COVID-19 patients with increasing age experience differential time to initial medical care and severity of symptoms.

We conducted a retrospective observational study in patients with laboratory-confirmed coronavirus disease (COVID-19) who received medical care in 688 COVID-19 ambulatory units and hospitals in Mexico City between 24 February 2020 and 24 December 2020, to study if the elderly seek medical care later than younger patients and their severity of symptoms at initial medical evaluation. Patients were categorised into eight groups (<20, 20-29, 30-39, 40-49, 50-59, 60-69, 70-79 and ≥80 years). Symptoms at initial evaluation were classified according to a previously validated classification into respiratory and non-respiratory symptoms. Comparisons between time from symptom onset to medical care for every age category were performed through variance analyses. Logistic regression models were applied to determine the risk of presenting symptoms of severity according to age, and mortality risk according to delays in medical care. In total, 286 020 patients were included (mean age: 42.8, s.d.: 16.8 years; 50.4% were women). Mean time from symptom onset to medical care was 4.04 (s.d.: 3.6) days and increased with older age categories (P < 0.0001). Mortality risk increased by 6.4% for each day of delay in medical care from symptom onset. The risk of presenting with the symptoms of severity was greater with increasing age categories. In conclusion, COVID-19 patients with increasing ages tend to seek medical care later, with higher rates of symptoms of severity at initial presentation in both ambulatory units and hospitals.

Epidemiological behavior and current forecast of syphilis in Mexico: increase in male population.

OBJECTIVES: Even when new cases of syphilis are notifiable since 1944, the Mexican National Epidemiological Surveillance System lacks information on the changes of the rate of case reports considering the geographic and demographic variables. Therefore, it is necessary to have evidence, with particular attention to the study of the epidemiological behavior by the identification of risk factors and groups. The objective of this study was to analyze the epidemiology, geographical distribution, and forecast of syphilis in Mexico. STUDY DESIGN: The design of the study was a secondary research of epidemiological databases. METHODS: A retrospective analysis of the national surveillance data (2007-2017) of acquired and congenital syphilis (CS) issued by the General Directorate of Epidemiology was performed. RESULTS: Of all cases, 34,998 and 1030 cases were reported for acquired syphilis (AS) and CS , respectively, reflecting an increasing trend in the whole country for both diseases. Cases and incidence of AS per year showed that, male gender presented an increase in reproductive age. Distribution of the rate of case reports is mostly commanded by the states in the extreme north (Gulf of California and northern Gulf of Mexico) and south (Gulf of southern Mexico and the Caribbean Sea). Likewise, the Seasonal Autoregressive Integrated Moving Average model was selected as the best-fit model for the forecast analysis. This model was used to forecast AS cases during 2018-2019. AS may have a slight fluctuation (on the rise) during the following 24 months. CONCLUSIONS: These findings underscore the importance of intensifying, as well as expanding screening and treatment in adult population, including men, who are not routinely benefiting from maternal and reproductive service-based syphilis screening and treatment.

T-cell tolerance as a potential effect of congenital leishmaniasis on offspring immunity.

Congenital transmission of leishmaniasis is recognized in cases detected by passive surveillance. Most cases are from low-resource countries, limiting the study of several important aspects of this route of infection, including the offspring's immune response. Studies on natural and experimentally infected animals suggest that parasites might be transmitted to the embryo or foetus at any time during pregnancy. As immune system undergoes sequential stages of development, an infection before the time of self-recognition could lead to central tolerance, making an individual specifically tolerant and susceptible to infection. In the alternative scenario, infection after self-recognition would allow the proper development of T-lymphocyte clones in response to Leishmania antigens, providing resistance to the disease. Newborns undergo a transient period of low expression of several immune surface molecules and a naïve adaptive immune response with no memory, which together might contribute to slow elimination of the parasite over several months. This insight is a proposed independent mechanism of the previously proven T-cell exhaustion and must be investigated. Analyses of infected placenta, cord blood and infant immunity are required for a better understanding of immunity in congenital leishmaniasis infection.

Evolution of incidence and geographical distribution of Chagas disease in Mexico during a decade (2007-2016).

