Differences in Pertussis Incidence by Race and Ethnicity in the United States, 2010-2017.

Background: An increased pertussis burden has been demonstrated among Hispanic or Latino and American Indian or Alaska Native (AI/AN) infants. However, data on potential disparities among other age and racial groups are limited. Methods: We analyzed pertussis cases reported through Enhanced Pertussis Surveillance from 2010 to 2017. Pertussis and severe pertussis incidence were calculated by race (White, Black or African American, AI/AN, and Asian or Pacific Islanders), ethnicity (Hispanic or Latino and non-Hispanic or non-Latino), and age. Results: Compared with White persons, overall incidence was lower among Black or African American (incidence rate ratio [IRR], .57; 95% confidence interval [CI], .53-.61), AI/AN (IRR, 0.65; 95% CI, .58-.72), and Asian or Pacific Islander persons (IRR, 0.39; 95% CI, .35-.43). Overall incidence of pertussis was higher (1.5-fold; 95% CI, 1.37-1.60) among Hispanic or Latino compared with non-Hispanic or non-Latino adults, potentially related to household size or lower pertussis vaccine uptake among adult Hispanic or Latino cases. Severe pertussis incidence was similar among Black or African American and AI/AN persons compared with White persons. Among infants, severe pertussis incidence was 1.4-fold higher (95% CI, 1.03-1.82) among Black or African American infants than among White infants, and 2.1-fold higher (95% CI, 1.67-2.57) among Hispanic or Latino infants than non-Hispanic or non-Latino infants. Conclusions: The contrast between lower reported incidence but similar or higher severe pertussis incidence among Black or African American and AI/AN persons compared with White persons warrants further investigation and may reflect underdiagnosis or underreporting of mild disease.

Effect of exogenous l-carnitine on aortic stiffness in dyslipidemic adolescents: Design of a quadruple-blind, randomized, controlled interventional trial.

Background: Atherosclerotic cardiovascular disease (ASCVD) risk factors including vascular remodeling leading to hypertension and dyslipidemia are prevalent among children and adolescents. Conflicting observational and Mendelian randomization data suggest endogenous carnitine may affect arterial stiffness and lipid traits. Because of this, we developed a study to evaluate the causal role for carnitine in arterial stiffness at a point when the lifecourse trajectory to hypertension can be modified. Methods: This study is a mechanistic, double-blinded, randomized control trial (RCT) in 166 adolescents with dyslipidemia for the effect of 6 months of maximum dose 3 g daily oral l-carnitine supplementation (CS+) versus placebo (CS-) on aortic stiffness measured as carotid-femoral pulse wave velocity (CFPWV) and pulse pressure (PP); lipid concentrations (total cholesterol, HDL-C, triglycerides, and LDL-C) and serum fatty acid oxidation biomarkers by metabolomic analysis. Conclusions: The simultaneous evaluation of endogenous carnitine genetic effects and exogenous l-carnitine supplementation may facilitate future therapies for youth with cardiometabolic derangement to arrest atherosclerotic changes.

High post-exposure prophylaxis (PEP) uptake among household contacts of pertussis patients enrolled in a PEP effectiveness evaluation - United States, 2015-2017.

BACKGROUND: Post-exposure prophylaxis (PEP) for pertussis is recommended for household contacts of pertussis cases in the United States within 21 days of exposure, but data on PEP effectiveness for prevention of secondary cases in the setting of widespread pertussis vaccination are limited. We implemented a multi-state evaluation of azithromycin PEP use and effectiveness among household contacts. METHODS: Culture- or PCR-confirmed pertussis cases were identified through surveillance. Household contacts were interviewed within 7 days of case report and again 14-21 days later. Interviewers collected information on exposure, demographics, vaccine history, prior pertussis diagnosis, underlying conditions, PEP receipt, pertussis symptoms, and pertussis testing. A subset of household contacts provided nasopharyngeal and blood specimens during interviews. RESULTS: Of 299 household contacts who completed both interviews, 12 (4%) reported not receiving PEP. There was no evidence of higher prevalence of cough or pertussis symptoms among contacts who did not receive PEP. Of 168 household contacts who provided at least one nasopharyngeal specimen, four (2.4%) were culture or PCR positive for B. pertussis; three of these received PEP prior to their positive test result. Of 156 contacts with serologic results, 14 (9%) had blood specimens that were positive for IgG anti-pertussis toxin (PT) antibodies; all had received PEP. CONCLUSIONS: Very high PEP uptake was observed among household contacts of pertussis patients. Although the number of contacts who did not receive PEP was small, there was no difference in prevalence of pertussis symptoms or positive laboratory results among these contacts compared with those who did receive PEP.

