Decrease of Postchemotherapy Complications With the Use of Probiotics in Children With Acute Lymphoblastic Leukemia.

INTRODUCTION: During the administration of antineoplastic drugs, acute complications because of toxicity occur, determining their hospital readmission, visits to the emergency department, use of antimicrobials, and possibilities of presenting systemic infections, impacting on their life quality. METHODS: Through a prospective cohort, 60 children with acute lymphoblastic leukemia were followed-up for 30 days after the hospital discharge because of chemotherapy administration, those patients were previously included in a single-blinded study in which 30 (group 1) received Lactobacillus rhamnosus GG probiotic during the administration of chemotherapy. The remaining 30 patients did not receive probiotics (group 2). There were evaluated gastrointestinal symptoms, such as diarrhea, dyspepsia, abdominal distension, meteorism, constipation, nausea, and vomit, development of infections, antibiotic use, number of emergency department visits, number of hospitalizations, and sepsis diagnosis. STATISTICAL ANALYSIS: To assess the impact of the use of probiotics, the difference in proportions between both study groups was evaluated. RESULTS: Gastrointestinal manifestations (nausea, vomiting, diarrhea, constipation) occurred in 30% of patients in group 1 versus 63% of group 2 (P=0.009). Nine of 30 patients (30.0%) in group 1 went to the emergency room, versus 33.3% of group 2 (P=0.7). Antimicrobials were used in 8 subjects (26.6%) in group 1 versus 6 subjects (53.3%) in group 2 (P=0.03) suspected of an infectious disease. Four (13.3%) group 1 patients were hospitalized versus 30% of group 2 (P=0.1). Two subjects (6.6%) in group 1 had sepsis versus 7 (23.3%) in group 2 (P=0.07).Conclusions:The results indicate that the use of probiotics can be a great alternative in the improvement of gastrointestinal symptoms and the adverse effects associated with chemotherapy.

COVID-19 epidemiology in a Mexican tertiary care hospital.

INTRODUCTION: As a result of COVID-19, many hospitals underwent a conversion for the care for this disease. OBJECTIVE: To analyze COVID-19 hospital epidemiological behavior from March to August 2020. METHODS: Through a series of cases, COVID-19 epidemiological behavior at the hospital was analyzed, for which simple case rates, percentages and incidence of COVID-19 per 100 hospital discharges were estimated. RESULTS: Out of 491 subjects who tested positive for SARS-CoV-2, 156 (31.7 %) were hospitalized for clinical data of moderate to severe disease. Average age was 59.1 years; 121 cases (75 %) were discharged due to improvement, and 32 (20.5 %), due to death. Average age of those who died was 69.7 years, and the most affected age group was 60 to 80 years (45.4 %). Calculated lethality was 20.5 per 100 hospital discharges, while that calculated taking into account positive patients (outpatients and hospitalized patients) was 6.5. CONCLUSIONS: COVID-19 epidemiological behavior was similar to that described in other studies; however, lethality and mortality are above national average. The analysis of this and of the factors that favored it in our population is pending.

INTRODUCCIÓN: A consecuencia de COVID-19, numerosos hospitales sufrieron una reconversión para la atención de esta enfermedad. OBJETIVO: Analizar el comportamiento epidemiológico hospitalario de COVID-19 entre marzo y agosto de 2020. MÉTODOS: En una serie de casos se analizó el comportamiento epidemiológico de COVID-19 en un hospital de tercer nivel, para lo cual se estimaron frecuencias simples de casos, porcentajes e incidencia por cada 100 egresos hospitalarios. RESULTADOS: De 491 sujetos con prueba positiva para SARS-CoV-2, 156 (31.7 %) fueron hospitalizados por datos clínicos de enfermedad moderada a grave. La edad promedio fue de 59.1 años; 121 casos (75 %) egresaron por mejoría y 32 (20.5 %), por defunción. El promedio de edad de quienes fallecieron fue de 69.7 años y el grupo etario más afectado fue el de 60 a 80 años (45.4 %). La letalidad calculada fue de 20.5 por 100 egresos hospitalarios, mientras que la calculada tomando en cuenta los pacientes positivos (ambulatorios y hospitalizados) fue de 6.5. CONCLUSIONES: El comportamiento epidemiológico de COVID-19 fue similar al descrito en otros estudios; sin embargo, la letalidad y la mortalidad están por encima de la media nacional. Está pendiente el análisis de estas y de los factores que las favorecieron en nuestra población.

