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Uropathogenic Escherichia coli (UPEC) is classified as the major causative agent of urinary tract infections (UTIs). UPEC virulence and antibiotic resistance can lead to complications in pregnant women and (or) newborns. Therefore, the aim of this study was to determine the etiological agents of UTIs, as well as to identify genes related to virulence factors in bacteria isolated from pregnant and nonpregnant women. A total of 4506 urine samples were collected from pregnant and nonpregnant women. Urine cultures were performed, and PCR was used to identify phylogroups and virulence-related genes. Antibiotic resistance profiles were determined. The incidence of UTIs was 6.9% (pregnant women, n = 206 and nonpregnant women, n = 57), and UPEC belonging to phylogroup A was the most prevalent. The presence of genes related to capsular protection, adhesins, iron acquisition, and serum protection in UPEC was associated with not being pregnant, while the presence of genes related to adhesins was associated with pregnancy. Bacteria isolated from nonpregnant women were more resistant to antibiotics; 36.5% were multidrug resistant, and 34.9% were extensively drug resistant. Finally, UTIs were associated with neonatal sepsis risk, particularly in pregnant women who underwent cesarean section while having a UTI caused by E. coli. In conclusion, UPEC isolated from nonpregnant women carried more virulence factors than those isolated from pregnant women, and maternal UTIs were associated with neonatal sepsis risk.
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Infecciones por Escherichia coli , Sepsis Neonatal , Infecciones Urinarias , Escherichia coli Uropatógena , Embarazo , Humanos , Femenino , Recién Nacido , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Virulencia/genética , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Sepsis Neonatal/tratamiento farmacológico , Cesárea , Farmacorresistencia Bacteriana/genética , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiología , Factores de Virulencia/genética , Escherichia coli Uropatógena/genéticaRESUMEN
AIM: The incidence of urinary tract infection (UTI) in pregnant women may vary from 5-10% and depends on parity, race, socioeconomic status and anatomical and functional changes in pregnancy. In Mexico, preterm birth accounts for 75% of perinatal deaths and 50% of the neurological sequelae attributable directly to prematurity. The objective of the present study is to describe maternal and perinatal complications in pregnant women with UTI caused by Escherichia coli and to find out the antimicrobial susceptibility pattern. METHODS: A descriptive and longitudinal study of pregnant women admitted to the Women's Hospital in Culiacan, Sinaloa, Mexico, was carried out from January 2013 to December 2014. Patients with E. coli infection were included, and infections caused by other microorganisms were excluded. The sociodemographic variables, causes of hospitalization and the type of maternal and perinatal complications were determined. RESULTS: The causes of admission to the hospital were threatened preterm labor, and fever and threatened abortion. Of 38 patients with threatened preterm labor, 33 went on to delivery, four were preterm births and two were neonatal deaths. E. coli was sensitive to over 90% of piperacillin-tazobactam, amikacin, nitrofurantoin and carbapenems. CONCLUSION: According to this study in a Mexican population, the number one admission diagnosis in women with UTI due to E. coli was threatened preterm labor, and fever and threatened abortion. E. coli was sensitive to more than 90% of piperacillin-tazobactam, amikacin, nitrofurantoin and carbapenems.
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Amenaza de Aborto/etiología , Infecciones por Escherichia coli/complicaciones , Fiebre/etiología , Trabajo de Parto Prematuro/etiología , Muerte Perinatal/etiología , Complicaciones Infecciosas del Embarazo , Infecciones Urinarias/complicaciones , Amenaza de Aborto/epidemiología , Adolescente , Adulto , Infecciones por Escherichia coli/epidemiología , Femenino , Fiebre/epidemiología , Humanos , Recién Nacido , México/epidemiología , Trabajo de Parto Prematuro/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones Urinarias/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: To determine the prevalence of urinary tract infection (UTI) in patients with preterm labor. METHODS: A prospective, observational, descriptive study, with a sample of 272 patients who were hospitalized in the Hospital de la Mujer at Culiacan, Sinaloa that presented symptoms of preterm labor. Age body mass index (BMI), parity, education, weeks of gestation, mode of delivery, history of preterm delivery and UTI were assessed. RESULTS: Of the 272 patients with threatened preterm delivery, 97 (35.6%) had positive urine culture and of these patients, 32 (32.9%) had preterm labor. Association between urinary tract infection and patients with a hemoglobin (Hb) less than 11 g/dL OR: 2.66 95% CI (1.55-4.55), p 0.0003. Was isolated E. coli in 72 (74.4%) patients, Proteus in 9 (9.2%) patients. It was found that 42% of E. coli strains were resistant to ampicillin and 38.4% to ciprofloxacin. CONCLUSION: The prevalence of UTI is higher than the national prevalence.