Chagas disease, whose aetiological agent is the protozoan Trypanosoma cruzi, mainly occurs in Latin America. In order to know the epidemiology and the geographical distribution of this disease in Mexico, the present work analyses the national surveillance data (10 years) for Chagas disease issued by the General Directorate of Epidemiology (GDE). An ecological analysis of Chagas disease (2007-2016) was performed in the annual reports issued by the GDE in Mexico. The cases and incidence were classified by year, state, age group, gender and seasons. A national distribution map showing Chagas disease incidence was generated. An increase of new cases was identified throughout the country (rates from 0.37 to 0.81 per 100 000 inhabitants). Of the total cases accumulated (7388), the major cases were attributed to the states of Veracruz, Chiapas, Quintana Roo, Oaxaca, Morelos and Yucatán. The analysis per age groups and gender revealed that, in most age groups, the incidence was higher in the male population. The most number of cases was identified in spring and summer; a direct relationship between the environmental temperature increase and the number of new cases was identified. The analysis showed that the rate of Chagas disease increased presumably due to state programmes; the search for new cases has expanded and we speculate that the disease is associated with occupational activities. These results summarise and recall how important it is to implement the monitoring of Chagas disease mainly in south states of the Mexican Republic in order to implement strategies to control this disease.

Beneficial effects of the n-3 long-chain polyunsaturated fatty acids in surgical patients: updating the evidence.

The use of n-3 polyunsaturated fatty acids in surgical patients has risen by the fact that this may attenuate systemic and acute inflammatory responses secondary to surgical trauma through modulation of inflammatory mediators and cell membrane interactions. Moreover, the inclusion of n-3 fatty acids in clinical trials as part of the therapy in patients, who expect to undergo a surgical stress, suggests benefits on clinical progress. Therefore, the objective of this article is to review data from n-3 polyunsaturated fatty acid effects on biochemical parameters and on reduced length of hospitalization, number of infections, and mortality as main clinical outcomes in human surgical patients.

Social and economic factors influencing a fetal surgery program for complicated monochorionic twin pregnancies in a developing country.

OBJECTIVE: To analyze social and economic factors affecting the implementation of a fetal surgery program in a developing country. MATERIALS AND METHODS: During an 18-month period, 30 women with complicated monochorionic diamniotic twin pregnancies were evaluated. 27 women had twin-to-twin transfusion syndrome (TTTS), 2 women had a selective intrauterine growth restriction, and 1 a discordant twin pregnancy with 1 fetus with a severe open neural tube defect. The TTTS cases were treated with fetoscopic laser ablation of the interplacental vascular communications and the remaining 3 cases with bipolar cord occlusion of the affected twin. The patients were evaluated using family income levels (very low, low, median, and high income). Demographic characteristics, gestational age at referral, the prevalence of infections, tocolysis care with hospital readmission, prolonged hospital stay until delivery, and gestational age at delivery were evaluated. RESULTS: The overall survival rate of fetuses treated with laser ablation was 60% (32/54). Survival of at least 1 twin was achieved in 21/27 pregnancies (77%), and survival of both twins in 12/27 pregnancies (44%). The 3 pregnancies treated with cord occlusion had survival of the normal twin. Patients with low and very low family income showed a significantly higher prevalence of vaginal infections, increased periods of tocolysis requiring hospitalization, prolonged hospital stay until the end of pregnancy, and lower gestational age at delivery. CONCLUSION: When a fetal surgery program is implemented in a developing country, social and economic factors will influence the overall healthcare costs and treatment outcomes.

Amniotic fluid interleukin-6 and the risk of early-onset sepsis among preterm infants.

BACKGROUND: High concentrations of interleukin-6 (IL-6) have been demonstrated in amniotic fluid (AF) from women with intra-amniotic infection. Recent studies have reported that IL-6 levels in AF were related to an increase in neonatal morbidity; moreover, higher IL-6 plasma levels have been observed in neonates with sepsis. METHODS: A cohort study was carried out at the National Institute of Perinatology in Mexico City. Inclusion criteria were the following: 1) preterm singleton pregnancy; 2) intact membranes at time of enrollment, and 3) written informed consent. Women with other complications of pregnancy were excluded. Newborn sepsis during the first 72 h was defined as early-onset sepsis. Amniotic fluid was obtained at the moment of delivery. Amniotic fluid IL-6 (AF IL-6) was determined by enzyme-linked immunoassays. RESULTS: Ninety-three women met the criteria for enrollment in the study and 31 (33%) of their newborns had early-onset neonatal sepsis. The mean AF IL-6 in mothers of septic newborns was 5779 +/- 2804 pg/ml compared to 729 +/- 382 pg/ml in mothers with non-infected neonates (p < 0.001). AF IL-6 concentrations higher than 1250 pg/ml were significantly associated with early-onset sepsis (OR 33.3; 95% CI 9.4-117.3) (p < 0.001). Gestational age under 32 weeks was also associated with neonatal sepsis (OR 2.56; 95% CI 1.2-9) (p = 0.002). Women whose infants developed neonatal sepsis had a higher frequency of clinical chorioamnionitis (p = 0.02). CONCLUSIONS: IL-6 determination in AF may be a useful indicator to identify neonates with higher risk of in utero bacterial infection.

