Randomized Double-blind Cost-effectiveness Comparison of Two 10% Urea Creams in Patients with Diabetic Foot Syndrome.

OBJECTIVE: To evaluate the cost-effectiveness of two 10% urea creams in patients with diabetic foot syndrome. METHODS: This was a prospective, longitudinal, single-center, randomized, double-blind, prospective clinical trial that evaluated the skin quality of 20 feet belonging to 10 patients with diabetic foot syndrome after the application of two 10% urea creams purchased from pharmacies and supermarkets. RESULTS: At follow-up, 19 (95%) of the participants' feet showed improved skin quality, irrespective of the cream applied. On visual inspection, participants had a decreased presence of xerosis, hyperkeratosis, and preulcerative signs such as subkeratotic bruising and areas of redness on the dorsum of the toes. At the 3-month follow-up, nine (90%) of the participants stated that they had continued to apply the cream as a method of self-management to prevent complications. CONCLUSIONS: Creams containing 10% urea purchased in supermarkets improve foot skin quality in patients with diabetic foot syndrome, regardless of their cost. Based on these findings, the authors recommend creams containing 10% urea as a self-management tool for patients with diabetic foot syndrome.

Plataforma CLIMSS como herramienta de alfabetización en salud durante la crisis sanitaria de Covid-19 / CLIMSS online platform as a health literacy tool during the health crisis of Covid-19

Resumen: Objetivo: Describir a la plataforma Cursos en Línea Masivos del IMSS (CLIMSS) como herramienta de alfabetización en salud, a través de la evaluación de la eficiencia terminal, la ganancia de competencias y satisfacción de los usuarios de cursos en línea masivos en el tema de Covid-19. Material y métodos: Se analizaron datos de 20 cursos ofertados entre marzo y octubre de 2020. Se evaluaron las calificaciones pre y pos, el número total de registros, el total de cursos terminados y la satisfacción del usuario. Resultados: Se registraron un total de 4.9 millones de usuarios y 10 millones de inscripciones, en todos los estados de la República mexicana, con una eficiencia terminal de 85%, una ganancia de competencias de 30% y una satisfacción de 9.34 (10). Conclusiones: La plataforma CLIMSS ha mostrado ser una herramienta para la alfabetización en salud con un alcance de millones de mexicanos en temas relacionados con la crisis sanitaria Covid-19.

Abstract: Objective: To describe the Massive Online Open Courses (MOOC) or Cursos en Línea Masivos del IMSS (CLIMSS) platform as a health literacy tool by evaluating the terminal efficiency, the competence gains, and the users' satisfaction of the massive online courses offered by the Mexican Institute of Social Security, on Covid- 19. Materials and methods: Data from 20 courses offered between March and October 2020 were analyzed. We evaluated scores from the pre and post-tests, the total number of registries, total courses completed, and users' satisfaction. Results: We registered a total of 4.9 million users and 10 million registrations, in all Mexican states, with a terminal efficiency of 85%, a competence gain of 30%, and a users' satisfaction of 9.34 (10). Conclusions: The CLIMSS platform has proven to be a tool for health literacy reaching millions of Mexicans on Covid-19 related topics.

EHO-85: A Multifunctional Amorphous Hydrogel for Wound Healing Containing Olea europaea Leaf Extract: Effects on Wound Microenvironment and Preclinical Evaluation.

The prevalence of chronic wounds is increasing due to the population aging and associated pathologies, such as diabetes. These ulcers have an important socio-economic impact. Thus, it is necessary to design new products for their treatment with an adequate cost/effectiveness ratio. Among these products are amorphous hydrogels. Their composition can be manipulated to provide a favorable environment for ulcer healing. The aim of this study was to evaluate a novel multifunctional amorphous hydrogel (EHO-85), containing Olea europaea leaf extract, designed to enhance the wound healing process. For this purpose, its moistening ability, antioxidant capacity, effect on pH in the wound bed of experimental rats, and the effect on wound healing in a murine model of impaired wound healing were assessed. EHO-85 proved to be a remarkable moisturizer and its application in a rat skin wound model showed a significant antioxidant effect, decreasing lipid peroxidation in the wound bed. EHO-85 also decreased the pH of the ulcer bed from day 1. In addition, in mice (BKS. Cg-m +/+ Leprdb) EHO-85 treatment showed superior wound healing rates compared to hydrocolloid dressing. In conclusion, EHO-85 can speed up the closure of hard-to-heal wounds due to its multifunctional properties that are able to modulate the wound microenvironment, mainly through its remarkable effect on reactive oxygen species, pH, and moistening regulation.

