Factors associated with tuberculosis disease in children from a hospital in Western Mexico.

BACKGROUND: This study aimed to describe the clinical and demographic characteristics of children with confirmed tuberculosis disease and identify associated factors. METHODS: We conducted a retrospective and observational study at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Inpatient and outpatient children under 18 years of age who were reported to the National Epidemiological Surveillance System (SINAVE, for its Spanish acronym) for suspected tuberculosis and who had molecular or microbiological tests for mycobacteria were included in the study. Multivariate analysis with logistic regression was used to analyze associated factors. RESULTS: One hundred and nine patients under 18 years of age with suspected tuberculosis were included in the study. About 50.5% (55/109) were male, and the median age was 11 years. Tuberculosis was confirmed in 55% (n = 60): 15% (9/60) had a pulmonary infection, and the rest (51/60) had an extrapulmonary infection. The diagnostic tests used were histopathological study (n = 26), expectoration or gastric aspirate stains (n = 17), polymerase chain reaction (n = 12), and cultures (n = 5). Positive purified protein derivative (PPD) or interferon-gamma release assay (IGRA) tests were found in 33.9%. Malnutrition (odds ratio [OR] 15.9, 95% confidence interval [CI]: 2.3-109), and consumption of unpasteurized products (OR 7.45, 95% CI: 1.02-54.3) were associated with tuberculosis disease in children. CONCLUSIONS: Malnutrition and consumption of unpasteurized dairy products are associated with tuberculosis.

INTRODUCCIÓN: El objetivo de este estudio fue describir las características clínicas y demográficas de niños con enfermedad tuberculosa confirmada e identificar los factores asociados. MÉTODOS: Se realizó un estudio observacional retrolectivo en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron menores de 18 años hospitalizados y ambulatorios que se notificaron al Sistema Nacional de Vigilancia Epidemiológica (SINAVE) por sospecha de tuberculosis y que contaron con pruebas moleculares o microbiológicas para micobacterias. El estudio de los factores asociados se realizó mediante análisis multivariado con regresión logística. RESULTADOS: Se incluyeron en el estudio 109 menores de 18 años con sospecha de tuberculosis. El 50.5% (55/109) fueron de sexo masculino y la mediana de edad fue de 11 años. Se confirmó enfermedad tuberculosa en el 55% (n = 60) de los casos: el 15% (9/60) presentaron infección pulmonar y el resto extrapulmonar. Las pruebas diagnósticas utilizadas fueron el estudio histopatológico (n = 26), tinciones de expectoración o aspirado gástrico (n = 17), reacción en cadena de la polimerasa (n = 12) y cultivos (n= 5). 33.9% de los pacientes presentaron prueba de derivado proteico purificado (PPD) o ensayo de liberación de interferón gamma (IGRA) positiva. Se observó que la desnutrición (razón de momios (RM) 15.9, intervalo de confianza (IC) 95% 2.3 ­ 109) y el consumo de productos no pasteurizados (RM 7.45, IC 95% 1.02 ­ 54.3) se asociaron con enfermedad tuberculosa en niños. CONCLUSIONES: La desnutrición y el consumo de lácteos no pasteurizados se asocian con la enfermedad tuberculosa.

Factors associated with tuberculosis disease in children from a hospital in Western Mexico / Factores asociados con enfermedad tuberculosa en niños de un hospital del occidente de México

Abstract Background: This study aimed to describe the clinical and demographic characteristics of children with confirmed tuberculosis disease and identify associated factors. Methods: We conducted a retrospective and observational study at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Inpatient and outpatient children under 18 years of age who were reported to the National Epidemiological Surveillance System (SINAVE, for its Spanish acronym) for suspected tuberculosis and who had molecular or microbiological tests for mycobacteria were included in the study. Multivariate analysis with logistic regression was used to analyze associated factors. Results: One hundred and nine patients under 18 years of age with suspected tuberculosis were included in the study. About 50.5% (55/109) were male, and the median age was 11 years. Tuberculosis was confirmed in 55% (n = 60): 15% (9/60) had a pulmonary infection, and the rest (51/60) had an extrapulmonary infection. The diagnostic tests used were histopathological study (n = 26), expectoration or gastric aspirate stains (n = 17), polymerase chain reaction (n = 12), and cultures (n = 5). Positive purified protein derivative (PPD) or interferon-gamma release assay (IGRA) tests were found in 33.9%. Malnutrition (odds ratio [OR] 15.9, 95% confidence interval [CI]: 2.3-109), and consumption of unpasteurized products (OR 7.45, 95% CI: 1.02-54.3) were associated with tuberculosis disease in children. Conclusions: Malnutrition and consumption of unpasteurized dairy products are associated with tuberculosis.

