Epidemiological and Clinical Characteristics of Hospitalized Pediatric Patients with SARS-CoV-2 Infection in Mexico City, Mexico.

Background: Evidence from across the world suggests that the pediatric population shows different clinical manifestations and has a lower risk of severe presentation of SARS-CoV-2 infection compared to adults. However, Mexico has one of the highest mortality rates in the pediatric population due to SARS-CoV-2 infection. Therefore, our objective was to explore the epidemiological and clinical characteristics associated with a positive confirmatory test in the Mexican pediatric population admitted to a tertiary care hospital in Mexico City. Methods: Clinical, imaging and laboratory data were retrospectively collected from 121 children hospitalized during the period from March 4th, 2020, to August 8th, 2021. The patients were identified as suspicious cases according to the guidelines of the General Directorate of Epidemiology of Mexico. Real-time polymerase chain reaction (RT-PCR) tests were used to confirm SARS-CoV-2 infection. Categorical variables were compared using the Chi-square test, and propensity score matching was performed to determine univariate and multivariate odds ratios of the population regarding a positive vs. negative SARS-CoV-2 result. Results: Of the 121 children, 36 had laboratory-confirmed SARS-CoV-2 infection. The main risk for SARS-CoV-2-associated pediatric hospitalization was contact with a family member with SARS-CoV-2. It was also found that fever and fatigue were statistically significantly associated with a positive SARS-CoV-2 test in multivariate models. Clinical and laboratory data in this Mexican hospitalized pediatric cohort differ from other reports worldwide; the mortality rate (1.6%) of the population studied was higher than that seen in reports from other countries. Conclusion: Our study found that fever and fatigue at hospital presentation as well as an antecedent exposure to a family member with SARS-CoV-2 infection were important risk factors for SARS-CoV-2 positivity in children at hospital admission.

[Results of the Program for the Rational Use of Antimicrobials in a Mexican hospital, 2013-2018Resultados de um programa para o uso racional de antimicrobianos num hospital no México, 2013-2018]. / Resultados del Programa de Uso Racional de Antimicrobianos en un hospital de México, 2013-2018.

OBJECTIVE: Describe the results of the Program for the Rational Use of Antimicrobials at Mexico's Juárez Hospital. METHODS: An observational, cross-sectional, retrospective, descriptive study was designed. For the consumption of antimicrobial agents, data from January 2013 to December 2018 were analyzed by calculating the defined daily dose (DDD). For the cost analysis, a traditional costing calculation was used. RESULTS: For the group of carbapenem agents, there was a sizeable reduction in the consumption of imipenem / cilastatin: the DDD declined from 2.3 in 2013 to 0.7 in 2018, a decrease of 70%. By contrast, for the other two agents, increases were observed. The consumption of meropenem increased by 2% (from 2.4 in 2013 to 2.5 in 2018); the consumption of ertapenem increased by 75% (from 1 in 2013 to 1.8 in 2018). The total expenditure on antimicrobial agents was USD 930 556.46 during 2013, compared to USD 856 079.10 during 2018, representing a difference of 8% or USD 74 905.61 of the total expenditure. CONCLUSIONS: Programs for the rational use of antimicrobials need to be evaluated continuously, by monitoring both consumption of agents by patients and related institutional expenditures.

OBJETIVO: Descrever os resultados do Programa para o Uso Racional de Antimicrobianos no Hospital Juárez de México. MÉTODOS: Elaboramos um estudo observacional, transversal, retrospectivo e descritivo. Analisamos o consumo de antimicrobianos de janeiro de 2013 a dezembro de 2018 pelo cálculo da dose diária definida (DDD); para a análise de custos, realizamos um cálculo de custos tradicional. RESULTADOS: No grupo dos carbapenens, a redução do consumo de imipenem/cilastatina foi notável: passou-se de uma DDD de 2,3 em 2013 para 0,7 em 2018, uma redução de 70%. Por outro lado, observou-se um aumento no uso dos dois outros medicamentos: no caso do meropenem, foi registrado um aumento de 2% (de 2,4 em 2013 a 2,5 em 2018); no consumo de ertapenem o aumento foi de 75% (de 1 em 2013 a 1,8 em 2018). No total, as despesas com antimicrobianos foram de USD 930 556,46 em 2013 e de USD 856 079,10 em 2018, uma diferença de 8%, o que equivale a uma redução de USD 74 905,61 nas despesas totais. CONCLUSÕES: É necessário avaliar continuamente os programas para o uso racional de antimicrobianos pelo monitoramento do consumo e das despesas derivadas.