Infección grave de piel y partes blandas por Fusarium oxysporum asociado a la administración subcutánea de insulina / Severe skin and soft tissue infection due to Fusarium oxysporum associated with subcutaneous insulin administration

Resumen La diabetes mellitus (DM) es una enfermedad crónica muy prevalente. Dentro de los tratamientos para la DM se encuentra la insulina que es el agente antidiabético más potente, sin embargo, una proporción significativa de pacientes no logra alcanzar el objetivo de hemoglobina glicosilada (HbA1c). Los errores en la aplicación de insulina son un factor importante y corregible en muchos casos. Se presenta el caso de una paciente con DM, antecedentes de neuropatía diabética, enfermedad renal crónica estadio V en hemodiálisis, hipertensión arterial, estenosis aórtica con recambio por válvula protésica, y anticoagulada, con escasa adherencia a recomendaciones higiénico dietéticas. Debido a la mala técnica de aplicación de insulina y falta de higiene, desarrolló varias infecciones polimicrobianas de piel y partes blandas, con evolución tórpida de las úlceras y mala respuesta al tratamiento indicado. Durante su internación, de una úlcera se aisló Fusarium oxysporum. Es importante jerarquizar la relevancia de la educación diabetológica en pacientes insulinizados y el rol de los educadores en diabetes en el cuidado de los mismos. Por otro lado, destacar la importancia de la toma de cultivos mediante punción de partes blandas ante la aparición de signos locales de infección.

Abstract Diabetes mellitus (DM) is a very prevalent chronic disease. Among the treatments for DM, insulin is the most potent antidiabetic agent. However a significant proportion of patients fail to achieve Errors in the application of insulin are an important and correctable factor in many cases. We present the case of a patient with DM who, due to poor insulin application technique and hygiene, develops a skin and soft tissue infection with subsequent appearance of Fusarium oxysporum. It is important to emphasize the relevance of diabetes education in insulin ized patients and the role of diabetes educators in their care. On the other hand, it is important to emphasize the importance of taking cultures by soft tissue puncture in case of local signs of infection.

[Severe skin and soft tissue infection due to Fusarium oxysporum associated with subcutaneous insulin administration]. / Infección grave de piel y partes blandas por Fusarium oxysporum asociado a la administración subcutánea de insulina.

Diabetes mellitus (DM) is a very prevalent chronic disease. Among the treatments for DM, insulin is the most potent antidiabetic agent. However a significant proportion of patients fail to achieve Errors in the application of insulin are an important and correctable factor in many cases. We present the case of a patient with DM who, due to poor insulin application technique and hygiene, develops a skin and soft tissue infection with subsequent appearance of Fusarium oxysporum. It is important to emphasize the relevance of diabetes education in insulinized patients and the role of diabetes educators in their care. On the other hand, it is important to emphasize the importance of taking cultures by soft tissue puncture in case of local signs of infection.