Explorative assessment of coronavirus-like short sequences from host-associated and environmental metagenomes.

The ongoing COVID-19 pandemic has not only globally caused a high number of causalities, but is also an unprecedented challenge for scientists. False-positive virus detection tests not only aggravate the situation in the healthcare sector, but also provide ground for speculations. Previous studies have highlighted the importance of software choice and data interpretation in virome studies. We aimed to further expand theoretical and practical knowledge in bioinformatics-driven virome studies by focusing on short, virus-like DNA sequences in metagenomic data. Analyses of datasets obtained from different sample types (terrestrial, animal and human related samples) and origins showed that coronavirus-like sequences have existed in host-associated and environmental samples before the current COVID-19 pandemic. In the analyzed datasets, various Betacoronavirus-like sequences were detected that also included SARS-CoV-2 matches. Deepening analyses indicated that the detected sequences are not of viral origin and thus should not be considered in virome profiling approaches. Our study confirms the importance of parameter selection, especially in terms of read length, for reliable virome profiling. Natural environments are an important source of coronavirus-like nucleotide sequences that should be taken into account when virome datasets are analyzed and interpreted. We therefore suggest that processing parameters are carefully selected for SARS-CoV-2 profiling in host related as well as environmental samples in order to avoid incorrect identifications.

Predictive values of foot plantar pressure assessment in patients with midfoot deformity secondary to Charcot neuroarthropathy.

AIMS: The principal aim of this study was to identify a cut-off point along the spectrum of peak plantar midfoot pressure that has an optimum combination of sensitivity and specificity to screen for neuropathic ulceration in patients with Charcot neuroarthropathy (CN). METHODS: A 1-year outcome study was performed in twenty-five patients with diabetes, affected with chronic CN midfoot deformity. Peak plantar pressure (PPP) and pressure/time Integral (PTI) in the midfoot region were registered. For selecting the optimal diagnostic cut-off points on the scale of pressure measurement, ROC curves were used. RESULTS: Twelve (48%) patients developed a plantar midfoot ulcer. Baseline PPP (24.04 ± 6.33 Vs. 12.85 ± 3.29 N/cm2) and PTI (11.89 ± 4.60 Vs. 5.42 ± 2.26 N/cm2/s) were significantly higher in the ulcerated group (p < .001 and p < .001, respectively). Using ROC analyses, optimal cut-off point for PPP was 16.45 N/cm2, yielding a sensitivity of 92% and a specificity of 85%; and for PTI, optimal cut-off point was 7.2 N/cm2/s, yielding a sensitivity of 92% and a specificity of 77%. CONCLUSIONS: Patients with CN midfoot deformity with cut-off values for PPP of 16.45 N/cm2 and PTI of 7.2 N/cm2/s showed an elevated risk of neuropathic ulceration in the plantar area of the midfoot.

Mapping green infrastructure and socioeconomic indicators as a public management tool: the case of the municipalities of Andalusia (Spain).

BACKGROUND: Green Infrastructure (GI) is defined as a strategically planned network of natural and semi-natural spaces that provide society, in both rural and urban areas, with a large number of goods and services of great value and economic importance such as clean air and water, carbon storage, pollination or protection against the effects of climate change. Traditionally, municipalities, like other territorial units, are characterized by a series of social and economic indicators that determine their degree of local development. The objective of this article is to identify and assess, through a system of indicators, what role urban and rural municipalities in Andalusia (Spain) play in the provision and reception of ecosystem services. To this end, Geographical Information System (GIS) techniques are used and a cluster analysis is carried out to contrast the results. RESULTS: Rural municipalities show the largest portion of GI area in the whole region. However, they show a low socioeconomic level, with high unemployment rates. CONCLUSIONS: It can be said that the municipalities in rural areas are "ecologically" financing the entire Andalusian population. Faced with this situation, the decisions, and actions of policymakers in this region should aim at promoting measures that can restore and conserve GIs, addressing the demographic and/or socioeconomic imbalances of the region.