Disinfection efficacy of ozone on ESKAPE bacteria biofilms: Potential use in difficult-to-access medical devices.

BACKGROUND: Medical devices can be reservoirs of multidrug-resistant bacteria that may be involved in the acquisition of infections since bacteria with the ability to form biofilms that are difficult to eradicate, mainly in mechanical ventilators. The aim of this work was to evaluate the efficacy of O3 against biofilms of bacteria ESKAPE group through disinfection studies. METHODS: The formation of biofilms of ESKAPE group bacteria was induced in vitro. O3 was injected at different exposure times at a constant dose of 600 mg/h. The recovery of surviving bacteria after O3 treatment was assessed by bacterial counts and biofilm disruption was analyzed. Finally, the viability and integrity of biofilms after O3 treatment was determined by confocal laser scanning microscopy (CLSM). RESULTS: O3 showed bactericidal activity on biofilms from 12 min/7.68 ppm for A. baumannii and C. freundii. P. aeruginosa, K. pneumoniae and S. aureus were killed after 15 min/9.60 ppm. Correlation analyses showed inversely proportional relationships between the variables "disruption versus O3". CLSM revealed that death was time-dependent of biofilms upon O3 exposure. Orthogonal plane analysis showed that bacteria located in the outer region of the biofilms were the ones that initially suffered damage from O3 exposure. CONCLUSIONS: Our findings suggest that this method could be an alternative for the disinfection in mechanical ventilators colonized by bacteria biofilm forming.

Neutralizing Antibodies against SARS-CoV-2: Importance of Comorbidities in Health Personnel against Reinfections.

One of the priority lines of action to contain the SARS-CoV-2 pandemic was vaccination programs for healthcare workers. However, with the emergence of highly contagious strains, such as the Omicron variant, it was necessary to know the serological status of health personnel to make decisions for the application of reinforcements. The aim of this work was to determine the seroprevalence against SARS-CoV-2 in healthcare workers in a Mexican hospital after six months of the administration of the Pfizer-BioNTech vaccine (two doses, 4 weeks apart) and to investigate the association between comorbidities, response to the vaccine, and reinfections. Neutralizing antibodies against SARS-CoV-2 were determined using ELISA assays for 262 employees of Hospital Juárez de México with and without a history of COVID-19. A beta regression analysis was performed to study the associated comorbidities and their relationship with the levels of antibodies against SARS-CoV-2. Finally, an epidemiological follow-up was carried out to detect reinfections in this population. A significant difference in SARS-CoV-2 seroprevalence was observed in workers with a history of COVID-19 prior to vaccination compared to those without a history of the disease (MD: 0.961 and SD: 0.049; <0.001). Beta regression showed that workers with a history of COVID-19 have greater protection compared to those without a history of the infection. Neutralizing antibodies were found to be decreased in alcoholic and diabetic subjects (80.1%). Notably, eight cases of Omicron reinfections were identified, and gender and obesity were associated with the presence of reinfections (6.41 OR; 95% BCa CI: 1.15, 105.0). The response to the vaccine was influenced by the history of SARS-CoV-2 infection and associated comorbidities. The above highlights the importance of prioritizing this segment of the population for reinforcements in periods of less than one year to guarantee their effectiveness against new variants.

A Novel Technique for the Evaluation and Interpretation of Elastography in Salivary Gland Involvement in Primary Sjögren Syndrome.

Ultrasound (US) of major salivary glands (MSG) evaluates echogenicity, border features and vascularization, with elastography, it can detect tissue elasticity and glandular fibrosis, related to inflammation in Primary Sjögren's syndrome (pSS). This study aimed to develop a novel technique by pixel analysis for evaluation and interpretation of elastography in MSG in pSS. A cross-sectional and observational multicenter study was conducted. The US of MSG performed in orthogonal planes in grayscale, Doppler, and shear-wave elastography. For elastography images of each gland were analyzed with the open-source program ImageJ to perform a pixel analysis. Statistical analysis was performed with the IBM-SPSS v25 program. Fifty-nine women with a mean age of 57.69 (23-83) years were recruited; pSS mean duration of 87 (5-275) months, and 12 healthy women without sicca symptoms as a control group with a mean age of 50.67 (42-60) years. Intragroup analysis showed p-values >0.05 between sicca symptoms, ocular/dryness tests, biopsy, US, and pixel analysis; correlation between Hocevar and pixel analysis was not found (rho < 0.1, p >0.5). MSG anatomical size was 41.7 ± 28.2 mm vs. 67.6 ± 8.8 mm (p ≤ 0.0001); unstimulated whole saliva flow rate was 0.80 ± 0.80 ml/5 min vs. 1.85 ± 1.27 ml/5 min (p = 0.016). The elastography values (absolute number of pixels) were 572.38 ± 99.21 vs. 539.69 ± 93.12 (p = 0.290). A cut-off point risk for pSS identified with less than 54% of red pixels in the global MSG mass [OR of 3.8 95% CI (1.01-15.00)]. Pixel analysis is a new tool that could lead to a better understanding of the MSG chronic inflammatory process in pSS.