Opportunities in the teaching of medical specialties, regarding influenza and COVID-19.

Medical specialties' teaching is an area of health systems that deserves special consideration in light of the lessons learned from influenza and COVID-19; educational programs and implementation of the training strategies that are used must be reevaluated, since the level of training of most specialty students does not allow to consider them as personnel who can face these global problems. The number of specialization courses has exponentially grown, and their main threat is the cancellation or partial execution of their academic programs as a consequence of not implementing functional operational strategies during a contingency.

La enseñanza en las especialidades médicas es un rubro de los sistemas de salud que merece consideraciones especiales de acuerdo con las lecciones aprendidas de la influenza y COVID-19. Deben reevaluarse los programas educativos y las estrategias de capacitación implementadas, ya que la preparación escolar de la mayoría de los alumnos no les permite ser considerados como personal que pueda enfrentar esos problemas globales. Los cursos de especialización han crecido en número, pero su principal amenaza es la suspensión de los programas académicos o que sean parcialmente cubiertos como consecuencia de no implementar estrategias operativas funcionales durante una contingencia.

Probiotic Supplementation Decreases Chemotherapy-induced Gastrointestinal Side Effects in Patients With Acute Leukemia.

INTRODUCTION: In children with acute leukemia, gut microbiota is modified secondary to chemotherapy administration, leading to gastrointestinal side effects. Probiotics are microorganisms that can restore gut microbiota and may help alleviate gastrointestinal symptoms. The aim of this pilot study was to assess the effects of probiotic supplementation on chemotherapy-induced gastrointestinal side effects in children with acute leukemia (AL). METHODS: In this randomized pilot study, patients under 17 years of age diagnosed with AL who were on remission induction or remission reinduction chemotherapy were randomly assigned to receive probiotic supplementation (a concentration of 5×109 CFU per sachet was administered at a standard dose twice daily, by mouth) or no probiotic supplementation. The primary endpoint was the prevalence of gastrointestinal side effects. Vomiting, nausea, flatulence, dyspepsia, diarrhea, constipation, abdominal pain, and abdominal distention were assessed in both groups. RESULTS: Gastrointestinal side effects were less prevalent in the probiotic group, and 3 of the 8 gastrointestinal side effects (nausea, vomiting, and abdominal distension) significantly decreased in the probiotic group (P<0.05). We found for diarrhea a relative risk of 0.5 (95% confidence interval [CI], 0.2-1.2; P=0.04); for nausea an RR of 0.5 (95% CI, 0.4-0.8; P=0.04) and for vomiting an RR of 0.4 (95% CI, 0.2-0.9; P=0.04). CONCLUSIONS: Daily supplementation with Lactobacillus rhamnosus reduced chemotherapy-induced gastrointestinal side effects in children with AL.

Newborn screening for six lysosomal storage disorders in a cohort of Mexican patients: Three-year findings from a screening program in a closed Mexican health system.

OBJECTIVE: To evaluate the results of a lysosomal newborn screening (NBS) program in a cohort of 20,018 Mexican patients over the course of 3years in a closed Mexican Health System (Petróleos Mexicanos [PEMEX] Health Services). STUDY DESIGN: Using dried blood spots (DBS), we performed a multiplex tandem mass spectrometry enzymatic assay for six lysosomal storage disorders (LSDs) including Pompe disease, Fabry disease, Gaucher disease, mucopolysaccharidosis type I (MPS-I), Niemann-Pick type A/B, and Krabbe disease. Screen-positive cases were confirmed using leukocyte enzymatic activity and DNA molecular analysis. RESULTS: From July 2012 to April 2016, 20,018 patients were screened; 20 patients were confirmed to have an LSD phenotype (99.9 in 100,000 newborns). Final distributions include 11 Pompe disease, five Fabry disease, two MPS-I, and two Niemann-Pick type A/B patients. We did not find any Gaucher or Krabbe patients. A final frequency of 1 in 1001 LSD newborn phenotypes was established. DISCUSSION: NBS is a major public health achievement that has decreased the morbidity and mortality of inborn errors of metabolism. The introduction of NBS for LSD presents new challenges. This is the first multiplex Latin-American study of six LSDs detected through NBS.