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Trabajo de Parto Prematuro , Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones Urinarias/epidemiología , Adolescente , Adulto , Niño , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Embarazo , Prevalencia , Estudios Prospectivos , Adulto JovenRESUMEN
Background/Aims: Noncardiac chest pain (NCCP) of esophageal origin is a challenging clinical problem of diverse etiology that affects more than 80 million Americans yearly. We assess the prevalence and impact of psychological disorders on NCCP of esophageal origin, describe possible mechanisms associated with this condition, and review psychological therapy options. Methods: Online search using PubMed and Medline from January 1, 1966, to April 30, 2023. Results: Psychological disorders have been reported in up to 79% of patients with NCCP of esophageal origin. Several psychological disturbances have been identified with this condition, including depression, anxiety, panic disorder, phobias, and obsessive-compulsive and somatoform disorders. It is unclear whether the psychological disorders trigger the chest pain or vice versa. Multiple psychological mechanisms have been linked to chest pain and may contribute to its pathogenesis and severity. These mechanisms include cardiophobia, poor coping strategies, negative social problem solving, stress and perceived control, hypervigilance to cardiopulmonary sensations, altered pain perception, and alexithymia. Psychological therapies for NCCP of esophageal origin include cognitive behavioral therapy, hypnotherapy, physical and relaxation training, breathing retraining, and alternative medicine. Among the therapeutic options, cognitive behavioral therapy has been shown to be an effective treatment for NCCP of esophageal origin. Conclusion: This review raises awareness about the high prevalence of psychological disorders in NCCP of esophageal origin and highlights the need for clinical trials and trained therapists to address the management of this taxing clinical problem.
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High-density lipoprotein cholesterol (HDL-c) removes cholesterol, an essential component in lipid rafts, and this cholesterol removal can regulate protein attachment to lipid rafts, modulating their functionality in the immune cell response. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can alter the lipid profile, there is little information on the role of HDL-c and other lipids in prognostic of the coronavirus disease 2019 (COVID-19) in Mexican population. This study aims to evaluate the predictive value of HDL-c and lipid profile on severity and survival of 102 patients infected with SARS-CoV-2 during the COVID-19 first wave. Our findings, derived from univariate and multivariate Cox proportional hazards regression models, highlighted age and hypertension as significant predictors of survival (HR = 1.04, p = 0.012; HR = 2.78, p = 0.027), while gender, diabetes, and obesity showed no significant impact. Triglycerides and HDL-c levels notably influenced mortality, with elevated triglycerides and lower HDL-c associated with higher mortality risk (p = 0.032). This study underscores the importance of lipid profiles alongside traditional risk factors in assessing COVID-19 risk and outcomes. It contributes to the understanding of COVID-19 patient management and emphasizes the need for further investigation into the role of dyslipidemia in influencing COVID-19 prognosis, potentially aiding in refined risk stratification and therapeutic strategies.
