Side effects of the Pfizer BioNTech vaccine in health workers of a hospital in the southeast of Mexico.

INTRODUCTION: The goal of this study was to evaluate the side effects of application of the Pfizer BioNTech vaccine on the workers at a Mexican hospital. METHODOLOGY: A cross-sectional study was carried out, in which 1351 workers from a tertiary care center in the Mexican southeast were included. Sociodemographic data, comorbidities, and side effects after the Pfizer BioNTech vaccine were obtained through an online survey. The variables were analyzed through descriptive statistics. The presence or absence of side effects was analyzed through the Chi-square test or t-test, as appropriate. The result was considered statistically significant at p < 0.05. RESULTS: A total of 1351 health workers participated in the online survey. The mean age was 37.8 ± 10.9 years and 56.4% were women. Among them, 8.2% suffered from high blood pressure. In addition, 76.7% manifested pain in the application area. The presence of side effects was associated with the female gender (p < 0.01). Side effects were more prevalent in younger age (37.2 ± 10.7) than older age (41.5 ± 10.8) (p < 0.01). There was no association with the presence of comorbidities (p > 0.05). CONCLUSIONS: The data suggest that pain in the application area is the most frequent side effect among workers in a Mexican hospital who received the Pfizer BioNTech vaccine against COVID-19. In addition, we observed sialorrhea as a side effect in the studied population and this had not previously been reported. The highest number of adverse events occurred between 24 to 72 hours after application.

Features of patients that died for COVID-19 in a hospital in the south of Mexico: A observational cohort study.

BACKGROUND: Due to the wide spread of SARS-CoV2 around the world, the risk of death in individuals with metabolic comorbidities has dangerously increased. Mexico has a high number of infected individuals and deaths by COVID-19 as well as an important burden of metabolic diseases; nevertheless, reports about features of Mexican individuals with COVID-19 are scarce. The aim of this study was to evaluate demographic features, clinical characteristics and the pharmacological treatment of individuals who died by COVID-19 in the south of Mexico. METHODS: We performed an observational study including the information of 185 deceased individuals with confirmed diagnoses of COVID-19. Data were retrieved from medical records. Categorical data were expressed as proportions (%) and numerical data were expressed as mean ± standard deviation. Comorbidities and overlapping symptoms were plotted as Venn diagrams. Drug clusters were plotted as dendrograms. RESULTS: The mean age was 59.53 years. There was a male predominance (60.1%). The mean hospital stay was 4.75 ± 4.43 days. The most frequent symptoms were dyspnea (88.77%), fever (71.42%) and dry cough (64.28%). Present comorbidities included diabetes (60.63%), hypertension (59.57%) and obesity (43.61%). The main drugs used for treating COVID-19 were azithromycin (60.6%), hydroxychloroquine (53.0%) and oseltamivir (27.3%). CONCLUSIONS: Mexican individuals who died of COVID-19 had shorter hospital stays, higher frequency of shortness of breath, and higher prevalence of diabetes than individuals from other countries. Also, there was a high frequency of off-label use of drugs for their treatment.

Utilidad de la prueba de detección de ácidos nucleicos GeneXpert tuberculosis (MTB/RIF) en muestras respiratorias y no respiratorias en un hospital de referencia / Utility of nucleic acids detection GeneXpert tuberculosis (MTB/RIF) in respiratory and non-respiratory hospital reference samples

Resumen: OBJETIVO Evaluar la sensibilidad y valores predictivos de BAAR-Ziehl-Neelsen y GeneXpert (MTB/RIF) en muestras respiratorias y no respiratorias en población general y con VIH. MATERIAL Y MÉTODO Estudio clínico abierto, sin distribución al azar, prospectivo, descriptivo y observacional efectuado de mayo de 2016 a enero de 2017. Los criterios de inclusión fueron: pacientes con datos clínicos epidemiológicos radiológicos que sugirieran tuberculosis en la evaluación diagnóstica o riesgo de padecerla. Se hizo toma simultánea de expectoración o muestra extrapulmonar para determinación de BAAR-Ziehl-Neelsen, GeneXpert MTB y cultivo; se utilizó como patrón de referencia el cultivo. RESULTADOS Se incluyeron en el estudio 120 pacientes, 88 (73.3%) hombres. La justificación de la realización de la prueba fue enfermedad aguda grave 76 (63.3%), el factor de riesgo de mayor prevalencia fue el VIH-SIDA 54 (45.5%). El mayor porcentaje correspondió a la forma respiratoria (n = 75, 62.5%). El total de las muestras (n = 89, 74.2%) fueron negativas respecto a BAAR en contraste con GeneXpert y cultivo, que fueron positivos en 94 casos (78.3%). CONCLUSIONES Los indicadores estables evaluados en la prueba GeneXpert mostraron que es una prueba útil, sobre todo en muestras extrapulmonares de pacientes con VIH-SIDA.