Resumen Introducción: El objetivo de este estudio fue describir las características clínicas y demográficas de niños con enfermedad tuberculosa confirmada e identificar los factores asociados. Métodos: Se realizó un estudio observacional retrolectivo en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron menores de 18 años hospitalizados y ambulatorios que se notificaron al Sistema Nacional de Vigilancia Epidemiológica (SINAVE) por sospecha de tuberculosis y que contaron con pruebas moleculares o microbiológicas para micobacterias. El estudio de los factores asociados se realizó mediante análisis multivariado con regresión logística. Resultados: Se incluyeron en el estudio 109 menores de 18 años con sospecha de tuberculosis. El 50.5% (55/109) fueron de sexo masculino y la mediana de edad fue de 11 años. Se confirmó enfermedad tuberculosa en el 55% (n = 60) de los casos: el 15% (9/60) presentaron infección pulmonar y el resto extrapulmonar. Las pruebas diagnósticas utilizadas fueron el estudio histopatológico (n = 26), tinciones de expectoración o aspirado gástrico (n = 17), reacción en cadena de la polimerasa (n = 12) y cultivos (n= 5). 33.9% de los pacientes presentaron prueba de derivado proteico purificado (PPD) o ensayo de liberación de interferón gamma (IGRA) positiva. Se observó que la desnutrición (razón de momios (RM) 15.9, intervalo de confianza (IC) 95% 2.3 - 109) y el consumo de productos no pasteurizados (RM 7.45, IC 95% 1.02 - 54.3) se asociaron con enfermedad tuberculosa en niños. Conclusiones: La desnutrición y el consumo de lácteos no pasteurizados se asocian con la enfermedad tuberculosa.

Incidencia y factores asociados con las reacciones adversas tras la primera dosis de la vacuna Pfizer-BioNTech en trabajadores de la salud.

OBJECTIVE: To determine the incidence of adverse reactions (AR) after the first dose of Pfizer-BioNTech vaccine, and to identify some factors associated with AR. METHOD: A retrospective cohort study was conducted. Data were obtained through an epidemiological survey answered online. Multivariate analyses were performed to identify factors associated with early (< 2 h) and late (≥ 2 h) AR. RESULTS: A total of 2295 health care workers were included; in them, the cumulative incidence of AR was 18.2% (95% confidence interval: 16.6-19.8), where the majority were late (78.2%). The associated factors that increased the risk of early AR were being female (odds ratio [OR]: 2.23, p = 0.002) and belonging to the medical staff (OR: 1.56; p = 0.041). In late AR were being female (OR: 1.94; p < 0.0001); on the other hand, diabetes (OR: 0.46; p = 0.021), asthma (OR: 0.53; p = 0.040) and smoking (OR: 0.44, p = 0.002) were inversely associated factors. Interestingly, history of COVID-19 was not associated with either early or late AR. CONCLUSIONS: The risk of presenting some type of AR due to the Pfizer-BioNTech vaccine in health care workers is < 20%.

OBJETIVO: Determinar la incidencia de reacciones adversas (RA) tras la primera dosis de la vacuna Pfizer-BioNTech e identificar algunos factores asociados con ellas. MÉTODO: Se realizó un estudio de cohorte retrospectiva. Los datos fueron obtenidos mediante una encuesta epidemiológica contestada en línea. Se realizaron análisis multivariados para identificar factores asociados con las RA tempranas (< 2 h) y tardías (≥ 2 h). RESULTADOS: Se incluyeron 2295 trabajadores de la salud; en ellos, la incidencia acumulada de RA fue del 18.2% (intervalo de confianza del 95%: 16.6-19.8%) y la mayoría fueron tardías (78.2%). Las RA tempranas más frecuentes fueron dolor local, cefalea y mareo; en las tardías fueron dolor local, cefalea y fatiga. No se documentaron casos de anafilaxia; sin embargo, en el grupo de RA tempranas y tardías hubo un caso y tres casos, respectivamente, con síntomas sistémicos que afectaron a dos órganos diferentes. Los factores asociados que incrementaron el riesgo de RA tempranas fueron ser mujer (odds ratio [OR]: 2.23; p = 0.002) y pertenecer al personal médico (OR: 1.56; p = 0.041). En las RA tardías fue ser mujer (OR: 1.94; p < 0.0001); por su parte, la diabetes (OR: 0.46; p = 0.021), el asma (OR: 0.53; p = 0.040) y el tabaquismo (OR: 0.44; p = 0.002) fueron factores asociados inversamente. Es interesante que la historia de COVID-19 no se asoció con RA tempranas ni tardías. CONCLUSIONES: El riesgo de presentar algún tipo de RA debido a la vacuna Pfizer-BioNTech en trabajadores de la salud es < 20%.