Antibiotic use before chemotherapy: a risk factor for developing neutropenic colitis in children with leukemia.

BACKGROUND: It has been shown that the use of antimicrobials is a determinant that favors intestinal dysbiosis. The objective of this study is to establish the association between the previous use of antimicrobials and the development of neutropenic colitis (NC). METHODS: A case-control study was carried out with subjects diagnosed with acute lymphoblastic leukemia from 2004 to July 2013. They were identified by cross-referencing the databases from the computing area and the records from the pediatric hematology section. Cases were children with neutropenia and fever, abdominal distension and pain, diarrhea or constipation, and ultrasonography or computed tomography showing an intestinal wall thickness of ≥4 mm. Controls were children with acute lymphoblastic leukemia with neutropenia and fever, with or without gastrointestinal symptomatology, but without images of NC. RESULTS: Thirty-eight cases and 75 controls were included. The factors associated with the development of NC were severe neutropenia (odds ratio [OR], 12.4; 95% confidence interval [CI], 3-51; P=0.00001), the use of antimicrobials for >10 days, within the month previous to the appearance of NC (OR, 12.4; 95% CI, 3-51; P=0.00001), and use of doxorubicin (OR, 5.43, 95% CI, 2.1-13.8, P=0.00004). In particular, the risk of developing CN was 3.46 (95% CI, 0.88-14; P=0.04) when ceftriaxone was used. CONCLUSIONS: The use of antimicrobials during >10 days before the administration of chemotherapy is a risk factor for developing NC, along with other factors previously studied.

Immunogenicity of RV1 and RV5 vaccines administered in standard and interchangeable mixed schedules: a randomized, double-blind, non-inferiority clinical trial in Mexican infants.

Introduction: Rotavirus-associated diarrheal diseases significantly burden healthcare systems, particularly affecting infants under five years. Both Rotarix™ (RV1) and RotaTeq™ (RV5) vaccines have been effective but have distinct application schedules and limited interchangeability data. This study aims to provide evidence on the immunogenicity, reactogenicity, and safety of mixed RV1-RV5 schedules compared to their standard counterparts. Methods: This randomized, double-blind study evaluated the non-inferiority in terms of immunogenicity of mixed rotavirus vaccine schedules compared to standard RV1 and RV5 schedules in a cohort of 1,498 healthy infants aged 6 to 10 weeks. Participants were randomly assigned to one of seven groups receiving various combinations of RV1, and RV5. Standard RV1 and RV5 schedules served as controls of immunogenicity, reactogenicity, and safety analysis. IgA antibody levels were measured from blood samples collected before the first dose and one month after the third dose. Non-inferiority was concluded if the reduction in seroresponse rate in the mixed schemes, compared to the standard highest responding scheme, did not exceed the non-inferiority margin of -0.10. Reactogenicity traits and adverse events were monitored for 30 days after each vaccination and analyzed on the entire cohort. Results: Out of the initial cohort, 1,365 infants completed the study. Immunogenicity analysis included 1,014 infants, considering IgA antibody titers ≥20 U/mL as seropositive. Mixed vaccine schedules demonstrated non-inferiority to standard schedules, with no significant differences in immunogenic response. Safety profiles were comparable across all groups, with no increased incidence of serious adverse events or intussusception. Conclusion: The study confirms that mixed rotavirus vaccine schedules are non-inferior to standard RV1 and RV5 regimens in terms of immunogenicity and safety. This finding supports the flexibility of rotavirus vaccination strategies, particularly in contexts of vaccine shortage or logistic constraints. These results contribute to the global effort to optimize rotavirus vaccination programs for broader and more effective pediatric coverage.Clinical trial registration: ClinicalTrials.gov, NCT02193061.