Digital Deformity Assessment Prior to Percutaneous Flexor Tenotomy for Managing Diabetic Foot Ulcers on the Toes.

The aim of this study is to evaluate the prevalence of digital deformities in patients with diabetes mellitus according to the McGlamry classification and relate the types of digital deformities with the history of digital ulcer. A cross-sectional study was performed in the diabetic foot unit between September 2016 and September 2017. All consecutive patients were classified by digital deformities according to the McGlamry classification (flexor stabilization, flexor substitution, and extensor substitution) using slow-motion videos. In all patients, the Foot Posture Index 6 was performed and previous toe ulceration, toe calluses, and nail dystrophy were evaluated. A total of 142 feet were evaluated, in which 29 (20.27%) feet did not show dynamic deformities, 65 (57.5%) were classified as flexor stabilization, 9 (8%) as flexor substitution, and 39 (34.5%) as extensor substitution. In total, 23% the feet with previous ulcer were classified as extensor substitution. A previous toe ulcer on the tip (p = .033; confidence interval [CI] 1.06 to 4.99; odds ratio [OR] 2.3), pronated foot according to the Foot Posture Index 6 (p = .048; 95% CI 0.9 to 8.9; OR 2.9), and callus on the tip (p = .002; 95% CI 1.47 to 6.41; OR 3.07) were associated with flexor stabilization deformities. Flexor stabilization, associated with the pronated foot, was the most prevalent dynamic deformity. Extensor substitution was present in approximately 40% of the patients and in 20% of the patients with previous ulcer, in whom flexor tenotomy could aggravate the digital deformity. An evaluation of dynamic deformities during gait should be included as a presurgical assessment to achieve successful surgical results.

Preliminary experience of an expert panel using Triangle Wound Assessment for the evaluation of chronic wounds.

OBJECTIVE: Wound assessment is an essential part of wound management and has traditionally focused on the wound bed. The Triangle of Wound Assessment (Triangle) is a new assessment tool that includes a holistic evaluation of the patient with a wound. The aim of this pilot study was to describe the use of the Triangle in our clinical practice in Spain. METHODS: Prospective, consecutive patients, male and female, over 18 years old, with wounds of any aetiology and duration, who attended the centres involved in the study, were recruited between May and June 2017. The TWA was used during the first presentation, to assess the wound bed, edge and periwound skin. The study's expert panel met to discuss the results collected by the assessment, as well as the advantages and disadvantages of the system. RESULTS: We recruited 90 patients. Non-viable tissue (necrotic/sloughy) was recorded in 57.8% of the patients, elevated exudate (medium/high) in 52.2%. Approximately 25% of the patients had signs or symptoms of local infection. Maceration was the most prevalent issue recorded on the wound edge and periwound skin assessment, affecting 31.1% and 30.0% of the patients, respectively. The presence of hyperkeratosis was high for the study population as the main aeitologies of the wounds identified here were DFU. CONCLUSIONS: The implementation of Triangle Wound Assessment could help in the holistic approach to patient care by focusing on more than local wound care, identifying barriers to achieving wound healing and evaluating wound response and patient compliance.

Metabolic Compensation of Fitness Costs Is a General Outcome for Antibiotic-Resistant Pseudomonas aeruginosa Mutants Overexpressing Efflux Pumps.