Economic and Epidemiological Impact of an Improvement Plan for the Decrease of Ventilator-Associated Pneumonia in a Tertiary Hospital in Mexico.

INTRODUCTION: The objective of this work is to measure the economic and epidemiological impact of the implementation of a comprehensive quality improvement plan (CQIP) for the prevention and reduction of ventilator-associated pneumonia (VAP) in the adult intensive care unit in a Mexican hospital. MATERIALS AND METHODS: A cross-sectional, ambispective, comparative, analytical, observational study was conducted with epidemiological data on cases of health care-associated infections and with information from the Hospital Epidemiological Surveillance Unit from August 2017 to July 2018. RESULTS: Before to the implementation of the CQIP, there were a total of 26 VAPs, with a rate of 32.2 per 1000 ventilator-days. After the implementation of CQIP, there were 14 VAPs, with a rate of 23.4 per 1000 ventilator-days, with a 46.2% decrease in incidence (P = 0.02). Before the installation of the interventions, the expense was $4,471,073.80, with an average cost per case of $171,964.38. The total cost per bed-day in the adult intensive care unit was $331,280.00, and for hospitalization, the cost was $192,038.00; for the use of antimicrobials, an expense of $749,689.20 was calculated, and for the use of mechanical ventilation, the cost was $2,974,275.60. The percentage of decrease in the cost of VAP after CQIP implementation was 46.5%. CONCLUSIONS: The implementation of CQIP based on the risk evaluation factors of VAP resulted in their decrease, which is reflected in a patient safety and quality care improvement.

Mental health impact by COVID-19 in hospitalized patients sample in Mexico City / Impacto en la salud mental en una muestra de pacientes hospitalizados por COVID-19 en la Ciudad de México

Una de las consecuencias de la pandemia es el aumento de la prevalencia de alteraciones mentales como la ansiedad, la depresión y el estrés. En este estudio transversal y observacional se evaluó la prevalencia de estrés, ansiedad y depresión en pacientes hospitalizados por COVID-19 así como la probable asociación con el impacto emocional recibido por familiares de pacientes hospitalizados por COVID-19. Cuarenta y cinco pacientes hospitalizados por COVID-19 con una edad promedio de 54.4 ± 9.6 años y cincuenta y cinco familiares de pacientes hospitalizados con una edad promedio de 43.2 ± 11.8 años respondieron una batería de preguntas y la encuesta DASS-21. Nuestros resultados revelaron una alta prevalencia de depresión, ansiedad y estrés identificados por DASS-21. En este estudio identificamos factores de riesgo asociados a la salud emocional como la edad (< 50 años: depresión RM = 2.99 [1.31, 6.80] p < .05 y ansiedad RM = 2.83 [1.15, 6.93], p < .05), el género (mujeres: ansiedad RM = 4.13 [1.57, 10.89], p < .05 y estrés RM = 5.38 [2.27, 12.8], p < .05) y el grupo de estudio (familiares: depresión RM = 3.83 [1.63, 8.96]; p < .05 , ansiedad RM = 3.60 [1.46, 8.88]; p < .05 y estrés RM = 3.30 [1.41, 7.70]; p < .05). Además, el género femenino y el nivel socioeconómico bajo de los pacientes (β = 3.23; 1.96) y familiares (β = 1.86; 2.31) se asociaron con puntuaciones más altas en ansiedad (p < .05) y estrés (p < .05). Concluimos que la muestra de pacientes con COVID-19 mantiene una alta prevalencia de alteraciones mentales y que algunos factores sociodemográficos se asocian con la magnitud de estos trastornos.(AU)