Effect of school reopening on pediatric morbidity and mortality during the third epidemiological wave of COVID-19 in a Mexican state.

BACKGROUND: Determining the effect of reopening schools on pediatric SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection rates increased the need to share the experience of governments in many geographic regions for better future decision-making in similar health emergencies. METHODS: Through a prospective study based on a population-based cohort, students from 18,988 schools in the State of Mexico who began returning to school were followed. Daily sanitation filters were implemented in each school and district liaisons were informed on a daily basis through a negative network. Identified cases were confirmed by reverse transcriptase-polymerase chain reaction. Simple case frequencies, percentages, and incidences of COVID-19 were estimated. State incidences were compared with the national incidence. RESULTS: A total of 3,586 cases were confirmed; 2,048 (57.1%) were children. Twenty-four (0.6%) were hospitalized for moderate to severe COVID-19; nine (37.5%) died, and only one was a schoolchild. From week 36, an average infection rate of 0.36 was observed. The highest infection rate in schoolchildren was observed in epidemiologic week 40 (1.01); from this week on, a decrease in the number of cases was observed until week 50. CONCLUSIONS: The use of non-pharmaceutical interventions has more advantages than limitations, as long as the strategies are homogeneous and properly implemented to ensure adequate control of infections.

INTRODUCCIÓN: La determinación del efecto de reabrir las escuelas sobre las tasas de infección pediátrica por SARS-CoV-2 (síndrome respiratorio agudo grave coronavirus 2) incrementó la necesidad de trasmitir la experiencia de los gobiernos de muchas regiones geográficas para mejores decisiones futuras en emergencias sanitarias similares. MÉTODOS: Mediante un estudio prospectivo basado en una cohorte poblacional se dio seguimiento a los alumnos de 18,988 escuelas del Estado de México que iniciaron con el regreso a clases. Se implementaron filtros sanitarios diarios en cada escuela y cotidianamente se informaban a los enlaces jurisdiccionales a través de una red negativa. Los casos identificados eran confirmados a través de RT-PCR (reacción en cadena de la polimerasa con transcriptasa inversa). Se estimaron frecuencias simples de casos, porcentajes e incidencias de COVID-19. Las incidencias del estado se compararon con la incidencia nacional. RESULTADOS: Un total de 3,586 casos fueron confirmados; 2,048 (57.1%) correspondieron a niños. Veinticuatro (0.6%) fueron hospitalizados por COVID-19 moderado a grave; nueve (37.5%) fallecieron, y solamente una correspondió a un escolar. A partir de la semana 36 se observó una tasa promedio de infecciones de 0.36. En la semana epidemiológica 40 se observó la mayor tasa de infección en escolares (1.01); a partir de esta semana se observa un declive de los casos hasta la semana 50. CONCLUSIONES: La implementación de intervenciones no farmacéuticas tiene más ventajas que limitaciones, siempre y cuando las estrategias sean homogéneas y correctamente ejecutadas, lo que asegurará un adecuado control en los contagios.

[Diarrheal disease caused by rotavirus in epidemic outbreaks]. / Enfermedad diarreica por rotavirus en brotes epidémicos.

