SARS-CoV-2 Variants and Clinical Outcomes: A Systematic Review.

BACKGROUND: From the start of the COVID-19 pandemic, new SARS-CoV-2 variants have emerged that potentially affect transmissibility, severity, and immune evasion in infected individuals. In the present systematic review, the impact of different SARS-CoV-2 variants on clinical outcomes is analyzed. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Two databases (PubMed and ScienceDirect) were searched for original articles published from 1 January 2020 to 23 November 2021. The articles that met the selection criteria were appraised according to the Newcastle-Ottawa Quality Assessment Scale. RESULTS: Thirty-three articles were included, involving a total of 253,209 patients and 188,944 partial or complete SARS-CoV-2 sequences. The most reported SARS-CoV-2 variants showed changes in the spike protein, N protein, RdRp and NSP3. In 28 scenarios, SARS-CoV-2 variants were found to be associated with a mild to severe or even fatal clinical outcome, 15 articles reported such association to be statistically significant. Adjustments in eight of them were made for age, sex and other covariates. CONCLUSIONS: SARS-CoV-2 variants can potentially have an impact on clinical outcomes; future studies focused on this topic should consider several covariates that influence the clinical course of the disease.

Characteristics and growth of the genetic HIV transmission network of Mexico City during 2020.

INTRODUCTION: Molecular surveillance systems could provide public health benefits to focus strategies to improve the HIV care continuum. Here, we infer the HIV genetic network of Mexico City in 2020, and identify actively growing clusters that could represent relevant targets for intervention. METHODS: All new diagnoses, referrals from other institutions, as well as persons returning to care, enrolling at the largest HIV clinic in Mexico City were invited to participate in the study. The network was inferred from HIV pol sequences, using pairwise genetic distance methods, with a locally hosted, secure version of the HIV-TRACE tool: Seguro HIV-TRACE. Socio-demographic, clinical and behavioural metadata were overlaid across the network to design focused prevention interventions. RESULTS: A total of 3168 HIV sequences from unique individuals were included. One thousand and one-hundred and fifty (36%) sequences formed 1361 links within 386 transmission clusters in the network. Cluster size varied from 2 to 14 (63% were dyads). After adjustment for covariates, lower age (adjusted odds ratio [aOR]: 0.37, p<0.001; >34 vs. <24 years), being a man who has sex with men (MSM) (aOR: 2.47, p = 0.004; MSM vs. cisgender women), having higher viral load (aOR: 1.28, p<0.001) and higher CD4+ T cell count (aOR: 1.80, p<0.001; ≥500 vs. <200 cells/mm3 ) remained associated with higher odds of clustering. Compared to MSM, cisgender women and heterosexual men had significantly lower education (none or any elementary: 59.1% and 54.2% vs. 16.6%, p<0.001) and socio-economic status (low income: 36.4% and 29.0% vs. 18.6%, p = 0.03) than MSM. We identified 10 (2.6%) clusters with constant growth, for prioritized intervention, that included intersecting sexual risk groups, highly connected nodes and bridge nodes between possible sub-clusters with high growth potential. CONCLUSIONS: HIV transmission in Mexico City is strongly driven by young MSM with higher education level and recent infection. Nevertheless, leveraging network inference, we identified actively growing clusters that could be prioritized for focused intervention with demographic and risk characteristics that do not necessarily reflect the ones observed in the overall clustering population. Further studies evaluating different models to predict growing clusters are warranted. Focused interventions will have to consider structural and risk disparities between the MSM and the heterosexual populations.

SARS-CoV-2 Reinfection among Healthcare Workers in Mexico: Case Report and Literature Review.

Since the onset of the COVID-19 pandemic, there have been multiple questions regarding reinfections associated with SARS-CoV-2. Healthcare workers on duty, due to overexposure in environments where there are more cases of COVID-19, are more prone to become infected by this virus. Here, we report 4 cases that meet the definition of clinical reinfection by SARS-CoV-2, as well as a literature review on this subject; all occurred in healthcare workers in Acapulco Guerrero, Mexico who provide their services in a hospital that cares for patients with COVID-19. The time between the manifestation of the first and second infection for each case was 134, 129, 107 and 82 days, all patients presented symptomatology in both events. The time between remission of the first infection and onset of second infection was 108, 109, 78 and 67 days for each case, while the time to confirmation by reverse transcription polymerase chain reaction (RT-PCR) between infections was 134, 124, 106 and 77 days. In two of the four cases the reinfection resulted in a more severe case, while in the remaining two cases the manifestation of symptoms and complications was similar to that presented in the first infection. Given this scenario, greater care is needed in the management of the pandemic caused by SARS-CoV-2 to protect healthcare workers and the general public from risks and complications caused by a possible reinfection by SARS-CoV-2.