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COVID-19 , HDL-Colesterol , SARS-CoV-2 , Humanos , COVID-19/mortalidad , COVID-19/sangre , Masculino , Femenino , Persona de Mediana Edad , HDL-Colesterol/sangre , Adulto , Anciano , SARS-CoV-2/aislamiento & purificación , Factores de Riesgo , Triglicéridos/sangre , Pronóstico , Lípidos/sangre , México/epidemiología , Dislipidemias/sangre , Modelos de Riesgos Proporcionales , Hipertensión/sangreRESUMEN
OBJECTIVES: We focused our study on examining the genotype and allele frequency of IL-6 (rs1800795), TNF-α (rs1800629) and IL-10 (rs1800872) single nucleotide polymorphisms (SNP) on preeclampsia (PE) diagnosed Mexican pregnant women. MATERIAL AND METHODS: A case-control study was designed including 86 preeclampsia patients and 100 normotensives pregnancies from Women's Hospital of Culiacan, Mexico. Genotyping of IL-6, TNF-α and IL-10 was performed using TaqMan SNP Genotyping. RESULTS: Not significant association was found between development of PE and genotypic (p > 0.05) and allelic (p > 0.05) frequencies of IL-6, TNF-α and IL-10 SNPs. Genotype distributions of IL-6 (p = 0.599), TNF-α (p = 0.721) and IL-10 (p = 0.761) polymorphisms in the two groups were in agreement with Hardy-Weinberg equilibrium. CONCLUSIONS: According to the findings, the IL-6, TNF-α and IL-10 SNPs are not exponents of susceptibility to developing PE.
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Interleucina-10 , Preeclampsia , Femenino , Humanos , Embarazo , Estudios de Casos y Controles , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Genotipo , Interleucina-10/genética , Interleucina-6/genética , México , Polimorfismo de Nucleótido Simple , Preeclampsia/genética , Factor de Necrosis Tumoral alfa/genéticaRESUMEN
BACKGROUND In the 18th century, Morgagni described membranous dysmenorrhea as the sudden and complete detachment of the decidua during menstruation. This causes intense and painful contractions of the myometrium, aggravated by the expulsion of tissues produced by the decidualization of the endometrium. It is a rare pathology associated with oral contraceptives, ectopic pregnancies, abortions, and natural cycles, with consequent thickening and endometrial decidualization with molding of the tissue of the uterine cavity of membranous appearance. The definitive diagnosis is made by histopathological examination. CASE REPORT A 43-year-old female patient came for urgent consultation for an acute picture of severe pain in the lower abdomen, radiating to the genital area with transvaginal bleeding of 2 h of evolution. She had no significant past medical history. A transvaginal ultrasound was performed and showed an unchanged endometrial cavity. A vaginal examination revealed a foreign body of soft consistency; therefore, a speculum examination was performed, which showed tissue of endometrial origin located in the cervical canal of a reddish spongy texture. The tissue was removed, thus improving the symptomatology, and was sent to the pathological anatomy service for histopathologic diagnosis. CONCLUSIONS Membranous dysmenorrhea is a rare gynecologic disorder with only a few documented cases. According to other case reports, our patient's case, at age 43 years, was an atypical presentation. The clinical features and association with this pathology allowed the diagnosis and its confirmation by histopathological examination.
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Dismenorrea , Útero , Adulto , Femenino , Humanos , Anticonceptivos Orales , Dismenorrea/etiología , Dismenorrea/diagnóstico , Endometrio , UltrasonografíaRESUMEN
Several human genetic variants have been associated with susceptibility or resistance to leprosy. The aim of this study was to assess whether gene polymorphisms of -308 G/A TNF-alpha and -819 T/C IL-10 are associated with lepromatous leprosy in Mexican mestizos patients from northwest Mexico. We genotyped these polymorphisms by means of polymerase chain reaction (PCR) and restriction fragment length polymorphisms (RFLPs) in 68 patients with lepromatous leprosy and 144 healthy Mexican Mestizos controls. We found that the -308G TNF-alpha allele was predominant in both cases (94.3%) and controls (92.3%) without statistical significance and the frequencies of -819C IL-10 allele were also similar for the cases (56.0%) and controls (59.0%). These negative findings suggest that other genes or polymorphisms may be important in the susceptibility to leprosy infection in the Mexican mestizos.