[Phosphatidylcholine induces an increase in the production of interleukin-6 and improves survival of rats with neonatal sepsis caused by Klebsiella pneumoniae]. / La fosfatidilcolina induce un aumento en la producción de interleucina-6 y mejora la sobrevida de ratas con sepsis neonatal por Klebsiella pneumoniae.

Infections by gram-negative bacteria are one of the major causes of death in newborns. Bacterial clearance is deficient in septic neonates, which seems to increase their susceptibility to infections. In this study, we observed a significant improvement in clearance of Klebsiella pneumoniae in newborn wistar rats inoculated by intraperitoneal via with 800 mg k soybean phosphatidylcholine (PC), compared to the control group injected with PBS (p 0.05). The overall survival rate was improved (p 0.05) and the white blood cell counts showed a greater leukocytosis and neutrophilia during the peak of bacteremia in the PC treated animals. Circulating levels of interleukin-6 were greater in the PC group, which developed an intense splenic hematopoiesis of the granulocyte (p 0.05) and megakariocyte series (p 0.01). No significant changes were observed in bone marrow granulocyte deposits in both study groups. The improvement in survival rate, the changes in leukocyte counts and the splenic hematopoiesis may be associated with the increased production of IL-6. These results suggest that IL-6 plays a role in the protection mechanism induced by PC in this experimental model of newborn septicemia. PC seems to be an immunomodulator of the acute response to gram-negative bacterial infection.

[Septic shock in newborn infants]. / Choque séptico en neonatos.

Systemic bacterial infections continue to be a main cause of death in newborns at neonatal intensive care units (NICU), worldwide. Bacteria causing neonatal septicemia are mainly the gram-negative, which possess endotoxin and are responsible for endotoxic shock. However, gram-positive bacteria are also able to induce septic shock, especially in immunocompromised hosts, like the newborns. Diagnosis and treatment of neonatal septic shock are quite difficult. Furthermore, there is not sufficient knowledge about its real frequency in Latin-american countries. The hyperdynamic phase of septic shock in newborns can be short and the hypodynamic phase is rapidly established, which increases the mortality. Since few years ago, some important aspects of physiopathology in septic shock have been studied and, at the same time that our knowledge about immunologic soluble mediators is increasing, new therapeutic modalities have been discovered. Such is the case of the therapeutic potentialities of cytokines, receptor antagonists and monoclonal antibodies, which is very encouraging at the present time.

[Intravenous immunoglobulin in the treatment of neonatal septicemia]. / Inmunoglobulina intravenosa en el tratamiento de septicemia neonatal.

Thirty-seven neonates with confirmed septicemia through hemoculture were studied. Of them, 18 were treated with antibiotic and the other 19 were given 500 mg/kg of intravenous immunoglobin with a pH of 4.25 (IGIV). The greater part of the neonates in this study were full-term or near full-term. There were no differences in age, gestational age and weight, nor in mortality, the bacterias found and the clinical manifestations which were seen in both groups. Yet, the hospitalary stay was shorter for those in the group treated with IGIV (13.9 +/- 5.7 days) than in the trial group (24.4 +/- 10.3 days); as well as some clinical manifestations like diarrhea and splenomegalia (P < 0.05). The serum of the neonates from the IGIV group showed a greater capacity of opsonization and inhibition of bacterial growth than those in the trial group (P < 0.001), coinciding with an increase of 300 mg/dL in the serum levels of IgG of the group treated with IGIV from the 3rd day of the study and the C4 and B-Properdine factor serum levels from the 7th day of the study, while in the trial group, there were no changes in these factors (P < 0.001). Even though no differences were seen in the mortality rate due to septicemia, the results suggest a much shorter evolution of the illness in patients treated with IGIV. In addition, the serum of those patients treated with IGIV showed in in vitro studies, a better bacteriostatic activity and a better capacity to opsonize the bacterias isolated in the hemocultures.(ABSTRACT TRUNCATED AT 250 WORDS)

[Neonatal septicemia: differences in full-term and pre-term newborn infants]. / Septicemia neonatal: diferencias entre recién nacidos a término y de pretérmino.