From the handling of an outbreak by an unknown pathogen in Wuhan to the preparedness and response in the face of the emergence of Covid-19 in Mexico.

On December 31, 2019, the Chinese health authorities informed the international community, through the mechanisms established by the World Health Organization (WHO), of a pneumonia epidemic of unknown etiology in Wuhan, Hubei Province. The first cases were reported early in that month and were linked to a history of having visited a market where food and live animals are sold. On January 7, 2020, isolation and identification of the culprit pathogen was achieved using next-generation sequencing, while the number of affected subjects continued to rise. The publication of full-genomes of the newly identified coronavirus (initially called 2019-nCoV, now called SARS-CoV2) in public and private databases, of standardized diagnostic protocols and of the clinical-epidemiological information generated will allow addressing the Public Health Emergency of International Concern (PHEIC), declared on January 30 by the WHO. With this document, we intend to contribute to the characterization of the pneumonia epidemic, now designated coronavirus disease (Covid-19) review the strengths Mexico has in the global health concert and invite health professionals to join the preparedness and response activities in the face of this emergency.

El 31 de diciembre de 2019, las autoridades chinas de salud informaron a la comunidad internacional, a través de los mecanismos establecidos por la Organización Mundial de la Salud (OMS), de una epidemia de neumonía con etiología desconocida en Wuhan, provincia de Hubei. Los primeros casos se notificaron a inicios de ese mes y se vincularon al antecedente de visitar un mercado de comida y animales vivos. El 7 de enero de 2020 se logró el aislamiento y reconocimiento del patógeno responsable mediante secuenciación de siguiente generación, mientras el número de afectados continuaba en ascenso. La publicación de genomas completos del nuevo coronavirus identificado (inicialmente denominado 2019-nCoV, ahora designado SARS-CoV2) en bases de datos públicas y privadas, de protocolos diagnósticos estandarizados y de la información clínica epidemiológica generada permitirá atender la Emergencia de Salud Pública de Importancia Internacional (ESPII) declarada el 30 de enero por la OMS. Con este documento pretendemos aportar a la caracterización de la epidemia de neumonía, ahora llamada enfermedad por coronavirus (Covid-19), revisar las fortalezas que tiene México en el concierto de la salud global e invitar a los profesionales de la salud a incorporarse a las actividades de preparación y respuesta ante esta emergencia.

De la atención de un brote por un patógeno desconocido en Wuhan hasta la preparación y respuesta ante la emergencia de Covid-19 en México / From the handling of an outbreak by an unknown pathogen in Wuhan to the preparedness and response in the face of the emergence of Covid-19 in Mexico

Resumen El 31 de diciembre de 2019, las autoridades chinas de salud informaron a la comunidad internacional, a través de los mecanismos establecidos por la Organización Mundial de la Salud (OMS), de una epidemia de neumonía con etiología desconocida en Wuhan, provincia de Hubei. Los primeros casos se notificaron a inicios de ese mes y se vincularon al antecedente de visitar un mercado de comida y animales vivos. El 7 de enero de 2020 se logró el aislamiento y reconocimiento del patógeno responsable mediante secuenciación de siguiente generación, mientras el número de afectados continuaba en ascenso. La publicación de genomas completos del nuevo coronavirus identificado (inicialmente denominado 2019-nCoV, ahora designado SARS-CoV2) en bases de datos públicas y privadas, de protocolos diagnósticos estandarizados y de la información clínica epidemiológica generada permitirá atender la Emergencia de Salud Pública de Importancia Internacional (ESPII) declarada el 30 de enero por la OMS. Con este documento pretendemos aportar a la caracterización de la epidemia de neumonía, ahora llamada enfermedad por coronavirus (Covid-19), revisar las fortalezas que tiene México en el concierto de la salud global e invitar a los profesionales de la salud a incorporarse a las actividades de preparación y respuesta ante esta emergencia.