Abstract: OBJECTIVE To assess the sensitivity and predictive values of BAAR Ziehl-Neelsen and GeneXpert (MTB/RIF) for respiratory and non-respiratory samples in the general population and HIV-patients. MATERIAL AND METHOD A clinical open, not-random, prospective, descriptive and observational study was done from May 2016 to January 2017. Inclusion criteria were: Patients with radiological, clinical and epidemiological data that suggested tuberculosis within the diagnostic evaluation or risk of having it. Simultaneous sputum or extrapulmonary sample was taken for determination of Ziehl-Neelsen, GeneXpert MTB and culture; the crop was used as a gold standard. RESULTS There were included 120 patients, 88 (73.3%) men; the justification for performing the test was severe acute disease (n = 76, 63.3%), the risk factor with the highest prevalence was HIV-AIDS (n = 54, 45.5%) The highest percentage was respiratory (n = 75, 62.5%). The total of samples 89 (74.2%) were negative with respect to BAAR in contrast to GeneXpert and culture, which reported positive in 94 (78.3%). CONCLUSIONS The stable indicators evaluated in the GeneXpert test showed that it is a useful test especially in extralung samples of patients with HIV-AIDS.

[Cosyntropin test in severe active tuberculosis]. / Prueba de cosintropina en tuberculosis activa grave.

BACKGROUND: Frequency of adrenal insufficiency in patients with tuberculosis varies from 0 to 58%; however, all published series excluded severely ill patients. Our objective was to investigate adrenal insufficiency with the low-dose cosyntropin test in patients with severe active tuberculosis. METHOD: From two large university affiliated hospitals, 18 patients with tuberculosis and criteria of sepsis or severe sepsis according to SCCM/ACCP criteria, defined by the present authors as severe active tuberculosis, participated in the study. A low-dose ACTH test with 10 mg of ACTH was performed. After ACTH test, all patients received a stress dose of hydrocortisone (240 mg/day) during their entire hospitalization along with four antituberculous drugs. Abnormal response was considered when elevation of serum cortisol was <7 microg/dl with respect to basal level, 60 min after ACTH administration. RESULTS: Adrenal insufficiency was found in seven patients (39%); no clinical or laboratory data were associated with the presence of abnormal adrenal response. Except in one patient with HIV infection, all the signs and symptoms improved after antituberculous and hydrocortisone treatment. The increment in serum cortisol value post-ACTH test was lower in patients with hypoalbuminemia. CONCLUSIONS: Adrenal insufficiency is frequent in severe active tuberculosis. The efficacy and security of supplemental steroid treatment in severe active tuberculosis should be established by a randomized clinical trial.

Prueba de cosintropina en tuberculosis activa grave / Cosyntropin test in severe active tuberculosis

BACKGROUND: Frequency of adrenal insufficiency in patients with tuberculosis varies from 0 to 58%; however, all published series excluded severely ill patients. Our objective was to investigate adrenal insufficiency with the low-dose cosyntropin test in patients with severe active tuberculosis. METHOD: From two large university affiliated hospitals, 18 patients with tuberculosis and criteria of sepsis or severe sepsis according to SCCM/ACCP criteria, defined by the present authors as severe active tuberculosis, participated in the study. A low-dose ACTH test with 10 mg of ACTH was performed. After ACTH test, all patients received a stress dose of hydrocortisone (240 mg/day) during their entire hospitalization along with four antituberculous drugs. Abnormal response was considered when elevation of serum cortisol was <7 microg/dl with respect to basal level, 60 min after ACTH administration. RESULTS: Adrenal insufficiency was found in seven patients (39%); no clinical or laboratory data were associated with the presence of abnormal adrenal response. Except in one patient with HIV infection, all the signs and symptoms improved after antituberculous and hydrocortisone treatment. The increment in serum cortisol value post-ACTH test was lower in patients with hypoalbuminemia. CONCLUSIONS: Adrenal insufficiency is frequent in severe active tuberculosis. The efficacy and security of supplemental steroid treatment in severe active tuberculosis should be established by a randomized clinical trial.