inequality exists in Mexico, associated with high prevalent levels of social exclusion in different areas of the country. Deep structural changes are needed to modify this situation, promote social development and lead to reducing the unfair disadvantages to which important population groups are exposed.

Lopinavir/rotonavir versus efavirenz como esquema antirretroviral de inicio en pacientes pediátricos con infección por virus de inmunodeficiencia humana / Lopinavir / rotonavir versus efavirenz as initial antiretroviral scheme in pediatric patients infected with human immunodeficiency virus

Es común la interrogante del esquema antirretrovirala utilizar de inicio, si la combinación de 2 inhibidores nucleósidos de la transcriptasa reversa (INTR) con lopinavir/ritonaviro o con efavirenz. No existen conclusiones sobre la superioridad de algún esquema en niños. Comparar la respuesta virológica, inmunológica y clínica del tratamiento inicial de pacientes pediátricos con infección VIH con esquemas basados en lopinavir/ritonavir y con efavirenz. Estudio comparativo, retrospectivo incluyendo pacientes con infecciones VIH del Hospital de Niños "J.M. de Los Ríos" entre 2000-2008, mediante revisión de la base de datos de la Unidad. Se incluyeron pacientes con terapia triple de inicio, agrupándose en esquemas con 2INTR más lopinavir/ritonavir o más efavirenz, comparando la respuesta virológica, inmunológica y clínica. Se calcularon medidas de tendencia central y Chi cuadrado. Se incluyeron 35 pacientes, 71,4% con lopinavir/ritonavir, 28,6% con efavirenz. El 64% del grupo con lopinavir/ritonavir presentó cargas virales indetectables y con efavirenz, 70% (P > 0,05). La indetectabilidad a las 24 semanas se evidenció en 87,5% de pacientes con lopinavir/ritonavir y en 57,1% con efavirenz (P > 0,05). De los pacientes con falla virológica, 55,6% del grupo lopinavir/ritonavir presentaron <10000 copias/mL, mientras que en el grupo con efavirenz fue 66,7% (P > 0,05). El ascenso de linfocitos TCD4+ en 1 año se produjo en 60% en el grupo con lopinavir/ritonavir y en 70% con efavirenz (P > 0,05). Del grupo lopinavir/ritonavir 68% tenían categoría clínica B o C y con efavirenz 60% igual que al inicio de ambos esquemas (P> 0,05). No se establecieron diferencias significativas en respuestas virológicas, inmunológicas y clínicas entre el grupo con lapinavir/ritonavir y el grupo efavirenz en la población pediátrica. Se evidencio tendencia al logro indetectabilidad en menos tiempo en el grupo de lopinavir/ritonavir.

It is not uncommon for the clinician the question about what to use between combinations of lopinavir/ritonavir or efavirenz with 2 NRTI as initial antiretroviral therapy in children. Superiority of one or another regimen in children is not conclusive. To compare the clinical, virological, and immunological response to regimens containing lopinavir/ritonavir or efavirenz, in combination with 2 NRTI. Retrospective, comparative study including VIH infected patients from Children Hospiyal "J.M. de Los Ríos", from 2000-2008. Unit data base was revised to compare two groups of children receiving initial triple antiretroviral therapy that included lopinavir/ritonavir or efavirenz, in combination with 2 NRTI, in terms of virological, immunological and clinical response to treatment. Statiscal calculations included chi square, and trends.