Diseño de un instrumento para evaluar las actividades profesionales confiables en cirugía general.

AIM: Competency-based medical education has become increasingly prevalent among surgical accreditation bodies that conduct assessments to ensure the competency of future professionals and judge the adequacy of training programs. MATERIALS AND METHODS: Cross-sectional study to validate an instrument to evaluate entrustable professional activities (EPA) according to the Single Program of Medical Specialties through content and construct validity by expert judgment, and internal consistency with Cronbach's alpha. RESULTS: Four of the rubrics scored high to optimal for univocity and relevance. Only one rubric had to be modified in two of its items. Internal consistency was high (Cronbach's alpha of 0.97). When applying the instrument, the residents showed differences in the level of competence according to postgraduate year, identifying better performance in the last year. DISCUSSION: The instrument was validated with a high degree of reliability in univocity and relevance, and high internal consistency. The residents demonstrated appropriate EPA to manage surgical patients safely, efficiently, with quality and warmth. The ability to reach the strategic level of performance is the main component of the competency-based medical education through the EPA.

OBJETIVO: La educación médica basada en competencias se ha vuelto cada vez más frecuente entre los organismos de acreditación quirúrgica que realizan evaluaciones para asegurar la competencia de los futuros profesionales y juzgar la idoneidad de los programas de formación. MATERIAL Y MÉTODOS: Estudio transversal para validar un instrumento para evaluar las actividades profesionales confiables (APC) según el Programa Único de Especialidades Médicas mediante validez de contenido y constructo por juicio de expertos, y consistencia interna con alfa de Cronbach. RESULTADOS: Cuatro de las rúbricas obtuvieron nivel alto a óptimo para univocidad y relevancia. Solo una rúbrica debió ser modificada en dos de sus ítems. La consistencia interna fue alta (alfa de Cronbach de 0.97). Al aplicar el instrumento, los residentes mostraron diferencias en el nivel competencial según el año de posgrado, identificando mejor desempeño el último año. DISCUSIÓN: El instrumento fue validado con un alto grado de fiabilidad en univocidad y relevancia, y una alta consistencia interna. Los residentes demostraron poseer las APC necesarias para tratar pacientes quirúrgicos de manera segura, eficiente, con calidad y calidez. La capacidad para alcanzar el nivel estratégico de desempeño es el componente principal de la educación médica basada en competencias a través de las APC.

Implementation of the Pediatric Index of Mortality 3 and the pediatric Sequential Organ Failure Assessment in an intensive care unit in Mexico. / Aplicación del índice de mortalidad pediátrica 3 y evaluación de falla orgánica secuencial pediátrica en una unidad de cuidados intensivos en México.

INTRODUCTION: The study objective was to analyze the Pediatric Index of Mortality 3 (PIM 3) and the pediatric Sequential Organ Failure Assessment (pSOFA) for the prediction of mortality. OBJECTIVE: Observational, prospective study; patients aged 1 month to 17.9 years were included. Assessment of area under the curve (AUC) accuracy and estimation of standardized mortality rate. RESULTS: A total of 244 admissions were studied: median age was 60 months. The main diagnoses were solid or hematologic neoplasms (26.5%). The mortality by admission was 18% (44/244). The AUC was 0.77 for PIM 3 and 0.81 for pSOFA; both scales showed an adequate calibration (p > 0.05). The standardized mortality rate was 1.91. CONCLUSIONS: We identified that the PIM 3 and pSOFA have an acceptable discrimination power. The calibration of the PIM 3 was not adequate in patients with solid or hematologic neoplasms.

Introducción. El objetivo del estudio fue analizar el índice de mortalidad pediátrica 3 (PIM 3) y la evaluación de falla orgánica secuencial pediátrica (pSOFA) para predicción de muerte. Métodos. Estudio observacional prospectivo; se incluyeron pacientes de 1 mes a 17,9 años. La precisión se evaluó con el área bajo la curva (AUC) y se estimó la tasa de mortalidad estandarizada. Resultados. Se estudiaron 244 ingresos; la mediana de edad fue 60 meses. Los diagnósticos principales fueron neoplasias sólidas o hematológicas (26,5 %). La mortalidad por ingresos fue del 18 % (44/244). Para PIM 3 el AUC fue de 0,77 y para pSOFA, de 0,81; ambas escalas mostraron adecuada calibración (p > 0,05). La tasa de mortalidad estandarizada fue de 1,91. Conclusiones. Identificamos que las escalas de evaluación de mortalidad PIM 3 y pSOFA muestran capacidad de discriminación aceptable. En pacientes con neoplasias sólidas o hematológicas, PIM 3 no mostró adecuada calibración.

