Effect of Liposuction on Body Weight and Serum Concentrations of Leptin, Lipids, Glucose, and Insulin: A Meta-Analysis.

BACKGROUND: Abdominal obesity has been associated with an increased risk of insulin resistance, metabolic syndrome, and diabetes. Central fat removal procedures such as liposuction, lipectomy, and abdominoplasty are among the most common surgical procedures. The impact of the latter on the former is controversial and understudied. The authors aimed to explore the effect of subcutaneous fat elimination procedures on insulin resistance measures and adipokine levels. METHODS: Relevant studies regarding the effects of surgical subcutaneous fat removal on glucose, insulin, adipokines, and lipid metabolism, as well as blood pressure, were identified by searching PubMed and Ovid-Cochrane without limits in date, type of publication, or language. After the selection process, 24 studies were obtained. The results of the articles were summarized using descriptive statistics. For the final analysis, a randomized effects model was used to evaluate heterogeneity; averages and meta-analytic differences were expressed with a confidence interval of 95%. RESULTS: All studies reported a reduction in weight (-2.64 kg; 95% CI, -4.32 to -0.96; P = 0.002; I 2 = 36%; P of I 2 < 0.001) and body mass index after liposuction. A significant improvement in triglycerides (-10.06 mg/dL; 95% CI, -14.03 to -6.09; P < 0.001; I 2 = 48%; P of I 2 = 0.05), serum glucose concentration (-4.25 mg/dL; 95% CI, -5.93 to -2.56; P < 0.001; I 2 = 68%; P of I 2 < 0.001), serum insulin concentration (-2.86 µIU/mL; 95% CI, -3.75 to -1.97; P < 0.001; I 2 = 59%; P of I 2 = 0.003), and serum leptin concentration (-7.70 ng/mL; 95% CI, -11.49 to -3.92; P = 0.0001; I 2 = 96%; P of I 2 < 0.001) was consistently observed. CONCLUSION: In addition to weight loss, there is a significant decrease in leptin, triglyceride, glucose, and insulin serum concentrations after liposuction, a fact that should be considered in future discussions.

Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020-2021: A death certificates study in a middle-income country.

Background: The death toll after SARS-CoV-2 emergence includes deaths directly or indirectly associated with COVID-19. Mexico reported 325,415 excess deaths, 34.4% of them not directly related to COVID-19 in 2020. In this work, we aimed to analyse temporal changes in the distribution of the leading causes of mortality produced by COVID-19 pandemic in Mexico to understand excess mortality not directly related to the virus infection. Methods: We did a longitudinal retrospective study of the leading causes of mortality and their variation with respect to cause-specific expected deaths in Mexico from January 2020 through December 2021 using death certificate information. We fitted a Poisson regression model to predict cause-specific mortality during the pandemic period, based on the 2015-2019 registered mortality. We estimated excess deaths as a weekly difference between expected and observed deaths and added up for the entire period. We expressed all-cause and cause-specific excess mortality as a percentage change with respect to predicted deaths by our model. Findings: COVID-19 was the leading cause of death in 2020-2021 (439,582 deaths). All-cause total excess mortality was 600,590 deaths (38⋅2% [95% CI: 36·0 to 40·4] over expected). The largest increases in cause-specific mortality, occurred in diabetes (36·8% over expected), respiratory infections (33·3%), ischaemic heart diseases (32·5%) and hypertensive diseases (25·0%). The cause-groups that experienced significant decreases with respect to the expected pre-pandemic mortality were infectious and parasitic diseases (-20·8%), skin diseases (-17·5%), non-traffic related accidents (-16·7%) and malignant neoplasm (-5·3%). Interpretation: Mortality from COVID-19 became the first cause of death in 2020-2021, the increase in other causes of death may be explained by changes in the health service utilization patterns caused by hospital conversion or fear of the population using them. Cause-misclassification cannot be ruled out. Funding: This study was funded by Conacyt.

Incidence of Guillain-Barré syndrome following SARS-CoV-2 immunization: Analysis of a nationwide registry of recipients of 81 million doses of seven vaccines.