It is generally assumed that the acquisition of antibiotic resistance is associated with a fitness cost. We have shown that overexpression of the MexEF-OprN efflux pump does not decrease the fitness of a resistant Pseudomonas aeruginosa strain compared to its wild-type counterpart. This lack of fitness cost was associated with a metabolic rewiring that includes increased expression of the anaerobic nitrate respiratory chain when cells are growing under fully aerobic conditions. It was not clear whether this metabolic compensation was exclusive to strains overexpressing MexEF-OprN or if it extended to other resistant strains that overexpress similar systems. To answer this question, we studied a set of P. aeruginosa mutants that independently overexpress the MexAB-OprM, MexCD-OprJ, or MexXY efflux pumps. We observed increased expression of the anaerobic nitrate respiratory chain in all cases, with a concomitant increase in NO3 consumption and NO production. These efflux pumps are proton/substrate antiporters, and their overexpression may lead to intracellular H+ accumulation, which may in turn offset the pH homeostasis. Indeed, all studied mutants showed a decrease in intracellular pH under anaerobic conditions. The fastest way to eliminate the excess of protons is by increasing oxygen consumption, a feature also displayed by all analyzed mutants. Taken together, our results support metabolic rewiring as a general mechanism to avoid the fitness costs derived from overexpression of P. aeruginosa multidrug efflux pumps. The development of drugs that block this metabolic "reaccommodation" might help in reducing the persistence and spread of antibiotic resistance elements among bacterial populations.IMPORTANCE It is widely accepted that the acquisition of resistance confers a fitness cost in such a way that in the absence of antibiotics, resistant populations will be outcompeted by susceptible ones. Based on this assumption, antibiotic cycling regimes have been proposed in the belief that they will reduce the persistence and spread of resistance among bacterial pathogens. Unfortunately, trials testing this possibility have frequently failed, indicating that resistant microorganisms are not always outcompeted by susceptible ones. Indeed, some mutations do not result in a fitness cost, and in case they do, the cost may be compensated for by a secondary mutation. Here we describe an alternative nonmutational mechanism for compensating for fitness costs, which consists of the metabolic rewiring of resistant mutants. Deciphering the mechanisms involved in the compensation of fitness costs of antibiotic-resistant mutants may help in the development of drugs that will reduce the persistence of resistance by increasing said costs.

Tackling antibiotic resistance: the environmental framework.

Antibiotic resistance is a threat to human and animal health worldwide, and key measures are required to reduce the risks posed by antibiotic resistance genes that occur in the environment. These measures include the identification of critical points of control, the development of reliable surveillance and risk assessment procedures, and the implementation of technological solutions that can prevent environmental contamination with antibiotic resistant bacteria and genes. In this Opinion article, we discuss the main knowledge gaps, the future research needs and the policy and management options that should be prioritized to tackle antibiotic resistance in the environment.

Metabolic compensation of fitness costs associated with overexpression of the multidrug efflux pump MexEF-OprN in Pseudomonas aeruginosa.

The acquisition of antibiotic resistance has been associated with a possible nonspecific, metabolic burden that is reflected in decreased fitness among resistant bacteria. We have recently demonstrated that overexpression of the MexEF-OprN multidrug efflux pump does not produce a metabolic burden when measured by classical competitions tests but rather leads to a number of changes in the organism's physiology. One of these changes is the untimely activation of the nitrate respiratory chain under aerobic conditions. MexEF-OprN is a proton/substrate antiporter. Overexpression of this element should result in a constant influx of protons, which may lead to cytoplasmic acidification. Acidification was not observed in aerobiosis, a situation in which the MexEF-overproducing mutant increases oxygen consumption. This enhanced oxygen uptake serves to eliminate intracellular proton accumulation, preventing the cytoplasmic acidification that was observed exclusively under anaerobic conditions, a situation in which the fitness of the MexEF-OprN-overproducing mutant decreases. Finally, we determined that the early activation of the nitrate respiratory chain under aerobic conditions plays a role in preventing a deleterious effect associated with the overexpression of MexEF-OprN. Our results show that metabolic rewiring may assist in overcoming the potential fitness cost associated with the acquisition of antibiotic resistance. Furthermore, the capability to metabolically compensate for this effect is habitat dependent, as demonstrated by our results under anaerobic conditions. The development of drugs that prevent metabolic compensation of fitness costs may help to reduce the persistence and dissemination of antibiotic resistance.

[Outpatient medical attention demand due to diabetes mellitus in the health primary care]. / Demanda de atención médica por diabetes mellitus en el primer nivel de atención.

Outpatient visits for medical attention because of Diabetes mellitus in the Instituto Mexicano del Seguro Social became very important for the magnitude that it represents. There is a clear increasing tendency for the coming years. The available data indicates a higher frequency and increased demand of women. Higher number of patients is observed between 40 and 59 years old. However, earlier age groups present considerable amount of cases. Having the number of patients allows knowing the average of consultations per patient, this parameter allows having an estimate of the follow up by the physician and it must be part of the evaluation of the medical attention programs. Diabetes mellitus is strongly associated with obesity, this condition affects a high percentage of diabetic patients in the Institution and weight loss must be encouraged.

[Smoking habits in beneficiaries of the social security]. / Consumo de tabaco en derechohabientes del IMSS.