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Interleucina-10/genética , Lepra Lepromatosa/genética , Polimorfismo Genético , Factor de Necrosis Tumoral alfa/genética , Adulto , Alelos , Estudios de Casos y Controles , Femenino , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Pruebas Genéticas , Humanos , Lepra Lepromatosa/epidemiología , Lepra Lepromatosa/patología , Masculino , México/epidemiología , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Polimorfismo de Longitud del Fragmento de Restricción , Grupos de Población , Regiones Promotoras Genéticas , Adulto JovenRESUMEN
Resumen OBJETIVO: Determinar la incidencia del espectro del acretismo placentario en pacientes ingresadas a la unidad de cuidados intensivos obstétricos del Hospital de la Mujer, Culiacán, Sinaloa. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y descriptivo fundamentado en el análisis de la base de datos del Hospital de la Mujer de pacientes internadas entre los años 2017 a 2020 con diagnóstico de espectro de placenta acreta, referidas o diagnosticadas en la institución e intervenidas para histerectomía por la complicación estudiada. RESULTADOS: Se analizaron 22 pacientes con diagnóstico de acretismo placentario que dieron una incidencia de 0.09%; de éstas, a 1 se le indicó cesárea; 19 de las 22 pacientes tenían antecedente de cicatriz uterina previa, todas con placenta previa. El promedio de edad fue de 30.86 ± 4 años. La cesárea se practicó, en promedio, a las 34 semanas de embarazo con dos técnicas quirúrgicas. El sangrado promedio estimado fue de 1.947 mL. Las complicaciones transoperatorias fueron las lesiones: ureteral (n = 2) y vesical (n = 1). La principal complicación posoperatoria fue la fístula vesicouterina (n = 1). El promedio de estancia fue de 2 días en 16 de las 22 pacientes y de 7 días en las 6 restantes. CONCLUSIONES: Lo importante del acretismo placentario es el diagnóstico oportuno que permita derivar a las pacientes a centros hospitalarios que cuenten con especialistas experimentados en la atención de estos casos.
Abstract OBJECTIVE: To determine the incidence of placental accretism spectrum in pregnant women admitted to the obstetric intensive care unit of the Hospital de la Mujer, Culiacán, Sinaloa. MATERIALS AND METHODS: Retrospective, cross-sectional, descriptive study based on the analysis of the database of the Hospital de la Mujer of patients admitted between 2017 and 2020 with a diagnosis of placenta accreta spectrum, referred or diagnosed at the institution and underwent hysterectomy for the complication studied. RESULTS: Twenty-two patients with a diagnosis of placenta accreta were analysed, giving a prevalence of 0.09%; of these, caesarean section was indicated in 0.2%. 19 of the 22 patients had a history of previous uterine scarring, all with placenta praevia. Mean age was 30.86 ± 4 years. Caesarean section was performed at a mean gestational age of 34 weeks using two surgical techniques. The mean estimated blood loss was 1,947 mL. The most common operative complications were ureteral (n = 2) and bladder (n = 1) injuries. The most common postoperative complication was vesico-uterine fistula (n = 1). The mean length of stay was 2 days in 16 of the 22 patients and 7 days in the remaining 6 patients. CONCLUSIONS: The most important aspect of placenta accreta is early diagnosis, which allows referral to hospital centres with specialists experienced in the management of these cases.
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Resumen ANTECEDENTE: El síndrome de Karsch-Neugebauer o ectrodactilia del pie o pie hendido, es una enfermedad congénita sumamente rara, caracterizada por aplasia-hipoplasia de las falanges y metatarsianos del pie. Cuando aparece de forma aislada se debe a una forma autosómica dominante de expresión variable, aunque también puede ser de carácter autosómico recesivo. CASO CLÍNICO: Paciente de 31 años, sin antecedentes heredofamiliares de importancia, con IMC de 25.95 kg/m2, signos vitales en parámetros normales. Con dos embarazos, cesárea previa sin complicaciones. El ultrasonido estructural 20 a 23.6 semanas del embarazo actual reportó un feto vivo, de sexo femenino y 22.2 semanas de gestación, con múltiples alteraciones anatómicas: arteria umbilical única, hueso nasal hipoplásico, micrognatia en ángulo facial y miembros inferiores con ectrodactilia bilateral. CONCLUSIONES: Los estudios ultrasonográficos, en especial el de las semanas 20 a 23.6 de gestación son decisivos para la detección de malformaciones congénitas. Sin embargo, a partir de las 11 a 13.6 semanas es posible establecer diagnósticos estructurales de manera temprana. Muchas alteraciones y síndromes, como el de Karsch-Neugebauer, suelen ser incapacitantes y al combinarse con otras anomalías pueden llegar a ser incompatibles con la vida. Se requieren diagnósticos tempranos para la toma de decisiones de manera consensuada con la familia y el equipo multidisciplinario.