BACKGROUND AND PURPOSE: Information on Guillain-Barré syndrome (GBS) as an adverse event following immunization (AEFI) against SARS-CoV-2 remains scarce. We aimed to report GBS incidence as an AEFI among adult (≥18 years) recipients of 81,842,426 doses of seven anti-SARS-CoV-2 vaccines between December 24, 2020, and October 29, 2021, in Mexico. METHODS: Cases were retrospectively collected through passive epidemiological surveillance. The overall observed incidence was calculated according to the total number of administered doses. Vaccines were analyzed individually and by vector as mRNA-based (mRNA-1273 and BNT162b2), adenovirus-vectored (ChAdOx1 nCov-19, rAd26-rAd5, Ad5-nCoV, and Ad26.COV2-S), and inactivated whole-virion-vectored (CoronaVac) vaccines. RESULTS: We identified 97 patients (52 males [53.6%]; median [interquartile range] age 44 [33-60] years), for an overall observed incidence of 1.19/1,000,000 doses (95% confidence interval [CI] 0.97-1.45), with incidence higher among Ad26.COV2-S (3.86/1,000,000 doses, 95% CI 1.50-9.93) and BNT162b2 recipients (1.92/1,00,000 doses, 95% CI 1.36-2.71). The interval (interquartile range) from vaccination to GBS symptom onset was 10 (3-17) days. Preceding diarrhea was reported in 21 patients (21.6%) and mild COVID-19 in four more (4.1%). Only 18 patients were tested for Campylobacter jejuni (positive in 16 [88.9%]). Electrophysiological examinations were performed in 76 patients (78.4%; axonal in 46 [60.5%] and demyelinating in 25 [32.8%]); variants were similar across the platforms. On admission, 91.8% had a GBS disability score ≥3. Seventy-five patients (77.3%) received intravenous immunoglobulin, received seven plasma exchange (7.2%), and 15 (15.5%) were treated conservatively. Ten patients (10.3%) died, and 79.1% of survivors were unable to walk independently. CONCLUSIONS: Guillain-Barré syndrome was an extremely infrequent AEFI against SARS-CoV-2. The protection provided by these vaccines outweighs the risk of developing GBS.

Congenital syphilis in Mexico. Analysis of national and international standards from the perspective of laboratory diagnosis

Introduction: Congenital syphilis continues to be a public health problem in Mexico. Objective: To assess the similarities and differences between national standards, guidelines and international documents related to the detection of syphilis in pregnant women and congenital syphilis. Method Two algorithms were developed based on the standard of female care during pregnancy and on the standard for prevention and control of sexually transmitted infections. Based on the Centers for Disease Control (CDC) guidelines, algorithms were developed for syphilis during pregnancy, syphilis in the newborn and sexual contacts. Results: The standard for pregnancy mentions that syphilis testing should be carried out in every pregnant woman on her first contact or at delivery, without diagnostic tests being specified. The Official Mexican Standard (NOM) on sexually transmitted infections mentions the traditional algorithm for syphilis detection, treatment follow-up, coinfection with human immunodeficiency virus and congenital syphilis criteria. The CDC recommend reverse algorithm, antibody titer, treatment and follow-up as part of diagnosis. Conclusions: The elimination of mother-to-child transmission of syphilis requires NOMs updating and homogenizing, as well as the study of stillbirths and neonates born to mothers with syphilis.

The hidden burden of Chikungunya in central Mexico: results of a small-scale serosurvey / La carga oculta de Chikungunya en el centro de México: resultados de una encuesta serológica a pequeña escala

Abstract: Objective: To estimate the seroprevalence of CHKV antibodies and assess correlates of seropositivity at a small geographical scale. Materials and methods: A community-based serosurvey of 387 households in Puente de Ixtla, Morelos (central Mexico). Serum IgG antibodies to CHKV were detected by immunoassay. Results: From 27 April to 29 May 2016, we interviewed and collected blood samples from 387 individuals at the same number of households. A total of 114 (29.5%) participants were seropositive to CHK, 36 (31.6%) of them reported no symptoms of CHKV infection within 12 months before the survey. Conclusion: The estimated seroprevalence to CHKV antibodies was higher than expected by the small number of confirmed cases of CHKV infection reported in Mexico by the National Surveillance System.

