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1.
Allergol Immunopathol (Madr) ; 49(3): 1-7, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33938182

RESUMEN

BACKGROUND: It has recently been argued that asthma does not increase the risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. If so, the prevalence of asthma in subjects diagnosed with COVID-19 should be lower than in the general population. OBJECTIVE: To determine the prevalence of asthma in Mexican children and adults with SARS-CoV-2 infection. METHODS: A public database of the Epidemiological Surveillance System for Viral Respiratory Disease in Mexico was analyzed. Those who underwent the real-time reverse transcriptase-polymerase chain reaction-SARS-CoV-2 (rtRT-PCR-SARS-CoV-2) test from February 27 to June 21, 2020, were included. In addition to the prevalence of asthma, some factors associated with it were investigated. RESULTS: Data from 417,366 subjects were analyzed. Asthma prevalence in children, adults, and global were 3.7%, 3.3%, and 3.3%, respectively. Although the asthma prevalence was lower in SARS-CoV-2 positive over negative patients, significant differences were only found in adults (2.8% vs. 3.7% respectively; odds ratio (OR) = 0.74; 95% confidence interval (CI): 0.71-0.77); but not in children (3.5% vs. 3.8%, respectively; OR = 0.91; 95%CI: 0.76-1.10). Multivariate analysis showed in younger than 18 years that girls and immunosuppression were factors associated with a decrease in the odds to develop asthma. In adults, asthma was positively associated with females, obesity, smoking, immunosuppression, chronic obstructive pulmonary disease, arterial hypertension, and cardiovascular disease. CONCLUSION: The prevalence of asthma in child and adult were lower than those previously reported. Our study seems to support the hypothesis that asthma patients have a lower risk of SARS-CoV-2 infection. Further studies are required to demonstrate the consistency of our findings.


Asunto(s)
Asma/epidemiología , Pandemias , /aislamiento & purificación , Adolescente , Adulto , Distribución por Edad , Anciano , Enfermedades Cardiovasculares/epidemiología , Niño , Preescolar , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Obesidad/epidemiología , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Reacción en Cadena en Tiempo Real de la Polimerasa , Insuficiencia Renal Crónica/epidemiología , Fumar/epidemiología , Adulto Joven
2.
Artículo en Inglés | MEDLINE | ID: mdl-33807339

RESUMEN

Few studies have considered more than one behavior, despite the tendency towards multiple behaviors, and there are none that have focused on a Latino population. We determined the concurrence of four unhealthy behaviors related to glycemic control and identified common cognitive factors at advanced stages of readiness for change in patients with type 2 diabetes treated in primary care. A cross-sectional study was carried out during August-December 2018 in northeastern Mexico. We consecutively included patients between 20 and 70 years who were without medical contraindication, physical impediment against exercise, pregnancy and edentulism, among other selection criteria (n = 407). Stages of behavior were measured according to the Transtheoretical Model. Pros, cons, self-efficacy, susceptibility, and severity data were collected by interview. Statistical analysis consisted of descriptive statistics and multiple logistic regression. A total of 36.7% exhibited more than one unhealthy behavior in precontemplation or contemplation (no interest or some interest in changing consumption of refined sugars and saturated fats, exercise, or oral hygiene behavior). Cons (p < 0.05) and self-efficacy (p < 0.001) were common to all four unhealthy behaviors, independent of potential confounders. Studies like ours facilitate the recognition of individuals with multiple unhealthy behaviors who share equivalent profiles of readiness for change before implementing public health programs.


Asunto(s)
Diabetes Mellitus Tipo 2 , Estudios Transversales , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Ejercicio Físico , Conductas Relacionadas con la Salud , Humanos , México , Autoeficacia
3.
Int J Mol Sci ; 22(6)2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33810183

RESUMEN

Human papillomavirus (HPV) DNA integration is a crucial event in cervical carcinogenesis. However, scarce studies have focused on studying HPV integration (HPVint) in early-stage cervical lesions. Using HPV capture followed by sequencing, we investigated HPVint in pre-tumor cervical lesions. Employing a novel pipeline, we analyzed reads containing direct evidence of the integration breakpoint. We observed multiple HPV infections in most of the samples (92%) with a median integration rate of 0.06% relative to HPV mapped reads corresponding to two or more sequence breakages. Unlike cancer studies, most integrations events were unique (supported by one read), consistent with the lack of clonal selection. Congruent to other studies, we found that breakpoints could occur, practically, in any part of the viral genome. We noted that L1 had a higher frequency of rupture integration (25%). Based on host genome integration frequencies, we found previously reported integration sites in cancer for genes like FHIT, CSMD1, and LRP1B and putatively many new ones such as those exemplified in CSMD3, ROBO2, and SETD3. Similar host integrations regions and genes were observed in diverse HPV types within many genes and even equivalent integration positions in different samples and HPV types. Interestingly, we noted an enrichment of integrations in most centromeres, suggesting a possible mechanism where HPV exploits this structural machinery to facilitate integration. Supported by previous findings, overall, our analysis provides novel information and insights about HPVint.