Abstract On December 31, 2019, the Chinese health authorities informed the international community, through the mechanisms established by the World Health Organization (WHO), of a pneumonia epidemic of unknown etiology in Wuhan, Hubei Province. The first cases were reported early in that month and were linked to a history of having visited a market where food and live animals are sold. On January 7, 2020, isolation and identification of the culprit pathogen was achieved using next-generation sequencing, while the number of affected subjects continued to rise. The publication of full-genomes of the newly identified coronavirus (initially called 2019-nCoV, now designated SARS-CoV2) in public and private databases, of standardized diagnostic protocols and of the clinical-epidemiological information generated will allow addressing the Public Health Emergency of International Concern (PHEIC), declared on January 30 by the WHO. With this document, we intend to contribute to the characterization of the pneumonia epidemic, now called Corona virus disease (Covid-19) review the strengths Mexico has in the global health concert and invite health professionals to join the preparedness and response activities in the face of this emergency.

Errores más comunes al redactar artículos médicos originales.

One of the skills that is more in need to be strengthened in the medical area is the dissemination of knowledge. For this reason, it is necessary to provide elements that promote training in scientific writing. Identifying the most common problems when writing medical original articles for publication will provide useful resources that should contribute to the generation of knowledge. There are multiple reasons that intervene for an original article not to be accepted in a medical journal, among which failure to follow instructions for authors and methodological, design and structural problems stand out. However, the aspect that most influences and that is seldom pointed out, is inadequate writing of research manuscripts, which becomes evident in the different sections that make up manuscripts. All the above-mentioned factors are the responsibility of the authors, and therefore must be taken care of properly. The purpose of this article is to identify the most common mistakes when writing original medical manuscripts, which, if avoided, will increase the possibility for research papers to be accepted for publication.

Una de las habilidades que más requiere ser fortalecida en el área médica es la difusión de conocimiento, por tal motivo, es necesario brindar elementos que promuevan la capacitación en redacción científica. Identificar cuáles son los problemas más comunes al redactar artículos médicos originales para su publicación proporcionará recursos útiles que contribuyan a la generación de conocimiento. Existen diversos motivos que intervienen para que un artículo original no sea aceptado en una revista médica, entre los que destacan falta de apego a las instrucciones para autores, problemas metodológicos y de diseño, así como de estructura, sin embargo, el aspecto que más influye y pocas veces se señala, es la redacción inadecuada de los escritos de investigación, la cual se hace patente en las diferentes secciones que componen los manuscritos. Todos los factores mencionados son responsabilidad de los autores, por lo que deben ser atendidos apropiadamente. El presente escrito tiene como objetivo señalar los errores más comunes al redactar escritos médicos originales, los cuales, de ser evitados, incrementarán la posibilidad de que sus trabajos de investigación sean aceptados para su publicación.

Algoritmo diagnóstico para la confirmación de casos de sarampión y rubéola en México.

Due to the successful implementation of measles and rubella elimination strategies, Mexico announced the interruption of endemic transmission of measles in 1996 and that of rubella in 2008. After a verification process, the region of the Americas was declared free of rubella and congenital rubella syndrome in 2015 and of measles in 2016. In order to maintain the elimination status in Mexico, it is essential to continue laboratory surveillance within the framework of the Global Measles and Rubella Laboratory Network. The Institute of Epidemiological Diagnosis and Reference, through the National Network of Public Health Laboratories, guarantees timely and reliable results in view of the possible reintroduction of these and other emerging pathogens.

Debido a la implementación exitosa de las estrategias de eliminación del sarampión y la rubéola, México enunció la interrupción de la transmisión endémica del sarampión en 1996 y de la rubéola en 2008. Después de un proceso de verificación, la región de las Américas fue declarada libre de rubéola y del síndrome de rubéola congénita en 2015 y del sarampión en 2016. Para mantener el estatus de eliminación en México es esencial continuar con la vigilancia por laboratorio en el marco de la Red Mundial de Laboratorios de Sarampión y Rubéola. El Instituto de Diagnóstico y Referencia Epidemiológicos, a través de la Red Nacional de Laboratorios de Salud Pública, garantiza resultados oportunos y confiables ante la posible reintroducción de estos y otros patógenos emergentes.