Resumen: Objetivo: Estimar la seroprevalencia de anticuerpos CHKV y evaluar correlatos de seropositividad a pequeña escala geográfica. Material y métodos: Encuesta serológica comunitaria en 387 hogares en Puente de Ixtla, Morelos (región central de México). Se detectaron anticuerpos IgG contra CHKV mediante inmunoensayo. Resultados: Del 27 de abril al 29 de mayo de 2016 se entrevistó a 387 individuos en el mismo número de hogares y se recolectaron muestras de sangre de los mismos. En total, 114 (29.5%) participantes fueron seropositivos a CHK, 36 (31.6%) de ellos negaron síntomas de infección por CHKV durante los 12 meses previos a la encuesta. Conclusión: La seroprevalencia estimada de anticuerpos contra CHKV; fue mayor a la esperada con base en el pequeño número de casos confirmados de infección por CHKV informados en México por el Sistema Nacional de Vigilancia.

CD4 Counts at Entry to HIV Care in Mexico for Patients under the "Universal Antiretroviral Treatment Program for the Uninsured Population," 2007-2014.

In Mexico, public health services have provided universal access to antiretroviral therapy (ART) since 2004. For individuals receiving HIV care in public healthcare facilities, the data are limited regarding CD4 T-lymphocyte counts (CD4e) at the time of entry into care. Relevant population-based estimates of CD4e are needed to inform strategies to maximize the impact of Mexico's national ART program, and may be applicable to other countries implementing universal HIV treatment programs. For this study, we retrospectively analyzed the CD4e of persons living with HIV and receiving care at state public health facilities from 2007 to 2014, comparing CD4e by demographic characteristics and the marginalization index of the state where treatment was provided, and assessing trends in CD4e over time. Our sample included 66,947 individuals who entered into HIV care between 2007 and 2014, of whom 79% were male. During the study period, the male-to-female ratio increased from 3.0 to 4.3, reflecting the country's HIV epidemic; the median age at entry decreased from 34 years to 32 years. Overall, 48.6% of individuals entered care with a CD4≤200 cells/µl, ranging from 42.2% in states with a very low marginalization index to 52.8% in states with a high marginalization index, and from 38.9% among individuals aged 18-29 to 56.5% among those older than 50. The adjusted geometric mean (95% confidence interval) CD4e increased among males from 135 (131,142) cells/µl in 2007 to 148 (143,155) cells/µl in 2014 (p-value<0.0001); no change was observed among women, with a geometric mean of 178 (171,186) and 171 (165,183) in 2007 and 2014, respectively. There have been important gains in access to HIV care and treatment; however, late entry into care remains an important barrier in achieving optimal outcomes of ART in Mexico. The geographic, socioeconomic, and demographic differences observed reflect important inequities in timely access to HIV prevention, care, and treatment services, and highlight the need to develop contextual and culturally appropriate prevention and HIV testing strategies and linkage programs.

The impact of altitude on hospitalization and hospital mortality from pandemic 2009 influenza A (H1N1) virus pneumonia in Mexico / El impacto de la altitud en las tasas de hospitalización y mortalidad por el virus de la influenza A (H1N1) pandémico en México

OBJECTIVE: To determine the effect of altitude of residence on influenza A (H1N1). MATERIALS AND METHODS: We analyzed 207 135 officially notified of influenza-like illness (ILI) cases, 23 048 hospitalizations and 573 deaths during the first months of the novel pandemic influenza A H1N1 virus, to examine if residents of high altitude had more frequently these adverse outcomes. RESULTS: Adjusted rates for hospitalization and hospital mortality rates increased with altitude, probably due to hypoxemia.