Asunto(s)
Papillomaviridae/fisiología , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/virología , Displasia del Cuello del Útero/epidemiología , Displasia del Cuello del Útero/etiología , Integración Viral , Transformación Celular Viral , Biología Computacional/métodos , Femenino , Genoma Viral , Genotipo , Humanos , México/epidemiología , Papillomaviridae/clasificación , Infecciones por Papillomavirus/epidemiología , Lesiones Precancerosas/epidemiología , Lesiones Precancerosas/etiología , Lesiones Precancerosas/patología , Análisis de Secuencia de ADN , Displasia del Cuello del Útero/patología
4.
J Int Med Res ; 49(4): 3000605211004020, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33823643

RESUMEN

OBJECTIVE: To determine the seroprevalence of Leptospira immunoglobulin (Ig)G and IgM antibodies and its association with the characteristics of the study population from the northern Mexican city of Durango, Mexico. METHODS: Through a cross-sectional study design, inhabitants of Durango City, Mexico were surveyed between June 2018 and November 2018. Serum samples from the subjects were analysed for anti-Leptospira IgG and IgM antibodies using commercially available enzyme-linked immunosorbent assays. Sociodemographic, clinical, behavioural and housing characteristics were recorded. Data were analysed by bivariate and multivariate analyses. RESULTS: The study enrolled 413 people, of which 124 (30.0%) and 137 (33.2%) were positive for anti-Leptospira IgG antibodies and anti-Leptospira IgM antibodies, respectively. Multivariate analysis showed that Leptospira seropositivity was associated with professional occupation, alcohol consumption, ill clinical status, memory impairment and a history of surgery. CONCLUSIONS: This is the first study to report the seroepidemiology of Leptospira infection in an urban general population in the north of Mexico. The seroprevalence of Leptospira infection found was higher than those previously reported in Mexican studies.


Asunto(s)
Leptospirosis , Ciudades , Estudios Transversales , Humanos , Leptospirosis/diagnóstico , Leptospirosis/epidemiología , México/epidemiología , Estudios Seroepidemiológicos
5.
Front Public Health ; 9: 570098, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33842415

RESUMEN

The first cases of unexplained pneumonia were reported in Wuhan, China, in December of 2019. Later, a novel coronavirus (SARS-CoV-2) was identified as the causal agent of pneumonia. This virus has since spread to more than 180 countries and has been declared a pandemic by the World Health Organization. Herein, we aimed to determine the epidemiological and clinical characteristics of symptomatic patients with coronavirus disease 2019 (COVID-19) and the relationship between the influenza vaccine with a lower risk of severe COVID-19 infection in the state of Sinaloa. We collected demographic and clinical data of 4,040 patients with acute respiratory infections across Sinaloa state hospitals from February 28 to May 15, 2020. The prevalence of COVID-19 among hospitalized patients with respiratory symptoms in Sinaloa showed 45.2% of men were more affected than women (p < 0.001), and people aged 40-49 years were the most affected. The main symptoms of COVID-19 infection were cough and fever (p < 0.001), while hypertension, obesity, and type 2 diabetes were the chronic diseases associated with COVID-19 than non-COVID-19 (p < 0.003). Healthcare workers were most likely to be infected compared to other occupations (p < 0.001). The general lethality rate was 14.1%, and males >62 years were the ones who had a higher lethality rate (p < 0.001); the aforementioned chronic diseases were related to higher lethality of COVID-19 (p < 0.001). Likewise, higher lethality was seen in housewives and patient retirees/pensioners compared with other occupations (p < 0.001). Finally, we found there was a relationship between influenza vaccination and a lower risk of severe COVID-19 infection and mortality (p < 0.001). These findings showed that healthcare workers, men >62 years with chronic diseases, and retired people were most affected. Furthermore, the influenza vaccine could decrease the severeness of COVID-19 cases.