La diabetes mellitus (DM) es una enfermedad crónica muy prevalente. Dentro de los tratamientos para la DM se encuentra la insulina que es el agente antidiabético más potente, sin embargo, una proporción significativa de pacientes no logra alcanzar el objetivo de hemoglobina glicosilada (HbA1c). Los errores en la aplicación de insulina son un factor importante y corregible en muchos casos. Se presenta el caso de una paciente con DM, antecedentes de neuropatía diabética, enfermedad renal crónica estadio V en hemodiálisis, hipertensión arterial, estenosis aórtica con recambio por válvula protésica, y anticoagulada, con escasa adherencia a recomendaciones higiénico dietéticas. Debido a la mala técnica de aplicación de insulina y falta de higiene, desarrolló varias infecciones polimicrobianas de piel y partes blandas, con evolución tórpida de las úlceras y mala respuesta al tratamiento indicado. Durante su internación, de una úlcera se aisló Fusarium oxysporum. Es importante jerarquizar la relevancia de la educación diabetológica en pacientes insulinizados y el rol de los educadores en diabetes en el cuidado de los mismos. Por otro lado, destacar la importancia de la toma de cultivos mediante punción de partes blandas ante la aparición de signos locales de infección.

Congenital Heart Diseases: Genetic Risk Variants and Their Methylation Status.

(1) Background: The interaction between single nucleotide variants (SNVs) associated with congenital heart diseases (CHDs) and their gene methylation status has not been well researched. The aim of the present study was to determine if there is a relationship between the methy lation status (MS) of genes and the allelic variants associated with CHDs. (2) Methods: Seven SNVs of the genes AXIN1, TBX1, TBX20, and MTHFR were selected from the literature. DNA extraction, genotyping, and a methylation analysis were performed on healthy subjects and subjects with CHDs. (3) Results: Twenty-two subjects with CHDs were selected as the case group (15 with ventricular septal defects (VSDs) and 7 with atrial septal defects (ASDs)), and 44 healthy subjects comprised the control group. The MTHFR and AXIN1 genes were hypermethylated in the control group when compared to the case group. When analyzed separately, those with atrial septum defects exhibited greater methylation, except for the gene MTHFR where there were no differences. Only the alternate alleles of MTHFR showed a significantly different methylation status in those without cardiopathy. (4) Conclusions: The MTHFR and AXIN genes were hypermethylated in the control group; however, only the alternate alleles of MTHFR (rs1801133 and rs1801131) showed a significantly different methylation status.

Safety and Efficacy of Lenabasum, a Cannabinoid Receptor Type 2 Agonist, in Patients with Dermatomyositis with Refractory Skin Disease: A Randomized Clinical Trial.

BACKGROUND: Treatment options are limited for skin disease in dermatomyositis. Lenabasum is a cannabinoid receptor type 2 agonist that triggers the resolution of inflammation. OBJECTIVE: The objective of this study was to evaluate the safety and efficacy of lenabasum in patients with refractory cutaneous dermatomyositis. DESIGN: This study was a single-center, double-blind, randomized, placebo-controlled phase 2 study conducted from July 2015 to August 2017. POPULATION: The population included subjects aged ≥18 years with at least moderately active dermatomyositis skin activity by Cutaneous Dermatomyositis Disease Area and Severity Index activity ≥ 14 and failure or intolerance to hydroxychloroquine. INTERVENTION: Participants received 20 mg lenabasum daily for 28 days and then 20 mg twice per day for 56 days or placebo. MAIN OUTCOMES AND MEASURES: The primary outcome was a change in Cutaneous Dermatomyositis Disease Area and Severity Index activity. Safety and other secondary efficacy assessments were performed till day 113. RESULTS: A total of 22 subjects were randomized to lenabasum (n = 11) or placebo (n = 11). No serious or severe adverse events were related to lenabasum, and no participants discontinued the study. The adjusted least-squares mean for Cutaneous Dermatomyositis Disease Area and Severity Index activity decreased more for lenabasum, and the difference was significant on day 113 (least-squares mean [standard error] difference = ‒6.5 [3.1], P = 0.038). Numerically greater improvements were seen in multiple secondary efficacy outcomes and biomarkers with lenabasum. CONCLUSION: Lenabasum treatment was well tolerated and was associated with greater improvement in Cutaneous Dermatomyositis Disease Area and Severity Index activity and multiple efficacy outcomes. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov, NCT02466243.