Abstract BACKGROUND: Karsch-Neugebauer syndrome, or ectrodactyly of the foot or cleft foot, is an extremely rare congenital disorder characterized by aplasia-hypoplasia of the phalanges and metatarsals of the foot. When it occurs in isolation, it is due to an autosomal dominant form of variable expression, although it can also be autosomal recessive. CLINICAL CASE: 31-year-old female patient with no significant hereditary family history, BMI of 25.95 kg/m2, vital signs within normal parameters. With two pregnancies, previous caesarean section without complications. Structural ultrasound 20 to 23.6 weeks of the current pregnancy showed a live fetus, female sex and 22.2 weeks gestation, with multiple anatomical anomalies: single umbilical artery, hypoplastic nasal bone, micrognathia in the facial angle and lower limbs with bilateral ectrodactyly. CONCLUSIONS: Ultrasound examinations, especially at 20 to 23.6 weeks of gestation, are crucial for the detection of congenital malformations. However, from 11 to 13.6 weeks it is possible to make early structural diagnoses. Many disorders and syndromes, such as Karsch-Neugebauer syndrome, are often disabling and, in combination with other anomalies, can become incompatible with life. Early diagnosis is necessary to make informed decisions with the family and the multidisciplinary team.
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Resumen ANTECEDENTES: Las quemaduras son la forma más severa de estrés que el cuerpo puede sufrir; pueden generarse por diferentes agentes térmicos y químicos. CASO CLÍNICO: Paciente de 25 años, con dolor intenso en la región genital de 12 horas de evolución, secundario a la introducción en la vagina de una piedra de alumbre. Se le hicieron múltiples irrigaciones con solución salina al 0.9% sin obtener el resto de la piedra de alumbre. Se le aplicó sulfadiazina de plata en la cavidad vaginal cada 12 horas, óvulos vaginales de ketanserina, miconazol y metronidazol cada 8 horas, ketorolaco por vía oral 10 mg cada 8 horas. Durante su estancia hospitalaria tuvo buena evolución, con disminución de la inflamación en la zona genital, epitelización adecuada. Al tercer día se dio de alta del hospital con cita para valoración a los siete días. CONCLUSIÓN: El tratamiento de las quemaduras en el área genital, por agentes químicos, tiene como piedra angular la identificación del agente causante de la lesión que permita actuar de forma inmediata y evitar las secuelas físicas, sexuales y psicológicas mediante el lavado exhaustivo con solución o agua estéril para remover el agente causal y disminuir que continúe actuando en el sitio afectado.
Abstract BACKGROUND: Burns are the most severe form of stress that the body can suffer; they can be caused by various thermal and chemical agents. CLINICAL CASE: A 25-year-old female patient presented with severe genital pain of 12 hours' duration, secondary to the introduction of an alum stone into the vagina. She underwent several irrigations with 0.9% saline without obtaining the rest of the alum stone. She was given vaginal silver sulfadiazine every 12 hours, vaginal ketanserin, miconazole and metronidazole every 8 hours and oral ketorolac 10 mg every 8 hours. During her stay in hospital, she progressed well, with a decrease in genital inflammation and adequate epithelialisation. She was discharged on the third day with an appointment for a seven-day follow-up. CONCLUSION: The management of genital burns caused by chemical agents is based on the identification of the agent causing the lesion, which allows immediate action and prevents physical, sexual and psychological sequelae by thorough washing with sterile solution or water to remove the causative agent and reduce its continued action in the affected area.
