Protecting vulnerable communities and health professionals from COVID-19 associated mental health distress: a comprehensive approach led by a public-civil partnership in rural Chiapas, Mexico.

BACKGROUND: The COVID-19 pandemic has stricken mental health worldwide. Marginalized populations in low- and middle-income countries have been the most affected, as they were already experiencing barriers to accessing mental health care prior to the pandemic and are unequally exposed to the stressors associated with the health emergency, such as economic ravages or increased risk of complicated disease outcomes. OBJECTIVE: The aim of this paper is to describe a comprehensive initiative resulting from a public-civil partnership to address the increased burden of mental health illness associated with the COVID-19 pandemic in rural Chiapas, Mexico. METHODS: To address the emerging health needs of the general population and health professionals resulting from the pandemic, Compañeros En Salud (CES), a non-profit civil society organization based in Chiapas, implemented a comprehensive strategy to compensate for the shortage of mental health services in the region in collaboration with the Chiapas Ministry of Health. The strategy included three components: capacity building in mental health care delivery, psychosocial support to the general population, and provision of mental health care to CES collaborating staff. In this capacity building article, implementers from CES and the government share descriptive information on the specific interventions carried out and their beneficiaries, as well as a critical discussion of the strategy followed. RESULTS: Through this strategy, we have been successful in filling the gaps in the public health system to ensure that CES-served populations and CES-collaborating health professionals have access to mental health care. However, further studies to quantify the impact of this intervention in alleviating the burden of mental health illnesses associated with the pandemic are needed. CONCLUSIONS: The current situation represents an opportunity to reimagine global mental health. Only through the promotion of community-based initiatives and the development of integrated approaches will we ensure the well-being of marginalized populations.

Leishmaniasis visceral refractaria al tratamiento con antimoniales: descripción de un caso / Refractary visceral leishmaniasis to antimonial treatment: one case description

Describimos el caso de una niña de 30 meses de edad, procedente del Estado Guárico, un foco endémico antiguo de Kala-azar, quien tras haber recibido 7 ciclos con antimonial pentavalente, a elevadas dosis y a intervalos irregulares, persistía con evidencia clínica y presencia del parásito Leishmania en médula ósea además de pancitopenia, hepatoesplenomegalia y fiebre. Se inició tratamiento con anfotericina B a dosis de 0,05 mg/kg peso/día de inicio, con incremento gradualmente hasta alcanzar 1 mg/Kg peso/día y, con una dosis total acumulada de 1 gramo. Se obtuvo excelente respuesta clínica y tolerancia a la droga, con escasos efectos colaterales. Al finalizar el tratamiento, se demostró la ausencia del parásito Leishmania mediante aspirado de médula ósea. Se describe el 5º caso conocido oficialmente, de Kala-azar en la población pediátrica, refractario al tratamiento convencional