One of the consequences of pandemic is the increase in the prevalence of mental alterations such as anxiety, depression and stress. Since here, we aimed to determinate through a transversal and observa-tional studyprevalence of stress, anxiety and depression within hospital-ized patients by COVID-19 as well as their likely association with the emo-tional impact received by relatives with hospitalized patients by COVID-19. Forty-five COVID-19 hospitalized patients with mean age of 54.4 ± 9.6 yearsand fifty-five relatives with mean age of 43.2 ± 11.8 yearsan-swered a questions battery and DASS-21 survey. Our resultsrevealed high prevalence of depression, anxiety and stress assessed by DASS-21 sub-scales. We also identified risk factors associated with the emotional health such as age (<50 years: depression OR=2.99 [1.31, 6.80], p< .05 and anxiety OR=2.83 [1.15,6.93], p< .05), by gender (female: anxiety OR = 4.13 [1.57, 10.89], p< .05 and stress OR = 5.38 [2.27, 12.8], p< .05), by group of study (relatives: depression OR = 3.83 [1.63, 8.96]; p< .05, anxie-ty OR = 3.60 [1.46, 8.88]; p< .05 and stress OR = 3.30 [1.41, 7.70]; p< .05). Additionally, female gender and low socioeconomic status in patients (β= 3.23; 1.96) and relatives (β= 1.86; 2.31) were associated with higher scores in anxiety (p< .05) and stress (p <.05). We concluded that our sample of COVID-19 patients maintain a high prevalence of mental altera-tions and age, gender and socioeconomic status modify the magnitude of these disorders.(AU)

[Tuberculous rheumatism "Poncet's disease". Case report]. / Reumatismo tuberculoso "enfermedad de Poncet". Reporte de caso.

BACKGROUND: Deaths due to tuberculosis have reached 2.5 million cases per year worldwide. Poncet's disease is an infrequent form of tuberculosis characterised by a clinical picture of polyarthritis. CLINICAL CASE: A 24-year-old male presented with morning stiffness, arthralgias, bilateral symmetric arthritis of the proximal interphalangeal joints, wrists, knees, ankles, and shoulders, and adenomegalies at the cervical, submandibular, left supraclavicular, axillary and inguinal levels, without fever. Laboratory results were as follows: ESR 44mm/h, C-reactive protein 4.35, normal levels of complement C3 and C4, negative rheumatoid factor and anticyclic citrullinated peptide antibodies, positive antinuclear antibodies with fine speckled pattern (1:320) and cytoplasm (1:160) pattern and negative anti-Smith, -double-stranded DNA, Sjogren's syndrome-antigen A and Sjogren's syndrome-antigen B. Histological report of cervical node tissue revealed granulomatous lesions compatible with tuberculosis. Rheumatoid arthritis and systemic lupus erythematosus were ruled out. Anti-tuberculosis agents were initiated that resolved the clinical picture. Diagnosis of Poncet's disease was confirmed. CONCLUSION: The differential diagnosis between tuberculosis and autoimmune inflammatory joint diseases is a clinical challenge.

Enfermedad de Poncet: manifestación inusual de tuberculosis / Poncets disease: unusual manifestation of tuberculosis

Resumen LA enfermedad de Poncet es una poliartritis aséptica reactiva poco frecuente que ocurre durante cualquier etapa de una infección activa pulmonar o extrapulmonar por Mycobacterium tuberculosis. Existen apenas 200 casos descritos en la bibliografía y hasta el momento permanece como diagnóstico de exclusión sin patogenia bien definida. Suele responder rápida y satisfactoriamente al tratamiento antituberculoso sin dejar secuelas. Este artículo revisa la epidemiología, patogenia, manifestación clínica, diagnóstico, tratamiento y pronóstico de la enfermedad de Poncet.

Abstract Poncet's disease is a rarely reported aseptic reactive polyarthritis associated to active pulmonary or extrapulmonary infection caused by Mycobacterium tuberculosis. There are no more than 200 cases reported in the literature and still remains as a diagnosis of exclusion with unknown pathogenesis. It quickly and remarkably resolves with antituberculous drugs, has usually a good prognosis and does not turn into chronic arthritis. This article reviews the epidemiology, pathogenesis, clinical presentation, diagnosis, treatment options and prognosis of Poncet's disease.

Policondritis recidivante: informe de un caso y revisión de la literatura / Policondritis: Acase report and review of literature

La policondritis recidivante (RP) es una enfermedad inflamatoria multisistémica caracterizada por lesión del cartílago, oídos, articulaciones y laringe. Su etiología es desconocida. Informamos de un paciente masculino de 48 años de edad, con dos meses de condritis auricular, proteinuria y alteraciones en la audición. La biopsia de cartílago mostró inflamación crónica. El tratamiento con prednisona fue efectivo para suprimir las manifestaciones agudas; sin embargo, ante la progresión del daño renal se administró azatioprina