OBJECTIVE: Determine the epidemiological profile of outbreaks of acute diarrheal disease caused by rotavirus (RV) occurring in pediatric patients, based on a critical review of the literature published between 2000 and 2010. METHODS: A search was carried out for articles published from January 2000 to April 2010, collected by the Artemisa, EBSCO, Embase, Imbiomed, Lilacs, Ovid, PubMed, and Science Direct databases. In the studies that met the inclusion criteria, possible confounding factors were identified and risks of bias were attributed based on the number of items considered inadequate in each case. The epidemiological and microbiological characteristics of the outbreaks were described. RESULTS: The sample was comprised of only 14 (10.8%) of the 129 titles identified, which accounted for 91 092 reported cases of acute diarrhea. In 5 250 of these cases, a search for rotavirus was conducted, yielding 1 711 (32.5%) positive isolations. It was observed that the RV from Group A was the causative agent in 100% of the outbreaks, while genotype G9 was documented in 50% of the articles. CONCLUSIONS: Rotavirus, mainly serotype G9, was one of the principal agents responsible for outbreaks of acute diarrheal disease over the past decade. A careful outbreak study can contribute valuable information for RV disease control and prevention.

Cell death induction by mycelium extracts from Pleurotus spp. on cervical cancer cell lines.

Mushrooms have health benefits, including anti-tumoral properties. We evaluated the cytotoxic and cell death induction effects of water-soluble extracts of Pleurotus ostreatus and Pleurotus eryngii mycelium in the cervical cancer cell lines HeLa (HVP18+) and SiHa (HVP16+) as well as the non-tumoral cell line HaCaT. Both Pleurotus extracts presented similar protein patterns from 190 to 10 kDa and displayed protease activity on a gelatine substrate. The mycelium extracts of both Pleurotus strains induced a dose-dependent cytotoxic effect on HPV+ cells IC50 65 µg), whereas HaCaT cells were less susceptible (IC50 90 µg). The cytotoxic effect at the IC50 concentration was not associated with apoptosis, the activation of Caspases-3/7 was not significantive; only P. eryngii induced a moderate (1.2-fold) increase in SiHa cells. Pleurotus extracts induced autophagy, mainly in SiHa cells (4.3-fold). Neither extracts induced changes in p53 protein expression, suggesting that the cytotoxic effect could be due to p53-independent pathways.

Congenital syphilis, a reemergent disease in Mexico: its epidemiology during the last 2 decades.

OBJECTIVE: To describe the epidemiologic profile of congenital syphilis in Mexico between 1990 and 2009. METHODS: The database of the General Direction of Epidemiology at the Ministry of Health in Mexico about congenital syphilis was reviewed. Data corresponding to the period between 1990 and 2009 were analyzed in every state of the Mexican republic. RESULTS: A total of 1717 cases of congenital syphilis were reported during the study period. A 16.6% increase was observed between 2005 and 2009 and the quinquennium between 2000 and 2004. A trend toward increase in the incidence of congenital syphilis was observed with 2.9 new cases for each 100,000 babies born alive. The states that displayed significant positive trends were as follows: Baja California, Colima, Chihuahua, Jalisco, Nayarit, Sinaloa, and Zacatecas. CONCLUSIONS: An increase in the number of cases of congenital syphilis is observed; the northern states are the ones that contribute the most to the statistics. There is a real need to refine the epidemiologic operations to detect and treat the cases of maternal and congenital syphilis in the country.

[Immunization with monovalent oral vaccine against rotavirus in Mexico. Evaluation of the data of two years of the system of temporarily adverse event reports associated to vaccination (ETAV)]. / Inmunización contra rotavirus en México con vacuna oral monovalente. Evaluación de los datos de dos años del sistema de reporte de eventos temporalmente asociados a vacunación.

BACKGROUND: The gastrointestinal manifestations are the adverse events mainly studied to the application of the vaccine against rotavirus. MATERIAL AND METHODS: In order subsequent to consider the risk of associated events taken care of the vaccination against rotavirus in infants, we realized a retrospective study of 2 years, evaluating 7,691,757 distributed doses of oral vaccine, in 2008 and 2009. RESULTS: The risk considered of an event associated after the application of the oral vaccine against rotavirus is of 2.9 events by 1,000,000 distributed doses. CONCLUSIONS: The taken care of associated events were little common subsequent to the vaccination against rotavirus.

Self-perceived knowledge level of epidemic management in medical residents prior to the start of the COVID-19 pandemic in Mexico.