OBJECTIVE: To determine the prevalence of tobacco consumption (TC) and frequency according to demographics and health aspects. METHODS: A cross-sectional study from the Mexican Family Life Survey Project was conducted. The past and present TC according to sociodemo-graphic variables and the presence of chronic diseases (CD) were achieved. RESULTS: The prevalence of TC in the past was 21.4 % with a male/female ratio of 2.5. Nowadays TC was 15.2 % and the ratio between male/female was 2.6 (23.0: 8.9); exposure levels by age decreased at present. Out of the total smokers in the past 71 % continue with the habit, 75 % began TC before the age of 20. In the 15 to 19 years group, 50 % of them started before the age of 14. The highest cigarette pack consumption mean was 2.5 per week and for the present smokers was 1.8; the prevalence for CD in the smoking population was above 20 %; present smoking diminished in those with a history of CD, especially cancer and heart disease. CONCLUSIONS: The prevalence of past and present TC is lower than that reported in other studies in the Mexican population, because of how the exposure to TC was measure.

[Violence in Mexican women using public health services]. / La violencia en las mujeres usuarias de los servicios de salud en el IMSS y la SSA.

OBJECTIVE: To compare the prevalence of violence and determine its risk factors among women who use Mexican Social Services (IMSS) clinics and do not have access to social security services. MATERIAL AND METHODS: Sociodemographic data linked to domestic violence reported by women attending the Mexican Institute of Social Security (IMSS) health services was analyzed. Bivariate and multivariate analysis was performed using STATAV.7. RESULTS: Psychological violence in IMSS women was 18% followed by physical violence (9.1%), sexual (6.7%) and economic (5%). Prevalence of violence in women with no social security care was psychological (21.4%), physical (10.5%), sexual (7.5%) and economical (5%). Women between 25 and 44 years of age with basic schooling and married and with family background of violence were the most affected. The daily consumption of alcohol by their partners was an important predictor of domestic violence. CONCLUSION: Violence in women with no social security is higher. Partner's alcohol intake pattern is an important risk factor. Detection of domestic violence in the clinical setting is necessary to recognize its real magnitude as a social problem.

[Diabetes mellitus in an adult population of the IMSS (Mexican Institute of Social Security). Results of the National Health Survey 2000]. / Diabetes mellitus en población adulta del IMSS. Resultados de la Encuesta Nacional de Salud 2000.

OBJECTIVE: To describe the prevalence and control of diabetes in the adult population served by the Instituto Mexicano del Seguro Social according to data from the National Health Survey 2000 (ENSA-2000). MATERIAL AND METHODS: The data for adults from the National Health Survey 2000 was used to estimate and describe the prevalence of diabetes in the population that belongs to the social security system in Mexico. Criteria used to define diabetes mellitus were the medical diagnosis of the disease (MDDM) and the glucose measurement from capillary blood (>126 mg/dL fasting sample and 200 mg/dL in casual blood sample). If diabetes was confirmed only through blood sample, the diabetes case was define as survey finding (SF). Prevalences were estimated for both groups, while means and medians were estimated for the four possible combination groups (SF+, MDDM+, SF+, MDDM-, SF-, MDDM+, SF-, MDDM-). Sampling results were adjusted for population estimates according to the methods established in the ENSA-2000. Diabetes is described according to age, sex, education level, geographic region, background of diabetes in the family, body mass index (BMI), abdominal perimeter. A logistic regression method was used to estimate potential associations with different risk factors. RESULTS: Overall prevalence was 8.7%; for MDDM, it was 7.1%, and for SF, only 1.5%. Glycemia was highest in SF+ and MDDM-, median 292 mg/dL and in MDDM+ but SF-, median 289 mg/dL. Major risk factors were background of diabetes in both parents, abdominal obesity, low educational level age (coef. = 0.5943 per decade) and BMI (coef. = 0.0133). CONCLUSIONS: Diabetes in social security population is higher than in the rest of the population, while genetic background, age, educational level, high BMI and abdominal perimeter have important influences in diabetes prevalence in this population. Glucose control is suboptimal even in patients under medical supervision.