Asunto(s)
/epidemiología , Vacunas contra la Influenza/administración & dosificación , Adulto , Comorbilidad , Tos/virología , Diabetes Mellitus Tipo 2 , Femenino , Fiebre/virología , Humanos , Hipertensión , Masculino , México/epidemiología , Persona de Mediana Edad , Obesidad , Análisis de Supervivencia
6.
Front Public Health ; 9: 642630, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33842423

RESUMEN

Meteorology and long-term trends in air pollutant concentrations may obscure the results from short-term policies implemented to improve air quality. This study presents changes in CO, NO2, O3, SO2, PM10, and PM2.5 based on their anomalies during the COVID-19 partial (Phase 2) and total (Phase 3) lockdowns in Mexico City (MCMA). To minimise the impact of the air pollutant long-term trends, pollutant anomalies were calculated using as baseline truncated Fourier series, fitted with data from 2016 to 2019, and then compared with those from the lockdown. Additionally, days with stagnant conditions and heavy rain were excluded to reduce the impact of extreme weather changes. Satellite observations for NO2 and CO were used to contrast the ground-based derived results. During the lockdown Phase 2, only NO2 exhibited significant decreases (p < 0.05) of between 10 and 23% due to reductions in motor vehicle emissions. By contrast, O3 increased (p < 0.05) between 16 and 40% at the same sites where NO2 decreased. During Phase 3, significant decreases (p < 0.05) were observed for NO2 (43%), PM10 (20%), and PM2.5 (32%) in response to the total lockdown. Although O3 concentrations were lower in Phase 3 than during Phase 2, those did not decrease (p < 0.05) from the baseline at any site despite the total lockdown. SO2 decreased only during Phase 3 in a near-road environment. Satellite observations confirmed that NO2 decreased and CO stabilised during the total lockdown. Air pollutant changes during the lockdown could be overestimated between 2 and 10-fold without accounting for the influences of meteorology and long-term trends in pollutant concentrations. Air quality improved significantly during the lockdown driven by reduced NO2 and PM2.5 emissions despite increases in O3, resulting in health benefits for the MCMA population. A health assessment conducted suggested that around 588 deaths related to air pollution exposure were averted during the lockdown. Our results show that to reduce O3 within the MCMA, policies must focus on reducing VOCs emissions from non-mobile sources. The measures implemented during the COVID-19 lockdowns provide valuable information to reduce air pollution through a range of abatement strategies for emissions other than from motor vehicles.


Asunto(s)
Contaminación del Aire/análisis , Control de Enfermedades Transmisibles , Monitoreo del Ambiente , Ciudades , Humanos , México/epidemiología , Material Particulado/análisis , Salud Pública
7.
Clin Appl Thromb Hemost ; 27: 1076029621999099, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33835872

RESUMEN

Among COVID-19 hospitalized patients, high incidence of alterations in inflammatory and coagulation biomarkers correlates with a poor prognosis. Comorbidities such as chronic degenerative diseases are frequently associated with complications in COVID-19 patients. The aim of this study was to evaluate inflammatory and procoagulant biomarkers in COVID-19 patients from a public hospital in Mexico. Blood was sampled within the first 48 h after admission in 119 confirmed COVID-19 patients that were classified in 3 groups according to oxygen demand, evolution and the severity of the disease as follows: 1) Non severe: nasal cannula or oxygen mask; 2) Severe: high flow nasal cannula and 3) Death: mechanical ventilation eventually leading to fatal outcome. Blood samples from 20 healthy donors were included as a Control Group. Analysis of inflammatory and coagulation biomarkers including D-dimer, interleukin 6, interleukin 8, PAI-1, P-selectin and VWF was performed in plasma. Routine laboratory and clinical biomarkers were also included and compared among groups. Concentrations of D-dimer (14.5 ± 13.8 µg/ml) and PAI-1 (1223 ± 889.6 ng/ml) were significantly elevated in severe COVID-19 patients (P < 0.0001). A significant difference was found in interleukin-6, PAI-1 and P-selectin in non-severe and healthy donors when compared to Severe COVID-19 and deceased patients (P < 0.001). VWF levels were also significantly different between severe patients (153.5 ± 24.3 UI/dl) and non-severe ones (133.9 ± 20.2 UI/dl) (P < 0.0001). WBC and glucose levels were also significantly elevated in patients with Severe COVID-19. Plasma concentrations of all prothrombotic biomarkers were significantly higher in patients with a fatal outcome.


