Assessment of early mitigation measures against COVID-19 in Puerto Rico: March 15-May 15, 2020.

On March 15, 2020 Puerto Rico implemented non-pharmaceutical interventions (NPIs), including a mandatory curfew, as part of a state of emergency declaration to prevent the community transmission of the SARS-CoV-2 virus. The strict enforcement of this curfew was extended through May 25, with a gradual relaxation beginning on May 1. This report summarizes an assessment of these early mitigation measures on the progression of the COVID-19 pandemic in the island. From March 15 to May 15, 2020, 70,656 results of molecular (RT-PCR) tests were reported to the Puerto Rico Department of Health. Of these, 1,704 were positive, corresponding to 1,311 individuals with COVID-19 included in the study. We derived the epidemic growth rates (r) and the corresponding reproductive numbers (R) from the epidemic curve of these 1,311 individuals with laboratory-confirmed diagnosis of COVID-19 using their date of test collection as a proxy for symptoms onset. Through May 31, 2020, there were 143 COVID-19 associated deaths in Puerto Rico, for a case fatality risk of 10.9%. We compared the observed cases and deaths with Gompertz model projections had the mitigation measures not been implemented. The number of daily RT-PCR-confirmed cases peaked on March 30 (85 cases), showing a weekly cyclical trend, with lower counts on weekends and a decreasing secular trend since March 30. The initial exponential growth rate (r) was 15.87% (95% CI: 7.59%, 24.15%), corresponding to R of 1.82 (95% CI:1.37, 2.30). After March 30, the r value reverted to an exponential decay rate (negative) of -2.95% (95% CI: -4.99%, -0.92%), corresponding to R of 0.93 (95% CI: 0.86, 0.98). We estimate that, had the initial growth rate been maintained, a total of 6,155 additional COVID-19 cases would have occurred by May 15, with 211 additional COVID-19 deaths by May 31. These findings are consistent with very effective implementation of early NPIs as mitigation measures in Puerto Rico. These results also provide a baseline to assess the impact of the transition from mitigation to subsequent containment stages in Puerto Rico.

[Assessment of efficacy of ketoconazole/clindamycin vs metronidazole/nistatine in candidiasic vaginitis and bacterial vaginosis]. / Evaluación de la eficacia de la combinación de ketoconazol/ clindamicina comparada con metronidazol/nistatina en vaginitis candidiásica y vaginosis bacteriana.

BACKGROUND: Term vaginitis refers to vaginal mucosa's inflammation, which produces a great variety of symptoms, including: abundant genital draining, of different color, fetid odor, pruritus, irritation, heat, dyspareunia, underwear spotting and frequently it is related to heat when urinating. OBJECTIVE: To compare the ketoconazole/klindamycin vs metronidazole/nistatine efficacy for the treatment of vaginitis. MATERIAL AND METHODS: Efficacy of the ketoconazole/klindamycin vs metronidazole/nistatine combination to treat Candida vaginitis and bacterial vaginosis by vaginal route was compared. Patients with diagnosis of vaginitis and bacterial vaginosis were included in a longitudinal, prospective, double-blind study. Patients were treated with ketoconazole/clindamycin vaginal tablets or metronidazole/ nistatine ovules for 6 days. Patients were evaluated at baseline and at day 7. RESULTS: The global result showed that ketoconazole/clindamycin is superior to metronidazole/nistatine in the treatment of vaginitis/ vaginosis. C. albicans was isolated in 23 patients, 12 in the ketoconazole/clindamycin group and 11 in the metronidazole/nistatine group. At the end of the study, cultures were negative in 66.7% of ketoconazole/clindamycin group and in 54.5% of metronidazole/nistatine group. Eighteen cases presented mixed vaginitis, 13 in ketoconazole/clindamycin group and 5 in metronidazole/nistatine. At the end of the study, culture was negative in ketoconazole/clindamycin (83.3%) group and in all metronidazole/nistatine cases. Anaerobes were isolated in 21 patients, 9 in ketoconazole/clindamycin group and 12 in metronidazole/nistatine. At the end of the treatment, cultures were negative in 77% of ketoconazole/clindamycin group and in 66% of metronidazole/nistatine group; adverse reactions were not reported. CONCLUSION: Treatment with ketoconazole/clindamycin for vaginitis/vaginosis is similar to that of metronidazole/nistatine. Microbiologically and clinically, treatment was well tolerated since there were not adverse reactions during the course of it.

La informatica y la descentralizacion de los servicios de salud publica en México

El presente trabajo pretende esbozar, de manera muy general, las acciones que el Gobierno Mexicano, por conducto de la Secretaría de Salud, ha emprendido en torno al proceso de descentralización administrativa de los servicios de salud y el papel que en ello tiene la informática como instrumento de apoyo fundamental. Para ello se exponen previamente una serie de conceptos y antecedentes que situan y enmarcam la problemática del tema central de esta ponencia