Demographic and climatic factors associated with dengue prevalence in a hyperendemic zone in Mexico: an empirical approach.

BACKGROUND: Many models for predicting dengue epidemics use incidence and short-term changes in climate variables, however, studies in real-life scenarios for correlations of seroprevalence (SP) with long-term climate variables and with integration of socio-economic factors are scarce. Our objective was to analyse the combined correlation between socio-economic and climate variables with the SP of dengue in Mexico. METHODS: We performed a seroepidemiological ecological study on the Mexican Pacific coast. Dengue SP was estimated by the presence of immunoglobulin G antibodies in 1278 inhabitants. We implemented multiple correlations with socio-economic, climatic and topographic characteristics using logistic regression, generalized linear models and non-linear regressions. RESULTS: Dengue SP was 58%. The age-adjusted correlation was positive with the male sex, while a negative correlation was seen with socio-economic status (SES) and scholl level (SL). The annual temperature showed a positive correlation, while the altitude was negative. It should be noted that these correlations showed a marked 'S' shape in the non-linear model, suggesting three clearly defined scenarios for dengue risk. CONCLUSION: Low SES and SL showed an unexpected paradoxical protective effect. Altitude above sea level and annual temperature are the main determinants for dengue in the long term. The identification of three clearly delineated scenarios for transmission could improve the accuracy of predictive models.

Effect of an ecosystem-centered community participation programme on the incidence of dengue. A field randomized, controlled trial.

OBJECTIVES: The purpose of this study is to analyse the effect of a community participation programme based on the ecosystem model on the incidence of dengue in urban communities. METHODS: A randomized controlled field trial was conducted in the state of Colima, Mexico. The intervention consisted of a community participation programme focused on the ecosystem; simultaneously, the control groups were communities that only received the usual official prevention programs. The incidence of dengue was estimated in people of both groups due to the appearance of de novo IgM antibodies during the follow-up period. RESULTS: The incidence of dengue in the intervened group was 2.58%/month (n = 818) and in control group 2.26%/month (n = 994), with a risk ratio of 1.14 (95% CI 0.89-1.45) and a PAF of 0.06 (95% CI - 0.056 to 0.16). The A. aegypti larval density (Breteau Index) was reduced in the treated group. CONCLUSIONS: The implementation of a community participation programme in the cities of Colima, Mexico, showed a slightly counterproductive effect on the incidence of dengue. This happened even with a reduction in the A. aegypti index.

The Evolution of Antimicrobial Resistance in Mexico During the Last Decade: Results from the INVIFAR Group.

Background: Surveillance of antimicrobial resistance (AMR) requires an international approach with national and local strategies. Our aim was to summarize a retrospective 10-year report of antibiotic resistance of gram-positive and gram-negative bacteria in Mexico. Methods: A total of 46 centers from 22 states of Mexico participated. Databases of AMR from January 2009 to December 2018 were included for most species. The 10-year period was divided into five 2-year periods. Results: For Staphylococcus aureus, a decrease in resistance in all specimens was observed for erythromycin and oxacillin (p < 0.0001 for each). For Enterobacter spp., resistance to meropenem increased for urine specimens (p = 0.0042). For Klebsiella spp., increased drug resistance in specimens collected from blood was observed for trimethoprim/sulfamethoxazole, gentamicin, tobramycin (p < 0.0001 for each), meropenem (p = 0.0014), and aztreonam (p = 0.0030). For Acinetobacter baumannii complex, high drug resistance was detected for almost all antibiotics, including carbapenems, except for tobramycin, which showed decreased resistance for urine, respiratory, and blood isolates (p < 0.0001 for each), and for amikacin, which showed a decrease in resistance in urine specimens (p = 0.0002). An increase in resistance to cefepime was found for urine, respiratory, and blood specimens (p < 0.0001 for each). For Pseudomonas aeruginosa, aztreonam resistance increased for isolates recovered from blood (p = 0.0001). Conclusion: This laboratory-based surveillance of antibiotic resistance shows that resistance is increasing for some antibiotics in different bacterial species in Mexico and highlights the need for continuous monitoring of antibiotic resistance.

Correlation between skinfold thickness and bioelectrical impedance analysis for the evaluation of body composition in patients on dialysis.