INTRODUCTION: COVID-19 was declared a pandemic in March 2020, requiring a comprehensive response from all healthcare systems, including Mexico's. As medical residents' training did not involve epidemic response, we decided to evaluate their level of training on this subject, specifically self-perceived knowledge level and capacity to respond to epidemiological crises. METHODOLOGY: Medical residents from two hospitals belonging to PEMEX (Mexico's state-owned petroleum company) were included in a cross-sectional study. All participants answered a modified version of the survey developed by the University of Lovaina's Center for Research and Education in Emergency Care. Participants were analyzed according to their relevant "clinical" or "surgical" residency tracks. Data were analyzed using through Chi-square tests, t-tests, Mann-Whitney U tests, Kruskal-Wallis tests, and Pearson and Spearman correlation coefficients with significance established at p < 0.05. RESULTS: Of a total of 94 resident participants in this study, 56.7% self-perceived themselves as being poorly prepared to confront the pandemic. Only 25.5% of the participants referred previous experience in medical responses to public health emergencies, and only 35.1% reported ever receiving education on this topic. CONCLUSIONS: Medical residents-who have been involved with caring for victims of the pandemic-are under the general perception that they are not prepared, experienced, or educated enough to respond to such a widespread massive public health emergency.

[The role of medical students in pandemics]. / El papel de los estudiantes de medicina en las pandemias.

There is a general perception that medical students should help in case of disaster situations or epidemiological contingencies; although, they may not have been properly educated to do so. In recent dates, the participation of students is important in staff training activities, triage, care of bureaucratic activities, volunteering; but they are not considered a first line of care at disaster sites or patient management. The perception of the participation of medical students in disasters and pandemics is reviewed in the literature and some of the needs for their training and teaching are established, so that they can truly become an option in times of crisis.

[Maternal chemoprophylaxis against group B Streptococcus colonization. The consequences of not adopting the international recommendation]. / Quimioprofilaxis para evitar la colonización materna por estreptococo grupo B. Consecuencias de no adoptar la recomendación internacional.

OBJECTIVE: To know the criteria which determine the chemoprophylaxis on pregnant women colonized by Streptococcus agalactiae (GBS) and the impact in our environment. MATERIAL AND METHODS: A retrospective analysis, identifying pregnant women with isolation of Streptococcus agalactiae on screening cultures, cervical swabs and urine culture. Two groups were analyzed, group 1 received chemoprophylaxis, and group 2 without chemoprophylaxis. Chi square was used to asses the difference between proportions. Chi square approximation to Poisson distribution was used to compare the means of neonatal infection. RESULTS: A total of 274 cultures were reported with GBS isolation, on 261 patients; 165 (60.2%) cervical swabs, 109 (39.7%) urine culture and 13 patients from 274 (4.7%) had positive culture on both specimens. Of this 261 patients, 53 (5.6%) received chemoprophylaxis during labor (p<0.05). The CDC criteria were followed accuracy on 29.2%. CONCLUSIONS: There have not been established criteria for screening colonization by GBS in Mexican pregnant women.

Effect of school reopening on pediatric morbidity and mortality during the third epidemiological wave of COVID-19 in a Mexican state / Efecto de la reapertura de escuelas en la morbimortalidad pediátrica durante la tercera ola epidemiológica por COVID-19 en un estado mexicano

Abstract Background: Determining the effect of reopening schools on pediatric SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection rates increased the need to share the experience of governments in many geographic regions for better future decision-making in similar health emergencies. Methods: Through a prospective study based on a population-based cohort, students from 18,988 schools in the State of Mexico who began returning to school were followed. Daily sanitation filters were implemented in each school and district liaisons were informed on a daily basis through a negative network. Identified cases were confirmed by reverse transcriptase-polymerase chain reaction. Simple case frequencies, percentages, and incidences of COVID-19 were estimated. State incidences were compared with the national incidence. Results: A total of 3,586 cases were confirmed; 2,048 (57.1%) were children. Twenty-four (0.6%) were hospitalized for moderate to severe COVID-19; nine (37.5%) died, and only one was a schoolchild. From week 36, an average infection rate of 0.36 was observed. The highest infection rate in schoolchildren was observed in epidemiologic week 40 (1.01); from this week on, a decrease in the number of cases was observed until week 50. Conclusions: The use of non-pharmaceutical interventions has more advantages than limitations, as long as the strategies are homogeneous and properly implemented to ensure adequate control of infections.