Aplicación del índice de mortalidad pediátrica 3 y evaluación de falla orgánica secuencial pediátrica en una unidad de cuidados intensivos en México / Implementation of the Pediatric Index of Mortality 3 and the pediatric Sequential Organ Failure Assessment in an intensive care unit in Mexico

Introducción. El objetivo del estudio fue analizar el índice de mortalidad pediátrica 3 (PIM 3) y la evaluación de falla orgánica secuencial pediátrica (pSOFA) para predicción de muerte. Métodos. Estudio observacional prospectivo; se incluyeron pacientes de 1 mes a 17,9 años. La precisión se evaluó con el área bajo la curva (AUC) y se estimó la tasa de mortalidad estandarizada. Resultados. Se estudiaron 244 ingresos; la mediana de edad fue 60 meses. Los diagnósticos principales fueron neoplasias sólidas o hematológicas (26,5 %). La mortalidad por ingresos fue del 18 % (44/244). Para PIM 3 el AUC fue de 0,77 y para pSOFA, de 0,81; ambas escalas mostraron adecuada calibración (p > 0,05). La tasa de mortalidad estandarizada fue de 1,91. Conclusiones. Identificamos que las escalas de evaluación de mortalidad PIM 3 y pSOFA muestran capacidad de discriminación aceptable. En pacientes con neoplasias sólidas o hematológicas, PIM 3 no mostró adecuada calibración.

Introduction. The study objective was to analyze the Pediatric Index of Mortality 3 (PIM 3) and the pediatric Sequential Organ Failure Assessment (pSOFA) for the prediction of mortality. Methods. Observational, prospective study; patients aged 1 month to 17.9 years were included. Assessment of area under the curve (AUC) accuracy and estimation of standardized mortality rate. Results. A total of 244 admissions were studied: median age was 60 months. The main diagnoses were solid or hematologic neoplasms (26.5%). The mortality by admission was 18% (44/244). The AUC was 0.77 for PIM 3 and 0.81 for pSOFA; both scales showed an adequate calibration (p > 0.05). The standardized mortality rate was 1.91. Conclusions. We identified that the PIM 3 and pSOFA have an acceptable discrimination power. The calibration of the PIM 3 was not adequate in patients with solid or hematologic neoplasms.

Incidence and factors associated with invasive candidiasis in a neonatal intensive care unit in Mexico.

INTRODUCTION: Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico. METHODS: Case-control study nested in a cohort and matched for birth weight. We estimated the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression. RESULTS: The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04, 95% CI 1.13-8.14), systemic antibiotics (OR 7.48, 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02, 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14, 95% CI 1.04-1.25) or with venous catheter central (OR 1.11, 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32, 95% CI 0.12-0.84). CONCLUSIONS: Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective.

Cuidado para el desarrollo Infantil. Estudio de caso: la experiencia del Perú / Child development care. Case study: the experience of Peru

El presente estudio de caso describe la integración del enfoque Cuidado para el Desarrollo Infantil (CDI) en las políticas públicas y en las prácticas de los agentes de distintos sectores y servicios del Perú, que ofrecen atenciones para la primera infancia y apoyo a las familias. CDI es un enfoque basado en evidencia que enriquece y fortalece los servicios existentes de atención a niños, niñas y sus cuidadores, mediante el fortalecimiento de las capacidades y los conocimientos de tomadores de decisión, gestores públicos y prestadores de servicios para brindar orientación a las familias sobre prácticas de crianza en un marco de cuidado cariñoso y sensible. Lo anterior incluye proporcionar a las niñas y los niños pequeños salud, alimentación, protección, nutrición y suficientes y apropiadas oportunidades de aprendizaje a través del juego y la comunicación en un entorno seguro

[Incidence and factors associated with invasive candidiasis in a neonatal intensive care unit in Mexico]. / Incidencia y factores asociados a candidiasis invasiva en una unidad de cuidados intensivos neonatales de México.

INTRODUCTION: Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico. METHODS: Case-control study nested in a cohort and matched for birth weight. We estimate the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression. RESULTS: The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04; 95% CI 1.13-8.14), systemic antibiotics (OR 7.48; 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02; 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14; 95% CI 1.04-1.25) or with venous catheter central (OR 1.11; 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32; 95% CI 0.12-0.84). CONCLUSIONS: Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective.

Evaluation of two microcosm systems for co-treatment of LDPEoxo and lignocellulosic biomass for biochar production.