INTRODUCTION: Patients on dialysis have important changes in body composition. OBJECTIVES: To determine the correlation between skinfold thickness (SKF) and bioimpedance analysis (BIA) for estimating fat mass (FM) and lean body mass (LBM) in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). METHODS: Cross-sectional study. We included 50 patients under dialysis treatment. To measure SKF, we used the Lange® skinfold caliper (Beta Technology, California, USA) and we carried out the impedance analysis with the Bodystat Quadscan 4000® (Quadscan, Isle of Man, UK). The measurements were performed post-hemodialysis. The PD patients were measured with and without peritoneal dialysate and body weight was corrected for peritoneal fluid. We determined the Pearson's correlation coefficient between SKF and BIA for estimating FM and LBM. We also evaluated the influence of age, sex, diuretic use, dialysis vintage, extracellular water (ECW), and intracellular water (ICW) through a multivariate regression analysis. RESULTS: Of the 50-patient total, 29 were men (58%) and patient mean age was 46.3 ± 16.5 years. The correlation between SKF and BIA was r = 0.784 (p < 0.001) for FM and r = 0.925 (p < 0.001) for LBM. Age and sex influenced the variability of FM, whereas sex, age, and ECW influenced the variability of LBM, both evaluated through the SKF and BIA methods. CONCLUSION: SKF and BIA are useful methods in clinical practice. The strong and statistically significant correlations between the two methods show they are interchangeable. Age, sex, ECW, and ICW influence the variability of FM and LBM.

Correlation between skinfold thickness and bioelectrical impedance analysis for the evaluation of body composition in patients on dialysis / Correlación entre la plicometría y el análisis de bioimpedancia eléctrica para la evaluación de la composición corporal en pacientes en diálisis

Introduction: Patients on dialysis have important changes in body composition. Objectives: To determine the correlation between skinfold thickness (SKF) and bioimpedance analysis (BIA) for estimating fat mass (FM) and lean body mass (LBM) in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). Methods: Cross-sectional study. We included 50 patients under dialysis treatment. To measure SKF, we used the Lange® skinfold caliper (Beta Technology, California, USA) and we carried out the impedance analysis with the Bodystat Quadscan 4000® (Quadscan, Isle of Man, UK). The measurements were performed post-hemodialysis. The PD patients were measured with and without peritoneal dialysate and body weight was corrected for peritoneal fluid. We determined the Pearson’s correlation coefficient between SKF and BIA for estimating FM and LBM. We also evaluated the influence of age, sex, diuretic use, dialysis vintage, extracellular water (ECW), and intracellular water (ICW) through a multivariate regression analysis. Results: Of the 50-patient total, 29 were men (58%) and patient mean age was 46.3 ± 16.5 years. The correlation between SKF and BIA was r = 0.784 (p < 0.001) for FM and r = 0.925 (p < 0.001) for LBM. Age and sex influenced the variability of FM, whereas sex, age, and ECW influenced the variability of LBM, both evaluated through the SKF and BIA methods. Conclusion: SKF and BIA are useful methods in clinical practice. The strong and statistically significant correlations between the two methods show they are interchangeable. Age, sex, ECW, and ICW influence the variability of FM and LBM (AU)

Introducción: los pacientes en tratamiento con diálisis presentan cambios importantes en la composición corporal. Objetivos: determinar la correlación entre la plicometría y el análisis de bioimpedancia eléctrica (BIE) para la estimación de la masa grasa (MG) y la masa magra (MM) en pacientes sometidos a hemodiálisis (HD) y diálisis peritoneal (DP). Métodos: diseño transversal-analítico. Se incluyeron 50 pacientes en tratamiento con diálisis. Se utilizó el plicómetro Lange® (Beta Technology, California, USA) para la medición de pliegues cutáneos y la BIE fue realizada con el Bodystat Quadscan 4000 ® (Quadscan, Isle of Man, UK). Las mediciones fueron realizadas poshemodiálisis. Los pacientes en DP fueron medidos con y sin líquido peritoneal y el peso corporal fue corregido. Determinamos el coeficiente de correlación de Pearson entre la plicometría y la BIE en la estimación de la MG y la MM. Se evaluaron otras variables como edad, sexo, uso de diuréticos, tiempo en tratamiento de diálisis, agua extracelular (AEC) e intracelular (AIC) a través de un análisis de regresión multivariada. Resultados: veintinueve pacientes (58%) son del sexo masculino; la edad promedio de 46,3 ± 16,5 años. Se obtuvo una correlación significativa y positiva entre la plicometría y la BIE [r = 0,784 (p < 0,001) para MG y r = 0,925 (p < 0,001)] para MM. La edad y el sexo influyeron en la variabilidad de la MG, mientras que el sexo, la edad y el AEC influyeron en la variabilidad de la MM, evaluados con ambos métodos. Conclusiones: la plicometría y la BIE son métodos útiles en la práctica clínica. La correlación que se obtuvo entre los dos métodos muestra que son intercambiables. Por otro lado, variables como la edad, el sexo, el agua AEC y AIC se identificó que influyen en la variabilidad de la MG y MM (AU)

Seroprevalence of Trypanosoma cruzi (TC) and risk factors in Colima, Mexico.