Asunto(s)
Biomarcadores/sangre , Mediadores de Inflamación/sangre , Adulto , Anciano , /epidemiología , Estudios de Casos y Controles , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Hospitalización , Humanos , Interleucina-6/sangre , Masculino , México/epidemiología , Persona de Mediana Edad , Selectina-P/sangre , Pandemias , Inhibidor 1 de Activador Plasminogénico/sangre , Pronóstico , Índice de Severidad de la Enfermedad , Trombosis/sangre , Trombosis/etiología , Factor de von Willebrand/metabolismo
8.
Clin Appl Thromb Hemost ; 27: 10760296211008988, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813911

RESUMEN

Coagulation abnormalities have been reported in COVID-19 patients, which may lead to an increased risk of Pulmonary Embolism (PE). We aimed to describe the clinical characteristics and outcomes of COVID-19 patients diagnosed with PE during their hospital stay. We analyzed patients with PE and COVID-19 in a tertiary center in Mexico City from April to October of 2020. A total of 26 (100%) patients were diagnosed with Pulmonary Embolism and COVID-19. We observed that 14 (54%) patients were receiving either prophylactic or full anticoagulation therapy, before PE diagnosis. We found a significant difference in mortality between the group with less than 7 days (83%) and the group with more than 7 days (15%) in Intensive Care Unit (P = .004); as well as a mean of 8 days for the mortality group compared with 20 days of hospitalization in the survivor group (P = .003). In conclusion, there is an urgent need to review antithrombotic therapy in these patients in order to improve clinical outcomes and decrease hospital overload.


Asunto(s)
/mortalidad , Hospitalización , Unidades de Cuidados Intensivos , Embolia Pulmonar/mortalidad , Adulto , Anciano , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Embolia Pulmonar/terapia , Estudios Retrospectivos , Centros de Atención Terciaria , Factores de Tiempo
9.
An Acad Bras Cienc ; 93(2): e20190144, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33852669

RESUMEN

The Chapala Lake is one of the most polluted lakes in Mexico, due to the in flow of effluents from several industrial plants, the lake accumulates pollutants such as chromium(VI) which is considered important for aquatic ecosystem. This study aimed was to evaluate the ability to decrease the concentration of chromium (VI) by Lysinibacillus macroides 2(1B)104A, isolated from sediments of the Chapala Lake. The strain was identified through 16S rRNA sequencing and phylogenetic analysis. Results showed that this strain grows in concentrations of 50, 100, 200 and 300 mgL-1 Cr(VI), in pH ranging 6 to 7, showing 79.508% reduction in concentration 50 mgL-1, determining that the reduction occurs extracellularly. Likewise, it was observed that Lysinibacillus macroides reduced the concentration of Cr(IV) in the broth, it was not observed that the bacteria could sequester Cr(VI) in the membrane or intracellularly. However, it reduced the concentration of Cr(VI) in the broth. Lysinibacillus macroides 2(1B)104A isolate showed having the ability that decrease the concentration of Cr(VI), which makes it a viable options for bioremediation of water polluted with this metal.


Asunto(s)
Ecosistema , Lagos , Bacillaceae , Cromo/análisis , Concentración de Iones de Hidrógeno , México , Oxidación-Reducción , Filogenia , ARN Ribosómico 16S/genética
10.
PLoS One ; 16(4): e0248357, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33819261

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a systemic disease that can rapidly progress into acute respiratory failure and death. Timely identification of these patients is crucial for a proper administration of health-care resources. OBJECTIVE: To develop a predictive score that estimates the risk of invasive mechanical ventilation (IMV) among patients with COVID-19. STUDY DESIGN: Retrospective cohort study of 401 COVID-19 patients diagnosed from March 12, to August 10, 2020. The score development cohort comprised 211 patients (52.62% of total sample) whereas the validation cohort included 190 patients (47.38% of total sample). We divided participants according to the need of invasive mechanical ventilation (IMV) and looked for potential predictive variables. RESULTS: We developed two predictive scores, one based on Interleukin-6 (IL-6) and the other one on the Neutrophil/Lymphocyte ratio (NLR), using the following variables: respiratory rate, SpO2/FiO2 ratio and lactic dehydrogenase (LDH). The area under the curve (AUC) in the development cohort was 0.877 (0.823-0.931) using the NLR based score and 0.891 (0.843-0.939) using the IL-6 based score. When compared with other similar scores developed for the prediction of adverse outcomes in COVID-19, the COVID-IRS scores proved to be superior in the prediction of IMV. CONCLUSION: The COVID-IRS scores accurately predict the need for mechanical ventilation in COVID-19 patients using readily available variables taken upon admission. More studies testing the applicability of COVID-IRS in other centers and populations, as well as its performance as a triage tool for COVID-19 patients are needed.