OBJETIVO: Determinar el efecto de la altitud del lugar de residencia sobre la epidemia de influenza A (H1N1). MATERIAL Y MÉTODOS: Se analizaron 207 135 casos notificados a la Secretaría de Salud, 23 048 hospitalizaciones y 573 muertes por enfermedad similar a la influenza (ILI, por sus siglas en inglés) durante los primeros meses de la pandemia del nuevo virus de la influenza A H1N1 durante 2009, para examinar si los residentes de zonas más altas presentaron tasas más altas de hospitalización y muerte. RESULTADOS: Las tasas ajustadas de hospitalización y mortalidad hospitalaria se incrementaron con la altitud probablemente por la presencia de hipoxemia.

Serotipos de dengue en México durante 2009 y 2010 / Dengue serotypes in México during 2009-2010

Introducción. El dengue en México es un problema prioritario de salud pública. Desde el 2008 el Departamento para la Vigilancia Epidemiológica y Virológica del InDRE implementó un nuevo algoritmo de diagnóstico del dengue, que utiliza la Red de Laboratorios Estatales de Salud Pública, para favorecer la representatividad geográfica, la oportunidad, la sensibilidad y la especificidad de la información que se obtiene. Métodos. La identificación de serotipos se realizó a partir de muestras positivas a la proteína NS1 por ensayo inmunoenzimático (ELISA). Las técnicas que se utilizaron fueron: aislamiento viral, PCR punto final y, desde 2009, RT-PCR en tiempo real (qRT-PCR). Resultados. En 2009 se analizaron 6,336 muestras; en 2,944 de éstas (46.6%) se identificó el serotipo DENV-1 que predominó sobre el serotipo DENV-2; el serotipo DENV-3 sólo se identificó en dos casos en Guerrero y el serotipo DENV-4 en un caso en Chiapas. En 2010 se analizaron 2,013 muestras. Se identificó algún serotipo en 1,607 muestras (79.88%) y, nuevamente, el serotipo DENV-1 predominó en todo el país. En Chiapas se identificaron los serotipos DENV-1, 2 y 4 y en Jalisco los serotipos DENV-1 y 3. Además, se identificó la circulación del serotipo DENV-3 en Guerrero y apareció el serotipo DENV-4 en San Luis Potosí. Conclusiones. Por la selección de muestras para vigilancia virológica de dengue mediante la positividad a la proteína NS1 y por la introducción de la técnica de qRT-PCR se optimizó la identificación de serotipos circulantes. La alta endemia, los brotes en nuevas regiones, el predominio del serotipo DENV-1 por varios años y la introducción lenta de otros serotipos, principalmente DENV-3, pueden favorecer la aparición de formas clínicas graves de dengue. La vigilancia epidemiológica inteligente del dengue brindará información para un mejor entendimiento de la enfermedad y promoverá acciones para su control y prevención.

Background. Dengue is a public health priority in Mexico. Since 2008, the dengue diagnostic algorithm for epidemiological and virological surveillance has been improved at InDRE and the public health laboratory network (RLESP) to optimize geographic representation, opportunity, sensitivity and specificity of the produced information. Methods. Dengue serotype identification is based on ELISA NS1 positive samples. Methods used are viral isolation, endpoint PCR and, since August 2009, real-time PCR (qRT-PCR). Results. In 2009, 6,336 serum samples were analyzed and 2,944 (46.6%) were positive for serotype identification. DENV-1 was detected in greater proportion followed by DENV-2, and DENV-3 4 was only identified in two cases in Guerrero and DENV-4 in one case in Chiapas. In 2010, 2,013 serum samples were analyzed and 1,607 (78.8%) were positive for serotype identification. DENV-1 was predominant throughout the country. In Chiapas, DENV-1, 2 and 4 were identified and in Jalisco DENV-1 and 3. DENV-3 was identified in Guerrero again and DENV-4 was detected in San Luis Potosí. Conclusions. The selection samples through NS1 positive samples and the introduction of qRT-PCR optimized serotype identification. Hyperendemicity, outbreaks in new geographic areas, the predominant circulation of DENV-1 for several years and the slow reintroduction of the other serotypes, mainly DENV-3, could increase clinical cases of severe dengue. An ¡intelligentí epidemiological surveillance program would offer information for a better understanding of the disease and promote action for its control and prevention.