Diagnostic algorithm for the confirmation of cases of measles and rubella in Mexico

Due to the successful implementation of measles and rubella elimination strategies, Mexico announced the interruption of endemic transmission of measles in 1996 and that of rubella in 2008. After a verification process, the region of the Americas was declared free of rubella and congenital rubella syndrome in 2015 and of measles in 2016. In order to maintain the elimination status in Mexico, it is essential to continue laboratory surveillance within the framework of the Global Measles and Rubella Laboratory Network. The Institute of Epidemiological Diagnosis and Reference, through the National Network of Public Health Laboratories, guarantees timely and reliable results in view of the possible reintroduction of these and other emerging pathogens.

Diagnostic algorithm for the confirmation of cases of measles and rubella in Mexico.

Due to the successful implementation of measles and rubella elimination strategies, Mexico announced the interruption of endemic transmission of measles in 1996 and that of rubella in 2008. After a verification process, the region of the Americas was declared free of rubella and congenital rubella syndrome in 2015 and of measles in 2016. In order to maintain the elimination status in Mexico, it is essential to continue laboratory surveillance within the framework of the Global Measles and Rubella Laboratory Network. The Institute of Epidemiological Diagnosis and Reference, through the National Network of Public Health Laboratories, guarantees timely and reliable results in view of the possible reintroduction of these and other emerging pathogens.

Nonalcoholic fatty liver disease can be predicted by retinal vascular changes in patients with obesity without hypertension or diabetes.

OBJECTIVE: To evaluate the utility of predicting nonalcoholic fatty liver disease (NAFLD) and obesity by retinal vascular changes (RVC) found in fundoscopy and to determine whether this is related to a low-grade inflammatory process. METHODS: We carried out a cross-sectional analysis that included 152 (ages 18-45 years) patients divided into four groups: NAFLD and BMI less than 25, absence of NAFLD and BMI less than 25, NAFLD and BMI more than 30, and absence of NAFLD and BMI more than 30. Retinal fundoscopy, hepatic ultrasound, metabolic profile, and cytokine measurement were performed. We calculated odds ratio [95% confidence interval (CI)], performed diagnostic utility tests, and carried out a 2 factorial analysis. RESULTS: Obesity was associated with RVC (odds ratio: 21.25; 95% CI: 8.79-51.4) and NAFLD [25 (9.07-72.6)]. NAFLD was associated with RVC [11.24 (4.98-26.48)], and the prediction of NAFLD showed a sensitivity of 75% (95% CI: 68-82) and a specificity of 81% (75-86); when RVC-obesity were combined, sensitivity increased to 90% (88-91.7), with a specificity of 85% (84-85.8). C-reactive protein was associated with the three factors, suggesting an independent contribution. Thin patients with RVC and NAFLD had higher concentrations of interleukin-2, interleukin-6, tumor necrosis factor-α, and interferon-γ. CONCLUSION: NAFLD in patients with obesity without diabetes or hypertension can be predicted by RVC, a noninvasive technique carried out by eye fundoscopy. NAFLD alone can drive inflammatory conditions in the absence of obesity that manifests as RVC.

Gut microbiota as a key player in triggering obesity, systemic inflammation and insulin resistance.

Obesity-related systemic inflammation contributes to develop insulin resistance. The main factors involved in the relationship of obesity with systemic inflammation and insulin resistance have not been completely elucidated. Microbiota includes around 1013 to 1014 microbes harboring the human gut, which are clustered in approximately a thousand different bacterial species. Several studies suggest that imbalance in the intestinal bacterial population could result in obesity, systemic inflammation and metabolic dysfunction. Here, we review the main bacterial groups observed in obesity as well as their possible role in increasing the intestinal permeability and lipopolysaccharide-related endotoxemia. Furthermore, we point out the role of intestinal dysbiosis in the inflammatory activation of macrophages with the ability to infiltrate in the visceral adipose tissue and induce insulin resistance. Finally, we discuss the apparent beneficial use of prebiotics and probiotics in ameliorating both systemic inflammation and metabolic dysfunction. Present information may be useful in the future design of novel therapies focused on treating obesity and insulin resistance by restoring the gut microbiota balance.