BACKGROUND: The co-transformation of solid waste of natural and anthropogenic origin can be carried out through solid-state-fermentation systems to obtain bio-products with higher added value and lower environmental impact. METHODS: To evaluate the effect of Pleurotus ostreatus on co-transformation of oxo-degradable low-density polyethylene (LDPEoxo) sheets and lignocellulosic biomass (LCB), were assembled two 0.75 L microcosm systems in vertical (VMS) and horizontal (HMS) position. The pre-treated sheets with luminescent O2 plasma discharges were mixed with pine bark, hydrolyzed brewer's yeast and paper napkin fragments and incubated for 135 days at 20 ± 1.0 °C in the presence of the fungus. With the co-transformation residues, biochar (BC) was produced at 300 ± 1.0 °C (BC300) for 1 h, then used to carry out adsorption studies, using the malachite green dye (MG) at pH 4.0, 7.0 and 9.0 ± 0.2. Finally, the biochar was the substrate for the germination of carnation seeds (Dianthus caryophyllus) and Ray-grass (Lolium sp.) in vitro. RESULTS: For HMS, the decrease in static contact angle (SCA) was 63.63% (p = 0.00824) and for VMS 74.45% (p = 0.00219), concerning the pristine. Plastic roughness in VMS was higher (26%) concerning the control. Throughout the 135 days, there were fungal growth and consequently laccase (Lac), manganese peroxidase (MnP) and lignin peroxidase (LiP) activities. During the first 75 days, CO2 production increased to 4.78 ± 0.01 and 4.98 ± 0.01 mg g-1 for HMS and VMS, respectively. In MG adsorption studies, the highest amount of the colourant adsorbed at both pH 4.0 and 7.0 ± 0.2. CONCLUSIONS: Finally, the biochar or the biochar enriched with low concentrations of plant growth-promoting microorganisms and inorganic fertilizer favours the germination of Dianthus caryophyllus and Lolium sp., seeds.

Supervivenciade pacientes pediátricos con inmunodeficiencias primarias en un hospital público del occidente de México / Survival of pediatric patients with primary immunodeficiencies in a public hospital in western Mexico

Se presenta una serie de casos de inmunodeficiencias primarias y se describen las variables asociadas a supervivencia en pacientes ≤ 16 años. Los diagnósticos fueron acordes a los criterios de la Unión Internacional de las Sociedades de Inmunología. Se realizó un análisis de supervivencia mediante curvas de Kaplan-Meier.Entre los años 2004 y 2019, se diagnosticaron 40 pacientes con inmunodeficiencias primarias. Las más frecuentes fueron inmunodeficiencias que afectaban la inmunidad celular y humoral, el 32,5 %, y deficiencias predominantemente de anticuerpos, el 32,5 %. La mediana de edad al inicio de los síntomas y al momento del diagnóstico fue de 3,01 y 10,4 meses, respectivamente. Fallecieron el 35 % y el riesgo fue mayor en pacientes con inmunodeficiencias que afectaban la inmunidad celular y humoral y en quienes presentaron manifestaciones clínicas y tuvieron el diagnóstico en los primeros seis meses de vida.

A case series of primary immunodeficiencies is presented and outcome measures associated with survival among patients ≤ 16 years old are described. Diagnoses were made based on the criteria by the International Union of Immunological Societies. Survival was analyzed using Kaplan-Meier curves.Between 2004 and 2019, 40 patients were diagnosed with primary immunodeficiencies. The most common were immunodeficiencies affecting humoral and cell-mediated immunity (32.5 %) and predominantly antibody deficiencies (32.5 %). The median age at the onset of symptoms and at the time of diagnosis was 3.01 and 10.4 months, respectively. Thirty-five percent of patients died, and the risk was higher among those with immunodeficiencies affecting humoral and cell-mediated immunity and those who developed clinical manifestations and were diagnosed in the first 6 months of life

Survival of pediatric patients with primary immunodeficiencies in a public hospital in western Mexico. / Supervivencia de pacientes pediátricos con inmunodeficiencias primarias en un hospital público del occidente de México.

A case series of primary immunodeficiencies is presented and outcome measures associated with survival among patients ≤ 16 years old are described. Diagnoses were made based on the criteria by the International Union of Immunological Societies. Survival was analyzed using Kaplan-Meier curves. Between 2004 and 2019, 40 patients were diagnosed with primary immunodeficiencies. The most common were immunodeficiencies affecting humoral and cell-mediated immunity (32.5 %) and predominantly antibody deficiencies (32.5 %). The median age at the onset of symptoms and at the time of diagnosis was 3.01 and 10.4 months, respectively. Thirty-five percent of patients died, and the risk was higher among those with immunodeficiencies affecting humoral and cell-mediated immunity and those who developed clinical manifestations and were diagnosed in the first 6 months of life.