Resumen Introducción: La determinación del efecto de reabrir las escuelas sobre las tasas de infección pediátrica por SARS-CoV-2 (síndrome respiratorio agudo grave coronavirus 2) incrementó la necesidad de trasmitir la experiencia de los gobiernos de muchas regiones geográficas para mejores decisiones futuras en emergencias sanitarias similares. Métodos: Mediante un estudio prospectivo basado en una cohorte poblacional se dio seguimiento a los alumnos de 18,988 escuelas del Estado de México que iniciaron con el regreso a clases. Se implementaron filtros sanitarios diarios en cada escuela y cotidianamente se informaban a los enlaces jurisdiccionales a través de una red negativa. Los casos identificados eran confirmados a través de RT-PCR (reacción en cadena de la polimerasa con transcriptasa inversa). Se estimaron frecuencias simples de casos, porcentajes e incidencias de COVID-19. Las incidencias del estado se compararon con la incidencia nacional. Resultados: Un total de 3,586 casos fueron confirmados; 2,048 (57.1%) correspondieron a niños. Veinticuatro (0.6%) fueron hospitalizados por COVID-19 moderado a grave; nueve (37.5%) fallecieron, y solamente una correspondió a un escolar. A partir de la semana 36 se observó una tasa promedio de infecciones de 0.36. En la semana epidemiológica 40 se observó la mayor tasa de infección en escolares (1.01); a partir de esta semana se observa un declive de los casos hasta la semana 50. Conclusiones: La implementación de intervenciones no farmacéuticas tiene más ventajas que limitaciones, siempre y cuando las estrategias sean homogéneas y correctamente ejecutadas, lo que asegurará un adecuado control en los contagios.

[Maternal B group Streptococcus colonization in Mexico: prevalence based on literature review]. / Colonización materna por Streptococcus del grupo B en México: estimación de la prevalencia basada en la revisión bibliográfica.

OBJECTIVE: To identify the prevalence of colonization of mexican pregnant women with Group B streptococci, based on a mexican literature review. METHODS: Trials of prevalence for Group B Streptococci colonization in mexican pregnant women were indentified using a MEDLINE, Artemisa, LILACS and Imbiomed search. Studies were elected only if in the result considered prevalence of Group B Streptococci colonization. RESULTS: Nine studies describing prevalence of Group B Streptococci colonization in Mexico. The global prevalence of Group B Streptococci colonization in pregnant women was 9.5% with range of 0.46 to 38.7%. The 9.5% rate of maternal colonization with Group B Streptococci found in our revision is significantly bigger than the rates found by many authors (chi2 < 0.05). CONCLUSIONS: The variability rates of prevalence for Group B Streptococci colonization in Mexico, to implicate different decisions about the perinatal management. The 9.5% rate of maternal colonization in our review is similar to 10.3% rate, national reference since some years ago.

[Staphylococcus haemolyticus with reduced susceptibility to vancomycin isolated from a patient with neonatal meningitis in a Mexican medical facility]. / Primer informe de staphylococcus haemolyticus con susceptibilidad reducida a vancomicina aislado de un paciente con neuroinfección neonatal en una institución mexicana.

Reduced susceptibility to vancomycin has been reported among clinical isolates of Staphylococcus in previous studies. The present study describes a heteroresistant Staphylococci strain from the cerebrospinal fluid of a 17 day-old premature male infant with neonatal meningitis. Screening was done for 44 strains of coagulase-negative staphylococci using Wong 's techniques (Disk-agar method with vancomycin-salt agar to demonstrate satellitism around an aztreonam disk). Strains were susceptible to vancomycin as disclosed by an automated antimicrobial susceptibly test (Microscan System Dade Behring). This is the first report of heterogeneous resistance to vancomycin in Mexico and an early warning for the possible emergence of vancomycin resistance among coagulase-negative staphylococcus in our country.