Neonatal septicemia was assessed by blood cultures in 115 newborns (NB) during a two years study in a pediatric hospital of reference in Mexico City. The studied patients were divided in two groups of gestational age, and the differences of etiologic agents, clinical signs, laboratory findings and clinical outcome were compared at term and preterm neonates. We observed Staphylococcus epidermidis became the first cause of septicemia in at term NB (P less than 0.001), while Escherichia coli and Klebsiella pneumoniae (P less than 0.01) were more frequent in the preterm neonates. The clinical manifestations of fever (P less than 0.001), hepatomegaly (P less than 0.01), splenomegaly (P less than 0.05), and rejection to feeding (P less than 0.05) were more common in at term NB. On the other hand, apneas (P less than 0.01), hypothermia (P less than 0.02), and abdominal distension (P less than 0.05) were more frequent in the preterm NB. The altered white blood cell counts were more commonly observed in the preterm group, as leukopenia (P less than 0.05), neutropenia (P less than 0.01), and high I/T ratio (P less than 0.05). There were not significant differences in complications or sequels between the two groups; however, the mortality ratio was higher in the preterm NB group (P less than 0.02). Changing etiology of neonatal septicemia is discussed, and we propose these kind of data are very useful for purpose of detection, diagnostic and treatment of septic neonates.

[Diarrhea associated with Trichomonas hominis in a newborn infant]. / Diarrea asociada a Trichomonas hominis en un neonato.

One female newborn infant with protracted diarrhea in whom associated Trichomonas homonis trophozoites were identified, is presented. Diarrhea in the infant persisted more than 30 days while in the hospital. Another causes of diarrhea, such as metabolic disorders, and bacterial, parasitic or viral infections were not identified. When furazolidone treatment was administered, the therapeutic response was very good, diarrhea disappeared and normal weight increase rate was recovered. It is pointed out that T. hominis might be a potential intestinal pathogen on human beings, specially on immunocompromised hosts, as newborn and malnourished infants are.

[Frequency of neonatal necrotizing enterocolitis at a pediatric hospital]. / Frecuencia de enterocolitis necrosante neonatal en un hospital pediátrico.

A revision study of 322 cases of neonatal necrotizing enterocolitis (NEC) in a six year period at a pediatric hospital is presented. The frequency of NEC was 7.2% of the newborn (NB) admitted to the hospital. Fifty two percent corresponded to grade I on Bell's classification, 37% to grade II and 11% to grade III. Most of the cases were seen in at term newborn (51.3%) even though the proportional frequency in relation to the admissions was 38% in at term newborn and 62% in premature. The main clinical manifestations were abdominal distention, vomiting, and blood in feces. The frequency and intensity of other clinical signs as well as other signs as acidosis, anemia, hyponatremia and hypoprothrombinemia were directly proportional to the severity of the NEC. The radiological data of portal pneumatosis were more frequent in grade III NEC, and several cases of gastric pneumatosis were seen in the grade II NEC. Thirty four patients (10.6%) underwent surgery. The global mortality was 29.5% and in those who underwent surgery 79.4%.

[Therapeutic effectiveness of an intravenous immunoglobulin with pH 4.25 in experimental neonatal sepsis caused by Klebsiella pneumoniae]. / Efectividad terapéutica de inmunoglobulina intravenosa pH 4.25 en sepsis neonatal experimental por Klebsiella pneumoniae.

The in vitro opsonic activity and in vivo therapeutic effect of an intravenous immunoglobulin (IGIV) pH 4.25 against Klebsiella pneumoniae were evaluated in this study. By an opsonophagocytic assay in microtiter plates, bacteria were opsonized with IGIV pH 4.25, 10% rabbit serum, or 10% rabbit serum heated at 56 degrees C for 30 minutes. Opsonized bacteria were challenged with polymorphonuclear leukocytes (PMNs) from normal adults and bacterial killing was measured at 60 and 150 minutes. Forty-four newborn Wistar rats were infected subcutaneously with a 75% lethal dose of Klebsiella pneumoniae, and 90 minutes after, 24 rats were assigned to receive 500 mg/kg of IGIV pH 4.25 by intraperitoneal route and the remaining 20 animals received an equal volume injection of PBS. Animal survival was observed during a ten-day period. The best bacterial killing index was reached when bacteria were previously opsonized with IGIV pH 4.25 at 60 minutes (p less than 0.001), as well as at 150 minutes (p less than 0.0001) of challenge with PMNs. Newborn rat survival was better in the IGIV group (17/24), than PBS group (5/20), with significant statistical difference (p = 0.0029). These data suggest IGIV pH 4.25 can be a useful adjunct in the treatment of Klebsiella pneumoniae newborn sepsis.