Se presenta una serie de casos de inmunodeficiencias primarias y se describen las variables asociadas a supervivencia en pacientes ≤ 16 años. Los diagnósticos fueron acordes a los criterios de la Unión Internacional de las Sociedades de Inmunología. Se realizó un análisis de supervivencia mediante curvas de Kaplan-Meier. Entre los años 2004 y 2019, se diagnosticaron 40 pacientes con inmunodeficiencias primarias. Las más frecuentes fueron inmunodeficiencias que afectaban la inmunidad celular y humoral, el 32,5 %, y deficiencias predominantemente de anticuerpos, el 32,5 %. La mediana de edad al inicio de los síntomas y al momento del diagnóstico fue de 3,01 y 10,4 meses, respectivamente. Fallecieron el 35 % y el riesgo fue mayor en pacientes con inmunodeficiencias que afectaban la inmunidad celular y humoral y en quienes presentaron manifestaciones clínicas y tuvieron el diagnóstico en los primeros seis meses de vida.

LDPE Transformation by Exposure to Sequential Low-Pressure Plasma and TiO2/UV Photocatalysis.

Low-density polyethylene (LDPE) sheets (3.0 ± 0.1 cm) received sequential treatment, first by the action of direct-current low-pressure plasma (DC-LPP) with a 100% oxygen partial pressure, 3.0 × 10-2 mbar pressure, 600 V DC tension, 5.6 cm distance, 6-min treatment. Then, sheets were submitted to TiO2 photocatalysis at UV radiation at 254 nm (TiO2/UV) with a pH value of 4.5 ± 0.2 and a TiO2 concentration of 1 gL-1. We achieved a complementary effect on the transformation of LDPE films. With the first treatment, ablation was generated, which increased hydrophilicity. With the second treatment, the cavities appeared. The changes in the LDPE sheets' hydrophobicity were measured using the static contact angle (SCA) technique. The photocatalytic degradation curve at 400 h revealed that the DC-LPP photocatalysis sequential process decreased SCA by 82°. This was achieved by the incorporation of polar groups, which increased hydrophilicity, roughness, and rigidity by 12 and 38%, respectively. These sequential processes could be employed for LDPE and other material biodegradation pretreatment.

Assessment of early mitigation measures against COVID-19 in Puerto Rico: March 15-May 15, 2020.

On March 15, 2020 Puerto Rico implemented non-pharmaceutical interventions (NPIs), including a mandatory curfew, as part of a state of emergency declaration to prevent the community transmission of the SARS-CoV-2 virus. The strict enforcement of this curfew was extended through May 25, with a gradual relaxation beginning on May 1. This report summarizes an assessment of these early mitigation measures on the progression of the COVID-19 pandemic in the island. From March 15 to May 15, 2020, 70,656 results of molecular (RT-PCR) tests were reported to the Puerto Rico Department of Health. Of these, 1,704 were positive, corresponding to 1,311 individuals with COVID-19 included in the study. We derived the epidemic growth rates (r) and the corresponding reproductive numbers (R) from the epidemic curve of these 1,311 individuals with laboratory-confirmed diagnosis of COVID-19 using their date of test collection as a proxy for symptoms onset. Through May 31, 2020, there were 143 COVID-19 associated deaths in Puerto Rico, for a case fatality risk of 10.9%. We compared the observed cases and deaths with Gompertz model projections had the mitigation measures not been implemented. The number of daily RT-PCR-confirmed cases peaked on March 30 (85 cases), showing a weekly cyclical trend, with lower counts on weekends and a decreasing secular trend since March 30. The initial exponential growth rate (r) was 15.87% (95% CI: 7.59%, 24.15%), corresponding to R of 1.82 (95% CI:1.37, 2.30). After March 30, the r value reverted to an exponential decay rate (negative) of -2.95% (95% CI: -4.99%, -0.92%), corresponding to R of 0.93 (95% CI: 0.86, 0.98). We estimate that, had the initial growth rate been maintained, a total of 6,155 additional COVID-19 cases would have occurred by May 15, with 211 additional COVID-19 deaths by May 31. These findings are consistent with very effective implementation of early NPIs as mitigation measures in Puerto Rico. These results also provide a baseline to assess the impact of the transition from mitigation to subsequent containment stages in Puerto Rico.

Studying human exposure to vehicular emissions using computational fluid dynamics and an urban mobility simulator: The effect of sidewalk residence time, vehicular technologies and a traffic-calming device.