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OBJECTIVE: To describe the clinical and epidemiological characteristics of dengue fever (DF) and dengue hemorrhagic fever (DHF). MATERIAL AND METHODS: A cross-sectional study was conducted in the Hospital General de Culiacan Dr. Bernardo J. Gastélum and the Hospital General de Zona 28 of IMSS from September to November 2003, with patients having dengue diagnosis, which was classified according to the WHO criteria. The statistical program Stata v6 was used for the analysis. RESULTS: 231 dengue cases (DF: 90.48 %; DHF 9.52 %) were included. Average age was 34.5 +/- 15 years. 61.7% of DF cases were women, while 77.3% of DHF cases were men. DHF cases went to the hospital in 4.7 +/- 2 days, while DF cases went in 3.4 +/- 2.2 days (p = 0.004). DHF cases had more often headache, retroocular pain, arthralgias, diarrhea and vomiting (p < 0.05). DF cases showed hemorrhagic manifestations (24.8%); plasma leakage (6.7%) and thrombocytopenia (34.4%); petequiae, gingival bleeding and epistaxis were associated to thrombocytopenia below 39 000/mm(3) (p < 0.05); neutropenia, prolonged partial thromboplastin time elevated transaminases were observed more often in DHF cases (p <0.05). CONCLUSIONS: the main variables associated with DHF were: male gender, fever, vomiting and gingival bleeding but not previous history of dengue; the major hemoconcentration, the major severity of thrombocytopenia.
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Dengue/diagnóstico , Dengue/epidemiología , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dengue Grave/diagnóstico , Dengue Grave/epidemiologíaRESUMEN
INTRODUCTION: Cleft lip and palate, the most common developmental deformity, is seen worldwide and the etiology involves a combination of genetic and environmental factors. The purpose of this study was to determine the maternal risk factors associated with the development of cleft lip and cleft palate. MATERIALS AND METHODS: We conducted a case control study at the Women's Hospital in Culiacan, Mexico. Medical records were analyzed, including patients who delivered babies with and without cleft lip and cleft palate from January 2010 to December 2015. Multiple variables were analyzed, including gestational age, weight at birth, the use of folic acid and multivitamins during pregnancy, smoking, alcohol abuse, the use of recreational drugs, history of sexually transmitted infections, marital status, socioeconomic status, education, and nutritional status. RESULTS: We found that the maternal risk factors with the strongest association for the development of cleft lip and cleft palate were the following: patients who were not taking folic acid during pregnancy [OR 3.27, 95% CI 1.32-8.09], P=0.00; patients who were not taking vitamin supplementation during pregnancy [OR 2.6, 95% CI 1.19-7.27], P=0.02; smoking during pregnancy [OR 2.05, 95% CI 1.23-3.41], P=0.01; and alcohol abuse during pregnancy [OR 1.90, 95% CI 1.17-3.08], P=0.03. CONCLUSIONS: The main risk factors associated with the development of cleft lip and cleft palate in a Mexican population at the Women's hospital in Culiacan, Sinaloa, Mexico were smoking, alcohol abuse, and patients not taking folic acid and multivitamins during pregnancy.
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AIM: To assess the proportion of refractive errors in the Mexican population that visited primary care optometry clinics in fourteen states of Mexico. METHODS: Refractive data from 676 856 patients aged 6 to 90y were collected from optometry clinics in fourteen states of Mexico between 2014 and 2015. The refractive errors were classified by the spherical equivalent (SE), as follows: sphere+½ cylinder. Myopia (SE>-0.50 D), hyperopia (SE>+0.50 D), emmetropia (-0.50≤SE≤+0.50), and astigmatism alone (cylinder≥-0.25 D). A negative cylinder was selected as a notation. RESULTS: The proportion (95% confidence interval) among all of the subjects was hyperopia 21.0% (20.9-21.0), emmetropia 40.7% (40.5-40.8), myopia 24.8% (24.7-24.9) and astigmatism alone 13.5% (13.4-13.5). Myopia was the most common refractive error and frequency seemed to increase among the young population (10 to 29 years old), however, hyperopia increased among the aging population (40 to 79 years old), and astigmatism alone showed a decreasing trend with age (6 to 90y; from 19.7% to 10.8%). There was a relationship between age and all refractive errors (approximately 60%, aged 50 and older). The proportion of any clinically important refractive error was higher in males (61.2%) than in females (58.3%; P<0.0001). From fourteen states that collected information, the proportion of refractive error showed variability in different geographical areas of Mexico. CONCLUSION: Myopia is the most common refractive error in the population studied. This study provides the first data on refractive error in Mexico. Further programs and studies must be developed to address the refractive errors needs of the Mexican population.