Asunto(s)
/terapia , Hospitalización , Intubación , Respiración Artificial , Adulto , Anciano , Biomarcadores/metabolismo , Femenino , Humanos , Interleucina-6/metabolismo , Masculino , México , Persona de Mediana Edad , Neutrófilos/metabolismo , Neutrófilos/patología , Frecuencia Respiratoria , Estudios Retrospectivos , Medición de Riesgo , Triaje
11.
PLoS One ; 16(4): e0247433, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33831042

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) is a systemic entity that frequently implies neurologic features at presentation and complications during the disease course. We aimed to describe the characteristics and predictors for developing in-hospital neurologic manifestations in a large cohort of hospitalized patients with COVID-19 in Mexico City. METHODS: We analyzed records from consecutive adult patients hospitalized from March 15 to June 30, 2020, with moderate to severe COVID-19 confirmed by reverse transcription real-time polymerase chain reaction (rtRT-PCR) for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Neurologic syndromes were actively searched by a standardized structured questionnaire and physical examination, confirmed by neuroimaging, neurophysiology of laboratory analyses, as applicable. RESULTS: We studied 1,072 cases (65% men, mean age 53.2±13 years), 71 patients had pre-existing neurologic diseases (diabetic neuropathy: 17, epilepsy: 15, history of ischemic stroke: eight, migraine: six, multiple sclerosis: one, Parkinson disease: one), and 163 (15.2%) developed a new neurologic complication. Headache (41.7%), myalgia (38.5%), dysgeusia (8%), and anosmia (7%) were the most common neurologic symptoms at hospital presentation. Delirium (13.1%), objective limb weakness (5.1%), and delayed recovery of mental status after sedation withdrawal (2.5%), were the most common new neurologic syndromes. Age, headache at presentation, preexisting neurologic disease, invasive mechanical ventilation, and neutrophil/lymphocyte ratio ≥9 were independent predictors of new in-hospital neurologic complications. CONCLUSIONS: Even after excluding initial clinical features and pre-existing comorbidities, new neurologic complications in hospitalized patients with COVID-19 are frequent and can be predicted from clinical information at hospital admission.


Asunto(s)
Hospitalización , Enfermedades del Sistema Nervioso , Adulto , Anciano , /diagnóstico , /terapia , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/terapia
12.
PLoS One ; 16(4): e0249773, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33831079

RESUMEN

There has been limited study of Native American whole genome diversity to date, which impairs effective implementation of personalized medicine and a detailed description of its demographic history. Here we report high coverage whole genome sequencing of 76 unrelated individuals, from 27 indigenous groups across Mexico, with more than 97% average Native American ancestry. On average, each individual has 3.26 million Single Nucleotide Variants and short indels, that together comprise a catalog of 9,737,152 variants, 44,118 of which are novel. We report 497 common Single Nucleotide Variants (with allele frequency > 5%) mapped to drug responses and 316,577 in enhancer or promoter elements; interestingly we found some of these enhancer variants in PPARG, a nuclear receptor involved in highly prevalent health problems in Mexican population, such as obesity, diabetes, and insulin resistance. By detecting signals of positive selection we report 24 enriched key pathways under selection, most of them related to immune mechanisms. No missense variants in ACE2, the receptor responsible for the entry of the SARS CoV-2 virus, were found in any individual. Population genomics and phylogenetic analyses demonstrated stratification in a Northern-Central-Southern axis, with major substructure in the Central region. The Seri, a northern group with the most genetic divergence in our study, showed a distinctive genomic context with the most novel variants, and the most population specific genotypes. Genome-wide analysis showed that the average haplotype blocks are longer in Native Mexicans than in other world populations. With this dataset we describe previously undetected population level variation in Native Mexicans, helping to reduce the gap in genomic data representation of such groups.


Asunto(s)
/genética , Genoma Humano , Filogenia , Polimorfismo de Nucleótido Simple , Secuenciación Completa del Genoma , /epidemiología , /genética , Bases de Datos de Ácidos Nucleicos , Femenino , Humanos , Masculino , México/epidemiología , México/etnología
13.
Artículo en Inglés | MEDLINE | ID: mdl-33919654

RESUMEN

The present qualitative research explores the factors that have influenced the use of urban green spaces (UGS) in Mexico City during the COVID-19 pandemic and the implications of their usage on residents' well-being. This study was conducted using a combination of solicited audio and written diaries, photography, and in-depth interviews with 16 participants, aged 22 to 58. The article provides a critical reflection on the incentives and deterrents to the UGS use of participants while social distancing measures were in place. The results show that in Mexico City: (1) participants' lack of access to UGS has hampered their use, mainly among those of low-income neighborhoods; (2) UGS size did not directly impact participants' UGS use during the pandemic; and (3) women were deterred from accessing UGS due to safety concerns related to the fear of violence. Overall, the results suggest that UGS use has served as a coping mechanism to decrease the effects of stress and isolation caused by the pandemic, increasing users' physical and mental well-being. This study's conclusions can help develop future citizen participation tools that are useful for resilience in urban design, as they provide interesting insights into the perceptions of residents, such as the most valued characteristics of UGS.