Serum concentrations of apoptosis-associated molecules in septic children with leukemia, neutropenia and fever.

It has been shown that Fas, Fas-L, TNF and TNFR-1 display high serum concentrations in subjects with sepsis. This suggests that these are potential severity markers. However, the serum concentration of these molecules in children with leukemia and suspected sepsis has to be established before proposing their use as diagnostic biomarkers. We included children <17 years of age diagnosed with acute lymphoblastic leukemia with neutropenia and fever (NF). The subjects were divided into two groups: (1) leukemia and NF with sepsis, (2) leukemia and NF without sepsis. Determination of serum levels of TNF-α, TNFR-1, Fas and Fas-L was performed using ELISA tests, and apoptosis percentage using flow cytometry. Seventy-two subjects with ALL and NF were included in the two groups. The highest serum levels of TNF-α (35.2 ± 7.6 pg/ml) and TNF-R1 (4102 ± 2440) and the lowest levels of Fas-L (19.4 ± 7.3 pg/ml) were found in group 2: however, the difference in comparison with patients without sepsis was not statistically significant. Low levels of Fas-L and low percentage of apoptotic cells are observed in septic subjects. This pattern may reflect the presence of sepsis among subjects with NF secondary to leukemia.

Epidemiología de COVID-19 en un hospital de tercer nivel mexicano / COVID-19 epidemiology in a Mexican tertiary care hospital

Resumen Introducción: A consecuencia de COVID-19, numerosos hospitales sufrieron una reconversión para la atención de esta enfermedad. Objetivo: Analizar el comportamiento epidemiológico hospitalario de COVID-19 entre marzo y agosto de 2020. Métodos: En una serie de casos se analizó el comportamiento epidemiológico de COVID-19 en un hospital de tercer nivel, para lo cual se estimaron frecuencias simples de casos, porcentajes e incidencia por cada 100 egresos hospitalarios. Resultados: De 491 sujetos con prueba positiva para SARS-CoV-2, 156 (31.7 %) fueron hospitalizados por datos clínicos de enfermedad moderada a grave. La edad promedio fue de 59.1 años; 121 casos (75 %) egresaron por mejoría y 32 (20.5 %), por defunción. El promedio de edad de quienes fallecieron fue de 69.7 años y el grupo etario más afectado fue el de 60 a 80 años (45.4 %). La letalidad calculada fue de 20.5 por 100 egresos hospitalarios, mientras que la calculada tomando en cuenta los pacientes positivos (ambulatorios y hospitalizados) fue de 6.5. Conclusiones: El comportamiento epidemiológico de COVID-19 fue similar al descrito en otros estudios; sin embargo, la letalidad y la mortalidad están por encima de la media nacional. Está pendiente el análisis de estas y de los factores que las favorecieron en nuestra población.

Abstract Introduction: As a result of COVID-19, many hospitals underwent a conversion for the care for this disease Objective: To analyze COVID-19 hospital epidemiological behavior from March to August 2020. Methods: Through a series of cases, COVID-19 epidemiological behavior at the hospital was analyzed, for which simple case rates, percentages and incidence of COVID-19 per 100 hospital discharges were estimated. Results: Out of 491 subjects who tested positive for SARS-CoV-2, 156 (31.7 %) were hospitalized for clinical data of moderate to severe disease. Average age was 59.1 years; 121 cases (75 %) were discharged due to improvement, and 32 (20.5 %), due to death. Average age of those who died was 69.7 years, and the most affected age group was 60 to 80 years (45.4 %). Calculated lethality was 20.5 per 100 hospital discharges, while that calculated taking into account positive patients (outpatients and hospitalized patients) was 6.5. Conclusions: COVID-19 epidemiological behavior was similar to that described in other studies; however, lethality and mortality are above national average. The analysis of this and of the factors that favored it in our population is pending.