Seborrheic Dermatitis in Older Adults: Pathogenesis and Treatment Options.

Seborrheic dermatitis is a common and chronic skin disease, which is particularly prevalent in older adults. While a specific cause of seborrheic dermatitis remains largely unelucidated, the currently understood pathogenesis of seborrheic dermatitis revolves around the presence of Malassezia yeast colonies and an inflammatory response in the affected individual. Keratinocyte proliferation resulting from inflammasome response in the host skin leads to the clinically relevant symptoms of seborrheic dermatitis. The increasing number of older adults as a percentage of the population in the USA will lead to an even higher prevalence of the disease in the ensuing decades. Fortunately, there are multiple treatment options based on individual patient situations and preferences. Topical treatment is the gold standard, but oral therapy may be required in certain cases. In order to maximize effectiveness and minimize adverse pharmacologic effects, effective treatment for older adults must take into account changes in lifestyle and metabolism that occur with aging.

Practices and activities among healthcare personnel with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection working in different healthcare settings-ten Emerging Infections Program sites, April-November 2020.

Healthcare personnel with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection were interviewed to describe activities and practices in and outside the workplace. Among 2,625 healthcare personnel, workplace-related factors that may increase infection risk were more common among nursing-home personnel than hospital personnel, whereas selected factors outside the workplace were more common among hospital personnel.

Maternal Folic Acid Intake and Methylation Status of Genes Associated with Ventricular Septal Defects in Children: Case-Control Study.

BACKGROUND: DNA methylation is the best epigenetic mechanism for explaining the interactions between nutrients and genes involved in intrauterine growth and development programming. A possible contributor of methylation abnormalities to congenital heart disease is the folate methylation regulatory pathway; however, the mechanisms and methylation patterns of VSD-associated genes are not fully understood. OBJECTIVE: To determine if maternal dietary intake of folic acid (FA) is related to the methylation status (MS) of VSD-associated genes (AXIN1, MTHFR, TBX1, and TBX20). METHODS: Prospective case-control study; 48 mothers and their children were evaluated. The mothers' dietary variables were collected through a food frequency questionnaire focusing on FA and the consumption of supplements with FA. The MS of promoters of genes was determined in the children. RESULTS: The intake of FA supplements was significantly higher in the control mothers. In terms of maternal folic acid consumption, significant differences were found in the first trimester of pregnancy. Significant differences were observed in the MS of MTHFR and AXIN1 genes in VSD and control children. A correlation between maternal FA supplementation and MS of AXIN1 and TBX20 genes was found in control and VSD children, respectively. CONCLUSIONS: A lower MS of AXIN1 genes and a higher MS of TBX20 genes is associated with FA maternal supplementation.

On sparse ensemble methods: An application to short-term predictions of the evolution of COVID-19.

Since the seminal paper by Bates and Granger in 1969, a vast number of ensemble methods that combine different base regressors to generate a unique one have been proposed in the literature. The so-obtained regressor method may have better accuracy than its components, but at the same time it may overfit, it may be distorted by base regressors with low accuracy, and it may be too complex to understand and explain. This paper proposes and studies a novel Mathematical Optimization model to build a sparse ensemble, which trades off the accuracy of the ensemble and the number of base regressors used. The latter is controlled by means of a regularization term that penalizes regressors with a poor individual performance. Our approach is flexible to incorporate desirable properties one may have on the ensemble, such as controlling the performance of the ensemble in critical groups of records, or the costs associated with the base regressors involved in the ensemble. We illustrate our approach with real data sets arising in the COVID-19 context.