Asunto(s)
Pandemias , Adulto , Ciudades , Femenino , Humanos , México/epidemiología , Persona de Mediana Edad , Parques Recreativos , Investigación Cualitativa , Adulto Joven
14.
JCO Glob Oncol ; 7: 577-584, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33891480

RESUMEN

PURPOSE: The COVID-19 pandemic is a colossal challenge for global health; nonetheless, specific subgroups face considerably higher risks for infection and mortality. Among patients with malignant diseases, those with hematologic neoplasms are at a higher risk for poor outcomes. The objective of this study was to register treatment modifications associated with the COVID-19 pandemic and their short-term consequences in Latin America. METHODS: Multicenter, prospective, observational, cohort study including patients older than 14 years from 14 centers in four countries (Mexico, Peru, Guatemala, and Panama) who had a confirmed diagnosis of acute leukemia, and who were undergoing active treatment since the first COVID-19 case in each country until the cutoff on July 15, 2020. RESULTS: We recruited 635 patients. Treatment modifications because of the COVID-19 pandemic were reported in 40.8% of cases. The main reason for such modifications was logistic issues (55.0%) and the most frequent modification was chemotherapy delay (42.0%). A total of 13.1% patients developed COVID-19 disease, with a mortality of 37.7%. Several factors were identified as independently associated with mortality, including a diagnosis of acute myeloid leukemia (odds ratio 2.38 [95% CI, 1.47 to 3.84]; P < .001), while the use of telemedicine was identified as a protective factor (odds ratio 0.36 [95% CI, 0.18 to 0.82]; P = .014). CONCLUSION: These results highlight the collateral damage of COVID-19 in oncology patients.


Asunto(s)
/prevención & control , Leucemia Mieloide/terapia , Oncología Médica/métodos , /aislamiento & purificación , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , /virología , Comorbilidad , Epidemias , Femenino , Guatemala/epidemiología , Humanos , Leucemia Mieloide/diagnóstico , Leucemia Mieloide/epidemiología , Masculino , México/epidemiología , Persona de Mediana Edad , Panamá/epidemiología , Perú/epidemiología , Estudios Prospectivos , Adulto Joven
15.
Artículo en Inglés | MEDLINE | ID: mdl-33801928

RESUMEN

The coronavirus disease (COVID-19) that broke out in China in December 2019 rapidly became a worldwide pandemic. In Mexico, the conditions requiring the declaration of a sanitary emergency were reached by the last week of March 2020, and health authorities' limited mobility and imposed social isolation were the main strategies to keep the virus from spreading. Thus, daily living conditions changed drastically in a few days, generating a stressful situation characterized by an almost complete lack of mobility, social isolation, and forced full-time interactions with family members. Soon, complaints of sleep disturbances, anxiety, and symptoms of depression were reported. The present study reports the results of an online survey performed during the first two months of isolation. Questionnaires exploring sleep disturbances, anxiety, and depression were sent to people who responded to an open invitation. A total of 1230 participants filled out the sleep questionnaire, 812 responded to the anxiety questionnaire, and 814 responded to the depression questionnaire. Both men and women reported poor sleep quality, but women showed a higher proportion (79%) than men (60%); young women were more likely to be affected by social isolation. Concerning anxiety and depression, both sexes reported high similar symptoms. These data suggest that stressful conditions related to social isolation and the economic uncertainty caused by the pandemic may induce mental health disturbances, which may become worse with sleep restriction.


Asunto(s)
Coronavirus , Ansiedad/epidemiología , China/epidemiología , Depresión/epidemiología , Femenino , Humanos , Masculino , Salud Mental , México/epidemiología , Pandemias , Sueño , Aislamiento Social
16.
Cad Saude Publica ; 37(4): e00045620, 2021.
Artículo en Español | MEDLINE | ID: mdl-33886705

RESUMEN

The aim was to analyze the level and characterize the use of clinical coordination mechanisms between levels of care, and their associated factors, in two public networks of health services in Mexico. A cross-sectional study was carried out using the COORDENA questionnaire to primary and specialized care physicians in the state of Veracruz. Differences were found between networks and levels of care, according to the mechanism. In both, the referral/counter-referral is mostly used to channel the patient to another level, mainly by primary care physicians. A high reception of referrals by specialists was identified, but few counterreferences in primary care. Being a man and recognizing the primary care physician, as responsible for monitoring the patient in his/her healthcare career, were factors associated with the frequent sending of the counter-referral by specialists. The discharge report is used in both networks to send clinical information to the other level, with more sending by specialist doctors, but with less reception in primary care. In both networks, the follow-up to the recommendations of the mechanisms to standardize clinical care was greater by primary care physicians than specialized ones. The use of coordination mechanisms between levels of care is deficient and limited, with greater use of mechanisms to transfer information than for clinical management. The need to implement strategies that consider the participation of professionals is evident, to favor local adaptation, appropriation and improve their use.