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INTRODUCTION: This study aimed to determine the resistance patterns of Escherichia coli (E. coli) in Mexico to several antibiotics and research some therapeutic options. METHODOLOGY: Positive cultures for E. coli isolated from bronchial secretions, urine, central catheter, blood, and infected wounds in the Culiacan General Hospital, Sinaloa, Mexico from 30 June 2004 to 1 July 2007 were studied. Resistance against multiple antibiotics was measured and compared by gender and the hospital unit where the bacteria were isolated. RESULTS: In total, 1511 specimens were analyzed from men (45.4%) and women (54.5%), of which 251 were positive for E. coli. Antimicrobial resistance was highest in the neurosurgery service (58.4%). Samples included sputum (14.7%), bronchial secretions (17.9%), wounds (35.4%), urine/Foley catheter tip (35.5%), central catheter tips (5.6%), and blood cultures (7.2%). Resistance to ampicillin was highest at 91% followed by ciprofloxacin at 80.6%, trimethoprim-sulfamethoxazole at 70.2%, piperacillin/tazobactam at 14.4%, and imipenem at 6.8%. CONCLUSIONS: Trimethoprim should not be recommended as an empiric option for E. coli infections and the benefit of quinolones is low. It is important to understand the resistance of the bacteria in each medical center, consider its frequency in each service within the same hospital, and take all necessary measures to ensure and create a clinical attitude of prevention.
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Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Infecciones por Escherichia coli/microbiología , Escherichia coli/efectos de los fármacos , Escherichia coli/aislamiento & purificación , Femenino , Humanos , Masculino , México , Pruebas de Sensibilidad MicrobianaRESUMEN
OBJECTIVES: To document the clinical and epidemiological characteristics present in dengue patients served by a hospital in Culiacan, Sinaloa, Mexico. METHODS: A cross-sectional, observational, and analytical study was carried out at the Hospital General Dr. Bernardo J. Gastélum de Culiacan from 1 October to 2 December 2003. Associations between the independent variables (the patients' clinical and epidemiological characteristics) and the dependent variable (confirmed hemorrhagic dengue) were determined through simple regression analysis. The variables that were significantly associated (P < 0.05) were submitted to multifactorial logistic regression analysis. RESULTS: Of the only 241 cases that met the study's inclusion criteria (207 dengue and 34 hemorrhagic dengue), the mean age was 34.7 +/- 15.1 years. According to the results of the multifactorial analysis (adjusted by age, sex, and the presence of dengue cases at the geographic location), the variables predictive of major complications of the disease were: the presence of ascites (odds ration [OR] = 22.12; 95% confidence interval [95%CI]: 5.00-97.87), gingivorrhagia (OR = 7.35; 95%CI: 2.11-25.61), hematemesis (OR = 7.40; 95%CI: 1.04-52.42), thrombocytopenia (platelets from 40,001/mm(3)-60,000/mm(3)) (OR = 5.43; 95%CI: 1.58-18.72), conjunctival hyperemia (OR = 4.27; 95%CI: 1.37-13.28), persistent vomiting (OR = 3.04; 95%CI: 1.05-8.80), and the absence of nasal congestion (OR = 0.015; 95%CI: 0.0004-0.473). CONCLUSIONS: The presence of ascites, gingivorrhagia, hematemesis, thrombocytopenia (with platelet values from 40,001/mm(3)-60,000/mm(3)), and persistent vomiting were confirmed as warning signs of an imminent dengue attack. Platelet counts of > 100,000/mm(3) were confirmed in cases with acute clinical symptoms (capillary leak) that were not classified as hemorrhagic dengue due to falling short of the criteria established by WHO.