Síndrome de burnout en el personal de enfermería de unidades de cuidado crítico y de hospitalización / Burnout syndrome in nursing personnel working in the critical care and hospitalization units

INTRODUCCIÓN: El objetivo del estudio fue identificar la prevalencia del Síndrome de Burnout y sus dimensiones en el personal de enfermería de unidades de cuidado crítico y de hospitalización. METODOLOGÍA: Se llevó a cabo un estudio observacional descriptivo, transversal en 90 enfermeras y enfermeros. Se utilizó el Cuestionario de Maslach Burnout Inventory para el personal de salud. Se realizó análisis exploratorio y análisis descriptivo e inferencial; se emplearon los estadísticos U de Mann Whitney y Kruskal Wallis. RESULTADOS: Se encontró nivel medio de Síndrome de Burnout 82.2%; Agotamiento Emocional bajo 62.2%; nivel bajo de Despersonalización 57.8% y nivel bajo de Falta de Realización Personal 40%. Se evidenció diferencia estadísticamente significativa entre Síndrome de Burnout y turno de trabajo, doble turno al mes, períodos vacacionales al año y carga de trabajo; entre Agotamiento Emocional y tipo de servicio, ingreso quincenal, doble turno al mes, períodos vacacionales, tipo de contratación y carga de trabajo; entre Despersonalización y carga de trabajo; y entre Falta de Realización Personal y tipo de servicio, gusto por el servicio, turno de trabajo, ingreso quincenal, períodos de descanso en el turno, períodos vacacionales al año y tipo de contratación. CONCLUSIONES: Un porcentaje mayor del personal de enfermería obtuvo nivel medio de Síndrome de Burnout. No se encontró diferencia estadísticamente significativa entre el síndrome de Burnout y sus dimensiones con las características sociológicas del personal de enfermería. Se encontró evidencia de que las características laborales son las que presentan mayor influencia en el desarrollo del Síndrome de Burnout

INTRODUCTION: The objective of the study was to identify the prevalence of the Burnout Syndrome and its dimensions in the nursing personnel working in the critical care and hospitalization units. METHODOLOGY: A descriptive, observational, and cross-sectional study was performed in 90 nurses. The Maslach Burnout Inventory for health personnel was used. An exploratory, descriptive, and inferential analysis was carried out; the Mann Whitney U and Kruskal Wallis tests statistics were used. RESULTS: A medium level regarding the burnout syndrome, 82.2%, was found; emotional exhaustion decreased by 62.2%; low level of depersonalization, 57.8%, and low level of lack of personal accomplishment, 40%. There was a statistically significant difference between burnout syndrome and work shift, double work shift per month, vacation periods per year, and workload; between emotional exhaustion and type of service, two-week income, double work shift, vacation periods, type of procurement, and workload; between depersonalization and workload; and between lack of personal accomplishment and type of service, work shift, two-week income, rest period during the shift, vacation periods per year, and type of procurement. CONCLUSIONS: A higher percentage of nursing personnel had a mild burnout syndrome. No statistically significant difference between burnout syndrome and its dimensions and the sociological characteristics of the nursing personnel was found. Evidence that job characteristics are those that show more influence in the development of the burnout syndrome was found

Diagnosis and management of pemphigus: Recommendations of an international panel of experts.

BACKGROUND: Several European countries recently developed international diagnostic and management guidelines for pemphigus, which have been instrumental in the standardization of pemphigus management. OBJECTIVE: We now present results from a subsequent Delphi consensus to broaden the generalizability of the recommendations. METHODS: A preliminary survey, based on the European Dermatology Forum and the European Academy of Dermatology and Venereology guidelines, was sent to a panel of international experts to determine the level of consensus. The results were discussed at the International Bullous Diseases Consensus Group in March 2016 during the annual American Academy of Dermatology conference. Following the meeting, a second survey was sent to more experts to achieve greater international consensus. RESULTS: The 39 experts participated in the first round of the Delphi survey, and 54 experts from 21 countries completed the second round. The number of statements in the survey was reduced from 175 topics in Delphi I to 24 topics in Delphi II on the basis of Delphi results and meeting discussion. LIMITATIONS: Each recommendation represents the majority opinion and therefore may not reflect all possible treatment options available. CONCLUSIONS: We present here the recommendations resulting from this Delphi process. This international consensus includes intravenous CD20 inhibitors as a first-line therapy option for moderate-to-severe pemphigus.