Asunto(s)
Atención Primaria de Salud , Derivación y Consulta , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , México
17.
Arch Osteoporos ; 16(1): 59, 2021 04 04.
Artículo en Inglés | MEDLINE | ID: mdl-33813681

RESUMEN

This study shows a diagnostic and therapeutic gap for osteoporosis in patients with fragility fractures of the hip, distal radius, and vertebrae. Patients with fragility fractures treated in Mexico fail to receive an osteoporosis diagnosis, referral, and follow-up treatment. The therapeutic gap is higher than reported in other countries. INTRODUCTION: Osteoporosis is a highly prevalent and disabling disease. While there is typically a gap between osteoporosis diagnosis and treatment after a fragility fracture, this gap has not been measured in Mexico. The study aimed to describe and quantify the gap between osteoporosis diagnosis and treatment after an incident fragility fracture. MATERIALS AND METHODS: A descriptive and 3-year retrospective chart review study was conducted on patients over the age of 50 with a diagnosis of an incident acute low-energy fracture of either the hip, distal radius, or vertebrae. RESULTS: We included 838 patients with a mean age of 76.3 ± 12.2 years. The sample was mostly women (665 participants, 79.4%); 589 (70.3%) had a hip fracture, 173 (20.6%) had a distal radius fracture, and 76 (9.1%) had a vertebral fracture. Only 28 (3.3%) had a previous diagnosis and were taking a pharmacological treatment for osteoporosis; 11 (1.3%) received their diagnosis while hospitalized. Immediately after the fracture, and 1 and 3 years later, 144 (17.1%), 71 (8.4%), and 96 (11.4%) respectively received a pharmacological treatment, 195 (23.2%), 65 (7.7%), and 45 (5.3%) supplementation, and 16 (1.9%), 16 (1.9%), and 21 (2.5%) a non-pharmacologic treatment. No significant differences in treatment prescriptions were found after a second or third fracture. CONCLUSION: The study quantifies the too high frequency of failure to diagnose and treat osteoporosis in patients with fragility fractures. Measures should be established to reduce the yawning gap between osteoporosis diagnosis and treatment after a fragility fracture.


Asunto(s)
Conservadores de la Densidad Ósea , Osteoporosis , Fracturas Osteoporóticas , Anciano , Anciano de 80 o más Años , Femenino , Humanos , México/epidemiología , Persona de Mediana Edad , Osteoporosis/diagnóstico , Osteoporosis/tratamiento farmacológico , Osteoporosis/epidemiología , Fracturas Osteoporóticas/diagnóstico , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/terapia , Estudios Retrospectivos
18.
Sci Rep ; 11(1): 8386, 2021 04 16.
Artículo en Inglés | MEDLINE | ID: mdl-33863997

RESUMEN

Diabetes is associated with severe COVID-19 and mortality. The aim of the present study was to determine the effect of age on the association between diabetes and mortality in patients with laboratory-confirmed COVID-19 in Mexico. This retrospective cohort study involved patients aged 20 years or older with symptoms of viral respiratory disease who were screened for SARS-CoV-2 infection across the System of Epidemiological Surveillance of Viral Respiratory Disease in Mexico from January 1 through November 4, 2020. Cox proportional-hazard regression was used to calculate the hazard ratio for 28-day mortality and its 95% confidence interval (CI). Among 757,210 patients with COVID-19 (outpatients and inpatients), 120,476 (16%) had diabetes and 80,616 died. Among 878,840 patients without COVID-19 (those who tested negative for SARS-CoV-2 infection), 88,235 (10.0%) had diabetes and 20,134 died. Among patients with COVID-19, diabetes was associated with a hazard ratio for death of 1.49 (95% CI 1.47-1.52), adjusting for age, sex, smoking habit, obesity, hypertension, immunodeficiency, and cardiovascular, pulmonary, and chronic renal disease. The strength of the association decreased with age (trend test: P = 0.004). For example, the adjusted hazard ratio for death was 3.12 (95% CI 2.86-3.40) for patients 20-39 years of age; in contrast, the adjusted hazard ratio of death for patients 80 years of age or older was 1.11 (95% CI 1.06-1.16). The adjusted hazard ratios were 1.66 (95% CI 1.58-1.74) in outpatients and 1.14 (95% CI 1.12-1.16) in inpatients. In hospitalized patients 80 years of age or older, no association was observed between diabetes and COVID-19-related mortality (adjusted hazard ratio: 1.03; 95% CI 0.98-1.08). Among patients without COVID-19, the adjusted hazard ratio for death was 1.78 (95% CI 1.73-1.84). In conclusion, in adult patients with COVID-19 in Mexico, the risk of death associated with diabetes decreased with age. No association between diabetes and mortality was observed among inpatients 80 years of age or older. Our findings should be verified in other populations.