INTRODUCTION: The present study was conducted to estimate the incidence of seropositivity to anti-Trypanosoma cruzi antibodies and analyze potential risk factors in Colima, on the western coast of Mexico. METHODOLOGY: Longitudinal studies of 209 subjects with negative serology in 1999 for anti-Trypanosoma cruzi antibodies by hemagglutination inhibition test were tested again in 2005. At the same time, 716 children under six years of age were surveyed serologically (total n = 925); the history of Trypanosoma cruzi infection was determined by the same hemagglutination inhibition test. The variables analyzed were age, sex, living in triatomine-infested places, type of community, quality of housing, presence of pets, and number of inhabitants per house. RESULTS: Trypanosoma cruzi seropositivity in the period of six years was 22/925 cases, with a point prevalence of 2.73% and an adjusted rate of 7.3/1,000 person-years. The variable living in triatomine-infested areas showed association with seropositivity anti-Trypanosoma cruzi antibodies (RR: 5.5; 95% CI: 1.28-23.5). The remaining variables showed no significant association. CONCLUSIONS: This study confirms the active transmission of Chagas disease in Mexico´s western-central region, which merits greater epidemiological surveillance and vector control, particularly in localities infested with triatomines.

Violencia doméstica y riesgo de conducta suicida en universitarios adolescentes / Domestic violence and risk of suicidal behavior among university students

OBJETIVO: Estimar el grado de asociación entre violencia doméstica física, verbal y sexual con la conducta suicida en adolescentes universitarios. MATERIAL Y MÉTODOS: Estudio de casos y controles pareado en estudiantes universitarios de Colima. Los casos fueron 235 adolescentes que presentaron tanto ideación suicida como intento suicida; los controles fueron 470 individuos de la misma edad y sexo. RESULTADOS: El abuso sexual mostró el mayor grado de asociación con conducta suicida (RM= 27.4), seguido de violencia verbal (RM= 9.28), uso de drogas (RM= 8.6), violencia física (RM= 5.5) y tabaquismo (RM= 3.6). La regresión logística multivariada mostró que la violencia verbal se asoció con conducta suicida en forma independiente, mientras que violencia física, abuso sexual, tabaquismo y uso de drogas parecen depender de aquella. CONCLUSIONES: La violencia intrafamiliar, particularmente la verbal, está fuertemente asociada con la conducta suicida en adolescentes y debe ser considerada dentro de programas preventivos contra suicidio.

OBJECTIVE: To estimate the degree of association between domestic violence -physical, verbal or sexual- with suicidal behavior among university students. MATERIAL AND METHODS: A matched case-control study was done with students attending the University of Colima, Mexico. The cases were 235 teenagers who presented both suicidal ideation and suicide attempt; the controls were 470 individuals of the same age and sex. RESULTS: Sexual abuse showed the highest degree of association with suicidal behavior (OR= 27.4), followed by verbal violence (OR= 9.28), drug use (OR= 8.6), physical violence (OR= 5.5) and smoking (OR= 3.6). Multivariate logistic regression showed that verbal violence was associated with suicidal behavior independently of the other variables, while physical violence, sexual abuse, smoking and drug use seem to depend on verbal violence. CONCLUSIONS: Domestic violence, particularly verbal or sexual, is strongly associated with suicidal behavior in adolescents and should be considered in suicide prevention programs.

[Domestic violence and risk of suicidal behavior among university students]. / Violencia doméstica y riesgo de conducta suicida en universitarios adolescentes.

OBJECTIVE: To estimate the degree of association between domestic violence -physical, verbal or sexual- with suicidal behavior among university students. MATERIAL AND METHODS: A matched case-control study was done with students attending the University of Colima, Mexico. The cases were 235 teenagers who presented both suicidal ideation and suicide attempt; the controls were 470 individuals of the same age and sex. RESULTS: Sexual abuse showed the highest degree of association with suicidal behavior (OR= 27.4), followed by verbal violence (OR= 9.28), drug use (OR= 8.6), physical violence (OR= 5.5) and smoking (OR= 3.6). Multivariate logistic regression showed that verbal violence was associated with suicidal behavior independently of the other variables, while physical violence, sexual abuse, smoking and drug use seem to depend on verbal violence. CONCLUSIONS: Domestic violence, particularly verbal or sexual, is strongly associated with suicidal behavior in adolescents and should be considered in suicide prevention programs.