A computational system consisting of an urban mobility simulator, validated fluid dynamics and an integral exposure model, is proposed to obtain cyclist and pedestrian exposure to PMx and NOx. Pedestrian activities in the urban anthroposphere include walking and running. The computational experiments take place in a computer-generated urban canyon, subject to emissions from diesel and gasoline Euro 5 and Euro 6 vehicular technologies, in continuous and stop-and-go traffic scenarios, and three wind directions at two speeds. The exposure time in the computational domain of slow and fast pedestrians were obtained. Slow pedestrians had exposure times around 17% more than fast pedestrians due to their higher sidewalk residence time. Runners and cyclists decreased their exposures by 57% and 73% respectively compared with walkers. Two traffic scenarios are implemented: one due the presence of a hump and another without a hump. The presence of the hump, increased exposure and fuel consumption by 60% per heavy duty vehicle, about 44-48% per light duty vehicle and about 54-71% per passenger car. Vehicular technology had a large influence on exposure: Heavy duty-Euro 6 vehicle decreased 86% the exposure to PM2.5 and 66% to NOX with respect to Euro 5. The proposed computational system provides information on how wind velocity influenced the inhomogeneous pollutant distribution in the street-canyon, causing exposure to be dependent on pedestrian route location. Microscale sidewalk areas in the order of meters containing higher concentrations were thus located. The cleanest routes in the urban canyon were identified. When the wind intensity doubled from 2 to 4 m s-1, exposure concentration decreased around 45%. The proposed system provides a computational platform to study urban atmospheric fluids, scenarios such as pedestrian routes, vehicular technologies, traffic velocities, meteorological conditions and urban morphology affecting pollution exposure.

Simultaneous bioconversion of lignocellulosic residues and oxodegradable polyethylene by Pleurotus ostreatus for biochar production, enriched with phosphate solubilizing bacteria for agricultural use.

A simultaneous treatment of lignocellulosic biomass (LCB) and low density oxodegradable polyethylene (LDPEoxo) was carried-out using Pleurotus ostreatus at microcosm scale to obtain biotransformed plastic and oxidized lignocellulosic biomass. This product was used as raw matter (RM) to produce biochar enriched with phosphate solubilizing bacteria (PSB). Biochar potential as biofertilizer was evaluated in Allium cepa culture at greenhouse scale. Experiments including lignocellulosic mix and LDPEoxo were performed for 75 days in microcosm. Biotransformation progress was performed by monitoring total organic carbon (TOC), CO2 production, laccase (Lac), manganese peroxidase (MnP), and lignin peroxidase (LiP) enzymatic activities. Physical LDPEoxo changes were assessed by atomic force microscopy (AFM), scanning electron microscopy (SEM) and static contact angle (SCA) and chemical changes by Fourier transform infrared spectroscopy (FTIR). Results revealed P. ostreatus was capable of LCB and LDPEoxo biotransformation, obtaining 41% total organic carbon (TOC) removal with CO2 production of 2,323 mg Kg-1 and enzyme activities of 169,438 UKg-1, 5,535 UKg-1 and 5,267 UKg-1 for LiP, MnP and Lac, respectively. Regarding LDPEoxo, SCA was decreased by 84%, with an increase in signals at 1,076 cm-1 and 3,271 cm-1, corresponding to C-O and CO-H bonds. A decrease in signals was observed related to material degradation at 2,928 cm-1, 2,848 cm-1, agreeing with CH2 asymmetrical and symmetrical stretching, respectively. PSB enriched biochar favored A. cepa plant growth during the five-week evaluation period. To the best of our knowledge, this is the first report of an in vitro circular production model, where P. ostreatus was employed at a microcosmos level to bioconvert LCB and LDPEoxo residues from the agroindustrial sector, followed by thermoconversion to produce an enriched biochar with PSB to be used as a biofertilizer to grow A. cepa at greenhouse scale.

Biodeterioration of plasma pretreated LDPE sheets by Pleurotus ostreatus.