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Dengue/diagnóstico , Dengue/epidemiología , Adulto , Anciano , Estudios Transversales , Femenino , Hospitales Generales , Humanos , Masculino , México , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJETIVO: Documentar las características clínicas y epidemiológicas de los pacientes con dengue atendidos en un hospital de Culiacán, Sinaloa, México. MÉTODOS: Estudio transversal, observacional y analítico realizado en el Hospital General Dr. Bernardo J. Gastélum de Culiacán entre el 1 de octubre y el 2 de diciembre de 2003. Se evaluó la asociación entre las variables independientes (las características clínicas y epidemiológicas de los pacientes) y la variable dependiente (diagnóstico confirmado de dengue hemorrágico) mediante el análisis de regresión simple. Las variables que mostraron una relación significativa (P < 0,05) se incluyeron en el análisis de regresión logística multifactorial. RESULTADOS: En los 241 casos que cumplieron los criterios de inclusión para este estudio (207 de dengue y 34 de dengue hemorrágico), la edad promedio fue de 34,7 ± 15,1 años. Según los resultados del análisis multifactorial ajustado por la edad, el sexo y la presencia de casos de dengue en la localidad, las variables con valor predictivo de una mayor gravedad de la enfermedad fueron: la presencia de ascitis (OR = 22,12; IC95 por ciento: 5,00 a 97,87), la gingivorragia (OR = 7,35; IC95 por ciento: 2,11 a 25,61), la hematemesis (OR = 7,40; IC95 por ciento: 1,04 a 52,42), la trombocitopenia (plaquetas entre 40 001/mm³ y 60 000/mm³) (OR = 5,43; IC95 por ciento: 1,58 a 18,72), la hiperemia conjuntival (OR = 4,27; IC95 por ciento: 1,37 a 13,28), los vómitos persistentes (OR = 3,04; IC95 por ciento: 1,05 a 8,80) y la ausencia de congestión nasal (OR = 0,015; IC95 por ciento: 0,0004 a 0,473). CONCLUSIONES: Se confirmó el valor de la presencia de ascitis, gingivorragia, hematemesis, trombocitopenia (con valores de plaquetas entre 40 001/mm³ y 60 000/mm³) y vómitos persistentes como signos de alarma que anuncian la inminencia del choque por dengue. Se observaron conteos plaquetarios > 100 000/mm3 en casos con cuadros clínicos graves (fuga capilar) que no se...
OBJECTIVES: To document the clinical and epidemiological characteristics present in dengue patients served by a hospital in Culiacan, Sinaloa, Mexico. METHODS: A cross-sectional, observational, and analytical study was carried out at the Hospital General Dr. Bernardo J. Gastélum de Culiacan from 1 October to 2 December 2003. Associations between the independent variables (the patients' clinical and epidemiological characteristics) and the dependent variable (confirmed hemorrhagic dengue) were determined through simple regression analysis. The variables that were significantly associated (P < 0.05) were submitted to multifactorial logistic regression analysis. RESULTS: Of the only 241 cases that met the study's inclusion criteria (207 dengue and 34 hemorrhagic dengue), the mean age was 34.7 ± 15.1 years. According to the results of the multifactorial analysis (adjusted by age, sex, and the presence of dengue cases at the geographic location), the variables predictive of major complications of the disease were: the presence of ascites (odds ration [OR] = 22.12; 95 percent confidence interval [95 percentCI]: 5.00-97.87), gingivorrhagia (OR = 7.35; 95 percentCI: 2.11-25.61), hematemesis (OR = 7.40; 95 percentCI: 1.04-52.42), thrombocytopenia (platelets from 40001/mm³- 60000/mm³) (OR = 5.43; 95 percentCI: 1.58-18.72), conjunctival hyperemia (OR = 4.27; 95 percentCI: 1.37-13.28), persistent vomiting (OR = 3.04; 95 percentCI: 1.05-8.80), and the absence of nasal congestion (OR = 0.015; 95 percentCI: 0.0004-0.473). CONCLUSIONS: The presence of ascites, gingivorrhagia, hematemesis, thrombocytopenia (with platelet values from 40001/mm³-60000/mm³), and persistent vomiting were confirmed as warning signs of an imminent dengue attack. Platelet counts of > 100000/mm3 were confirmed in cases with acute clinical symptoms (capillary leak) that were not classified as hemorrhagic dengue due to falling short of the criteria established by WHO.