La violencia en las mujeres usuarias de los servicios de salud en el IMSS y la SSA / Violence in Mexican women using public health services

OBJETIVO: Comparar la prevalencia y determinar los factores de riesgo asociados a la violencia entre las mujeres derechohabientes del IMSS y sin servicios de seguridad social (SSS). MATERIAL Y MÉTODOS: Se analizó la información sobre violencia doméstica de la ENVIM notificada por las mujeres usuarias de los servicios de salud del IMSS y de la población femenina sin servicios de seguridad social SSA y seguro popular. El análisis bivariado y multivariado se realizó en STATA V.7. RESULTADOS: La prevalencia en mujeres derechohabientes del IMSS de violencia psicológica fue 18 por ciento; seguida por la física (9.1 por ciento); la sexual (6.7 por ciento) y la económica (5 por ciento). En mujeres sin seguridad social fue: psicológica (21.4 por ciento); física (10.5 por ciento); sexual (7.5 por ciento) y económica (5.2 por ciento). Las mujeres entre 25 y 44 años, con nivel secundaria o menor instrucción educativa, casadas, sufren de mayor violencia doméstica en ambas poblaciones. Los factores de riesgo identificados para los cuatro tipos de violencia fueron el consumo de alcohol en la pareja, las edades jóvenes, el estar casadas o en unión libre y el antecedente de violencia ejercida por los padres u otros miembros de la familia. CONCLUSIONES: La violencia es ligeramente mayor en mujeres sin seguridad social. El consumo diario de alcohol por su pareja es un factor de riesgo muy importante para cualquier tipo de violencia, en particular cuando el consumo es diario o casi habitual. La detección de la violencia doméstica en los servicios de salud es indispensable para conocer su magnitud como problema social.

OBJECTIVE: To compare the prevalence of violence and determine its risk factors among women who use Mexican Social Services (IMSS) clinics and do not have access to social security services. MATERIAL AND METHODS: Sociodemographic data linked to domestic violence reported by women attending the Mexican Institute of Social Security (IMSS) health services was analyzed. Bivariate and multivariate analysis was performed using STATA V.7. RESULTS: Psychological violence in IMSS women was 18 percent followed by physical violence (9.1 percent), sexual (6.7 percent) and economic (5 percent). Prevalence of violence in women with no social security care was psychological (21.4 percent), physical (10.5 percent), sexual (7.5 percent) and economical (5 percent). Women between 25 and 44 years of age with basic schooling and married and with family background of violence were the most affected. The daily consumption of alcohol by their partners was an important predictor of domestic violence. CONCLUSION: Violence in women with no social security is higher. Partner's alcohol intake pattern is an important risk factor. Detection of domestic violence in the clinical setting is necessary to recognize its real magnitude as a social problem.

Obesity and overweight in IMSS female workers in Mexico City.

OBJECTIVE: To estimate the prevalence and risk factors for overweight (OW) and obesity (OB) in women working at the Mexican Social Security Institute (IMSS, per its abbreviation in Spanish) in Mexico City, using two different classification criteria. MATERIAL AND METHODS: A cross-sectional study was performed from July 1999 to September 2000. It included 588 women 20 to 65 years of age and who were working at the IMSS. The criteria used to estimate the prevalence of OW and OB were the WHO criteria and the Mexican Official Norm (NOM) for the integrated management of obesity in Mexico. RESULTS: The frequency of OB, according to WHO criteria, was 27.6% (26% adjusted) and for OW 43.2% (40.2% adjusted). According to the NOM, the levels of OB in those with short height (< 1.50 m) increased to 75% and to 52.2% for those with height > 1.50 m. Comparison of BMI between the two height groups showed no differences. The risk factor associated with OB and OW was age. Education and exercise were protective factors. CONCLUSIONS: The high prevalences detected in this particular working group highlight the importance of prevention and control of OB in health personnel because it can result in a high number of disability and premature retirement due to disease. The use of the NOM criteria for the identification of women at risk may be useful for early detection of high-risk groups.

Clinical profile of dengue hemorrhagic fever cases in Mexico.