Low-density polyethylene (LDPE) waste generates an environmental impact. To achieve the most suitable option for their degradation, it is necessary to implement chemical, physical and biological treatments, as well as combining procedures. Best treatment was prognosticated by Plackett-Burman Experimental Design (PB), evaluating five factors with two levels (0.25 mM or 1.0 gL-1 glucose, 1.0 or 2.0 mM CuSO4, 0.1 or 0.2 mM ABTS [2, 20-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid)], pH 4.5 ± 0.2 or 7.0 ± 0.2 and 30 or 90 day incubation), which was reproduced for 150 days. Therefore, PB identified a sequential treatment (plasma followed by fungus) for partial LDPE biodeterioration. Sheets were pretreated with glow discharge plasma (O2, 3.0 x 10(-2) mbar, 600 V, 6 min.), followed by Pleurotus ostreatus biodeterioration. Fungus growth, colonization percentage, and pigment generation followed. Laccase (Lac), manganese peroxidase (MnP) and lignin peroxidase (LiP) activities were appraised. Additionally, contact angle (CA), functional group presence and changes and carbonyl and vinyl indices (Fourier transformed infrared spectroscopy) were evaluated. LDPE surface changes were assessed by Young's modulus, yield strength, scanning electronic microscopy (SEM), Fourier transformed infrared spectroscopy (FTIR) and atomic force microscopy (AFM). Plasma discharge increased hydrophilicity, decreasing CA by 76.57% and increasing surface roughness by 99.81%. P. ostreatus colonization was 88.72% in 150 days in comparison with untreated LDPE (45.55%). After this treatment carbonyl groups (C = O), C = C insaturations, high hydrophilicity CA (16 ± 4) °, and low surface roughness (7 ± 2) nm were observed. However, the highest Lac and LiP activities were detected after 30 days (Lac: 2.817 U Lac g-1 and LiP: 70.755 U LiP g-1). In addition, highest MnP activity was observed at day 120 (1.097 U MnP g-1) only for P. ostreatus treated LDPE. Plasma favored P. ostreatus adsorption, adherence, growth and colonization (88.72%), as well as partial LDPE biodeterioration, supported by increased hydrophilicity and presence of specific functional chemical groups. The approximate 27% changes in LDPE physical properties support its biodeterioration.

[Meningoencefalitis: etiología infecciosa en pacientes pediátricos de un hospital de referencia]. / Meningoencephalitis: infectious etiology in pediatric patients at a reference hospital.

Introducción: Las causas de meningoencefalitis, meningitis o encefalitis pueden ser infecciosas o no infecciosas. Para el diagnóstico microbiológico se requieren cultivos y pruebas moleculares. El objetivo del estudio fue describir las causas infecciosas de meningoencefalitis y su presentación clínica. Métodos: Estudio transversal realizado en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron pacientes mayores de 28 días de vida con síndrome de meningitis, encefalitis o meningoencefalitis. Se identificó la etiología infecciosa mediante cultivos, tinciones de Gram y pruebas moleculares de líquido cefalorraquídeo. Se compararon las características de pacientes con y sin diagnóstico etiológico. Resultados: Se incluyeron en el estudio 50 pacientes con meningoencefalitis (n = 25), meningitis (n = 19) o encefalitis (n = 6). La mediana de edad fue de un año y el 62% de los pacientes fueron de sexo masculino. Se realizó diagnóstico etiológico infeccioso en el 42%: el 65.2% (n = 15) se debió a virus y el 34.8% (n = 8) a bacterias. En los pacientes con diagnóstico etiológico, se presentó un mayor número de leucocitos en líquido cefalorraquídeo (92 leu/mm3 vs. 12 leu/mm3, p = 0.001). Fue más frecuente el antecedente de gastroenteritis (razón de momios [RM]: 3.5; intervalo de confianza al 95% [IC 95%]: 1.007-12.1; p = 0.04) y ante la exploración, fue más frecuente la rigidez de cuello (RM: 3.8; IC 95%: 1-15.2; p = 0.04). Conclusiones: El 42% de los pacientes con meningitis, encefalitis o meningoencefalitis tuvieron diagnóstico etiológico infeccioso. La causa más frecuente fue el enterovirus. Background: The etiologies of meningoencephalitis, meningitis or encephalitis may be infectious or non-infectious. For the microbiological diagnosis it is necessary to perform cultures and molecular tests. The objective of this study was to describe the infectious causes of meningoencephalitis and their clinical presentation. Methods: Cross-sectional study performed at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Patients older than 28 days of life with meningitis, encephalitis or meningoencephalitis syndrome were included in the study. Infectious etiology was identified through cultures, Gram stains, and molecular tests of cerebrospinal fluid. The characteristics of patients with and without etiological diagnosis were compared. Results: Fifty patients with meningoencephalitis (n = 25), meningitis (n = 19) or encephalitis (n = 6) were included in the study. The mean age was one year and 62% were male. An infectious etiological diagnosis was performed in 42%; 65.2 % (n = 15) were viruses and 34.8% (n = 8) bacteria. In patients with etiological diagnosis, a higher number of leukocytes were found in cerebrospinal fluid (92 leu/mm3 vs. 12 leu/mm3, p = 0.001); the history of gastroenteritis was more frequent (odds ratio [OR]: 3.5; 95% confidence interval (CI): 1.007-12.1; p = 0.04) and upon examination, neck stiffness was more common (OR: 3.8; 95% CI: 1-15.2; p = 0.04). Conclusions: 42 % of the patients with meningitis, encephalitis or meningoencephalitis had an infectious etiological diagnosis; the most frequent cause was enterovirus.