Asunto(s)
/mortalidad , Diabetes Mellitus Tipo 2/complicaciones , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , /epidemiología , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , México/epidemiología , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Adulto Joven
19.
Sensors (Basel) ; 21(7)2021 Apr 03.
Artículo en Inglés | MEDLINE | ID: mdl-33916716

RESUMEN

Deaths due to heart diseases are a leading cause of death in Mexico. Cardiovascular diseases are considered a public health problem because they produce cardiorespiratory arrests. During an arrest, cardiac and/or respiratory activity stops. A cardiorespiratory arrest is rapidly fatal without a quick and efficient intervention. As a response to this problem, the VirtualCPR system was designed in the present work. VirtualCPR is a mobile virtual reality application to support learning and practicing of basic techniques of cardiopulmonary resuscitation (CPR) for experts or non-experts in CPR. VirtualCPR implements an interactive virtual scenario with the user, which is visible by means of employment of virtual reality lenses. User's interactions, with our proposal, are by a portable force sensor for integration with training mannequins, whose development is based on an application for the Android platform. Furthermore, this proposal integrates medical knowledge in first aid, related to the basic CPR for adults using only the hands, as well as technological knowledge, related to development of simulations on a mobile virtual reality platform by three main processes: (i) force measurement and conversion, (ii) data transmission and (iii) simulation of a virtual scenario. An experiment by means of a multifactorial analysis of variance was designed considering four factors for a CPR session: (i) previous training in CPR, (ii) frequency of compressions, (iii) presence of auditory suggestions and (iv) presence of color indicator. Our findings point out that the more previous training in CPR a user of the VirtualCPR system has, the greater the percentage of correct compressions obtained from a virtual CPR session. Setting the rate to 100 or 150 compressions per minute, turning on or off the auditory suggestions and turning the color indicator on or off during the session have no significant effect on the results obtained by the user.


Asunto(s)
Reanimación Cardiopulmonar , Paro Cardíaco , Aplicaciones Móviles , Realidad Virtual , Adulto , Paro Cardíaco/terapia , Humanos , México
20.
PLoS One ; 16(4): e0249584, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33886590

RESUMEN

The perinatal consequences of SARS-CoV-2 infection are still largely unknown. This study aimed to describe the features and outcomes of pregnant women with or without SARS-CoV-2 infection after the universal screening was established in a large tertiary care center admitting only obstetric related conditions without severe COVID-19 in Mexico City. This retrospective case-control study integrates data between April 22 and May 25, 2020, during active community transmission in Mexico, with one of the highest COVID-19 test positivity percentages worldwide. Only pregnant women and neonates with a SARS-CoV-2 result by quantitative RT-PCR were included in this study. Among 240 pregnant women, the prevalence of COVID-19 was 29% (95% CI, 24% to 35%); 86% of the patients were asymptomatic (95% CI, 76%-92%), nine women presented mild symptoms, and one patient moderate disease. No pregnancy baseline features or risk factors associated with severity of infection, including maternal age > 35 years, Body Mass Index >30 kg/m2, and pre-existing diseases, differed between positive and negative women. The median gestational age at admission for both groups was 38 weeks. All women were discharged at home without complications, and no maternal death was reported. The proportion of preeclampsia was higher in positive women than negative women (18%, 95% CI, 10%-29% vs. 9%, 95% CI, 5%-14%, P<0.05). No differences were found for other perinatal outcomes. SARS-CoV-2 test result was positive for nine infants of positive mothers detected within 24h of birth. An increased number of infected neonates were admitted to the NICU, compared to negative neonates (44% vs. 22%, P<0.05) and had a longer length of hospitalization (2 [2-18] days vs. 2 [2-3] days, P<0.001); these are potential proxies for illness severity. This report highlights the importance of COVID-19 detection at delivery in pregnant women living in high transmission areas.


Asunto(s)
/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto , /transmisión , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Tamizaje Masivo , México/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Resultado del Embarazo , Prevalencia , Estudios Retrospectivos , Centros de Atención Terciaria , Adulto Joven
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