OBJECTIVE: Dengue hemorrhagic fever is a public health problem in Mexico since 1994. With four serotypes circulating the risk of epidemic dengue hemorrhagic fever is increasing. MATERIAL AND METHODS: We describe the clinical features of confirmed cases in the social security health system (IMSS) from 1995 to 2003. Clinical picture and epidemiological features were compared and a multivariate model was fitted to evaluate associations. RESULTS: Cases were divided into two groups: 438 patients with dengue fever, including 109 cases with hemorrhagic manifestations without thrombocytopenia, and 977 cases with dengue hemorrhagic fever, including 79 deaths. The main risk factors associated with mortality were hematemesis (RR 2.6; CI 95% 1.4-4.6) and melena (RR 2.2; Cl 95% 1.2-3.7). CONCLUSIONS: Our results characterize the clinical profile of dengue hemorrhagic fever cases in Mexico and identify prognostic factors to alert clinician for the prevention of a fatal evolution.

Predicted versus measured energy expenditure by continuous, online indirect calorimetry in ventilated, critically ill children during the early postinjury period.

OBJECTIVE: Compare the energy expenditure, predicted by anthropometric equations, with that measured by continuous on-line indirect calorimetry in ventilated, critically ill children during the early postinjury period. DESIGN: Prospective, clinical study. SETTING: Pediatric intensive care unit of a pediatric university hospital. PATIENTS: A total of 43 ventilated, critically ill children during the first 6 hrs after injury. INTERVENTIONS: An indirect calorimeter was used to continuously measure the energy expenditure for 24 hrs. MEASUREMENTS AND MAIN RESULTS: Clinical data collected were age, gender, actual and ideal weight, height, and body surface. Nutritional status was assessed by Waterlow and Shukla Index. Severity of illness was determined by Pediatric Risk of Mortality, Physiologic Stability Index, and Therapeutic Intervention Scoring System. Energy expenditure was measured (MEE) by continuous on-line indirect calorimetry for 24 hrs. Predicted Energy Expenditure (PEE) was calculated using the Harris-Benedict, Caldwell-Kennedy, Schofield, Food and Agriculture/World Health Organization/United Nation Union, Maffeis, Fleisch, Kleiber, Dreyer, and Hunter equations, using the actual and ideal weight. MEE and PEE were compared using paired Student's t-test, linear correlation (r), intraclass correlation coefficient (pI), and the Bland-Altman method. Mean MEE resulted in 674 +/- 384 kcal/day. Most of the predictive equations overestimated MEE in ventilated, critically ill children during the early postinjury period. MEE and PEE differed significantly (p<.05) except when the Caldwell-Kennedy and the Fleisch equations were used. r2 ranged from 0.78 to 0.81 (p<.05), and pI was excellent (>.75) for the Caldwell-Kennedy, Schofield, Food and Agriculture/World Health Organization/United Nation Union, Fleisch, and Kleiber equations. The Bland-Altman method showed poor accuracy; the Caldwell-Kennedy equation was the best predictor of energy expenditure (bias, 38 kcal/day; precision, +/- 179 kcal/day). The accuracy in the medical group was higher (pI range,.71-.94) than in surgical patients (pI range,.18-.75). CONCLUSIONS: Predictive equations do not accurately predict energy expenditure in ventilated, critically ill children during the early postinjury period; if available, indirect calorimetry must be performed.

Seroprevalence of hepatitis B in pregnant women in Mexico.

OBJECTIVE: To determine the seroprevalence of hepatitis B in pregnant women from several regions of Mexico, as well as the risk factors associated with its occurrence. MATERIAL AND METHODS: A cross-sectional study was conducted between May and August 2000. It included 9,992 pregnant women attending the health services of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social-IMSS) in five cities: Tijuana, Ciudad Juarez, Acapulco, Cancun, and Mexico City (northeast and southeast regions). RESULTS: The overall prevalence for confirmed cases was 1.65% (165/9,992). The prevalences for individual cities were as follows: Tijuana, 1.27%; Ciudad Juarez, 1.46%; Acapulco, 2.47%; Cancun, 0.93%; northeastern Mexico City, 1.20%, and southeastern Mexico City, 2.52%. The risk factors found to be associated with HBsAg were: age, age at first sexual intercourse, city (Acapulco and southeastern Mexico City), and marital status (single or divorced). CONCLUSIONS: The prevalence of HBsAg in pregnant women (1.65%) was greater than that reported in previous studies and showed geographical differences. This high prevalence suggests that a considerable amount of cases of hepatitis B occurs perinatally and through contact with carriers in the general population. Vaccination of newborns of high-risk pregnant women should be considered.