Reporte de un caso de dengue neonatal / Neonatal dengue. Case report

Introducción. Existe poca información sobre los efectos por dengue en el embarazo y feto, a pesar de que el riesgo se incrementa durante epidemias, por lo cual los reportes son pocos a pesar del número documentadas de éstas en países tropicales. La transmisión vertical del dengue se ha descrito poco. En Colombia se reportó una frecuencia de 0.3% en 10 años en recién nacidos y ningún caso en Guinea. Caso clínico. Nace al quinto día de enfermedad febril materna, parto eutócico, de 40 semanas, masculino, calificación de Apgar 8/9 en tiempos convencionales, peso, talla y perímetro cefálico en percentil 50, exploración física normal. Al tercer día de vida (octavo día de dengue hemorrágico materno), presentó fiebre, se sospechó sepsis neonatal y se inició antibióticos; al cuarto día de vida requirió fototerapia y presentó leucopenia, irritabilidad, llanto intenso e hiperreflexia, con sospecha de neuroinfección. Se agregó cefotaxima (sin punción lumbar por trombocitopenia y TPT prolongado). Hemocultivo negativo. Serología IgM positiva para virus del dengue del binomio madre-producto. A los 12 días de vida se encuentra asintomático y con exámenes de laboratorio normales. Conclusión. Las embarazadas con dengue clásico por lo general presentan un parto y puerperio normales, como en este caso. En el dengue hemorrágico existe mayor riesgo de retardo en el crecimiento intrauterino, amenazas de aborto y parto pretérmino, ruptura prematura de membranas, preeclampsia y muerte materno-fetal.

Introduction. There is little information about the effects of dengue infection upon the fetus, although the risk for this event increases during epidemic outbreaks. The vertical transmission of dengue is a rare event, a case is described below. Case report. The patient was a male, born after 40 weeks of gestation and on the 5th day of a maternal febrile illness. His Apgar score was 8/9, with weight, size and cephalic perimeter in the range of the 50 percentile. On the first 24 hours after the delivery the patient developed fever and antibiotics was given for neonatal sepsis. On the postpartum day 4 he showed irritability, intense crying and hypereflexia, meanwhile the laboratory revealed thrombocytopenia and leucopoenia. Neuroinfection was presumed and treatment with phototherapy and cefotaxime was begun (the lumbar puncture was avoided because thrombocytopenia and prolonged TPT). The blood culture was negative. IgM antibodies for dengue virus were positive in both, mother and neonate. On postpartum day 12, both, mother and child were discharged from the hospital, asymptomatic and with normal laboratory values. Conclusions. Usually, pregnant women with classic dengue have normal parturition and puerperium, as in this case. However, in the hemorrhagic dengue form there is an increased risk of delayed intrauterine growth, abortion, prematurity, premature rupture of membranes, preeclampsia and maternal or fetal death. The neonatal transmission of dengue is very rare, even in endemic countries with large epidemics; however it is an important condition that needs to be considered in the differential diagnosis of septic new-borns in endemic areas.

[Re-emergence of hemorrhagic disease in newborns. Implications for its prevention]. / Resurgimiento de enfermedad hemorrágica del recién nacido. Implicaciones para su prevención.

OBJECTIVE: To describe the occurrence of hemorrhagic disease of the newborn (HDN) at a tertiary care pediatric hospital of Morelos state. MATERIAL AND METHODS: A retrospective case series study was conducted between 1997-2000 at Hospital del Niño Morelense (Morelos State Children's Hospital), in 46 newborns aged under 12 weeks. Study subjects were referred from peripheral units with a diagnosis of HDN. RESULTS: The severe late-onset form of HDN was present in 91% of the cases. Fifty-two percent of childbirths were assisted by a physician and 48% by an empiric midwife. Application of vitamin K was unknown in 61% of cases, in 39% it was not applied and in 4% it was applied. The majority of infants presented severe symptoms due to intra-cranial bleeding, 11% died, and 41% had severe disease sequelae. CONCLUSIONS: Given the high prevalence of HDN in the State of Morelos, reproductive health programs should be reviewed and training programs intensified to promote the utilization of vitamin K by physicians and nurses for preventing this disease.

Resurgimiento de enfermedad hemorrógica del recién nacido. Implicaciones para su prevención / Re-emergence of hemorrhagic disease in newborns. Implications for its prevention

OBJECTIVE: To describe the occurrence of hemorrhagic disease of the newborn (HDN) at a tertiary care pediatric hospital of Morelos state. MATERIAL AND METHODS: A retrospective case series study was conducted between 1997-2000 at Hospital del Niño Morelense (Morelos State Children's Hospital), in 46 newborns aged under 12 weeks. Study subjects were referred from peripheral units with a diagnosis of HDN. RESULTS: The severe late-onset form of HDN was present in 91 of the cases. Fifty-two percent of childbirths were assisted by a physician and 48 by an empiric midwife. Application of vitamin K was unknown in 61 of cases, in 39 it was not applied and in 4 it was applied. The majority of infants presented severe symptoms due to intra-cranial bleeding, 11 died, and 41 had severe disease sequelae. CONCLUSIONS: Given the high prevalence of HDN in the State of Morelos, reproductive health programs should be reviewed and training programs intensified to promote the utilization of vitamin K by physicians and nurses for preventing this disease.