Efecto de la aplicación de un recubrimiento de almidón de yuca modificado por vía ácida sobre el tomate larga vida / Effect of the application of an acid-modified cassava starch coating on the long-life tomato

RESUMEN Se buscó minimizar el efecto de factores ambientales sobre la calidad pos cosecha del tomate, mediante la aplicación de recubrimiento elaborado con almidón de yuca modificado por vía ácida. La modificación de la estructura original de una suspensión de almidón de yuca variedad SM 707-17, se realizó mediante adición de ácido cítrico, en concentración de 15% p/p respecto al almidón en base seca, bajo condiciones de temperatura y de velocidad de agitación controladas. El efecto de este recubrimiento, se comparó con el efecto de la aplicación de otros elaborados con base en almidón modificado enzimáticamente y almidón nativo. Se midieron las variables: sólidos solubles totales, firmeza, pH, acidez titulable, tasa de respiración, pérdida de peso y color durante 15 días, aplicando un diseño factorial completamente al azar 4x6. Los resultados, se analizaron mediante el software SPSS versión 19, con el cual, se encontró que el factor "Recubrimiento" no influyó sobre las variables de respuesta analizadas, a diferencia del factor "Tiempo", que tuvo efecto decisivo sobre las mismas.

ABSTRACT The aim was to minimize the effect of environmental factors on postharvest of tomato quality by applying a coating made with cassava starch modified by acid route. The modification of the original structure of a suspension of native starch of cassava variety SM 707-17, was carried out by addition of citric acid in concentration of 15% w/w with respect to the starch in dry base, under controlled temperature and speed of controlled agitation. The effect of this coating was compared with the effect of the application of others made on the basis of enzymatically modified starch and native starch. The variables total soluble solids, firmness, pH, titrable acidity, respiration rate, weight loss and color for 15 days were measured, applying a completely randomized 4x6 factorial design. The results were analyzed using SPSS software version 19, which found that the "Coating" factor did not influence the response variables analyzed, unlike the "Time" factor that had a decisive effect on them.

Grado de sobrecarga y caracterización de cuidadores de personas adultas mayores con diabetes mellitus tipo 2 / Work overload degree and characterization of caregivers of older adults with type 2 diabetes mellitus

Objetivo: Determinar la relación entre el grado de sobrecarga y las características sociodemográficas de cuidadores informales de personas adultas mayores con Diabetes Mellitus tipo 2. Metodología: Estudio cuantitativo, descriptivo, correlacional, de corte transversal a 83 cuidadores informales de personas adultas mayores con Diabetes Mellitus tipo 2, provenientes del sector noreste de Ciudad Obregón, Sonora, México. Para medir la sobrecarga se utilizó la Escala Zarit, se incluyeron ítems sobre características sociodemográficas. Resultados: El perfil del cuidador con tendencia a sobrecarga fue: mujer (81.9%), ama de casa (47%), con un promedio de edad de 40 años, casada (53%), hija del adulto mayor (72.3%), de baja escolaridad (66.1%) e ingresos económicos mensuales menores o igual a 6,799 pesos mexicanos (51.8%) que lleva de uno a tres años como cuidadora (54.2%) dedicando más de 17 horas/ diarias al mismo (51.8%). El 48.2% de los cuidadores presentó sobrecarga intensa, el 44.6% ausencia de sobrecarga y 7.2% sobrecarga leve. Se encontró asociación estadísticamente significativa (p=0.02) entre el grado de sobrecarga y las variables estado civil y ocupación. Conclusiones: La asociación significativa indica que el estado civil y la ocupación se relaciona con el grado de sobrecarga percibido en los cuidadores, lo cual es importante proponer que las intervenciones sean dirigidas a estas características para la disminución de la sobrecarga, la cual es un riesgo para la salud de los cuidadores con dicho perfil, ya que se encuentra asociada a mayor morbimortalidad médica, psiquiátrica y social del cuidador

Objective: to determinate association between overload degree and sociodemographic characteristics of informal caregivers of older adults with type 2 diabetes mellitus. Material and method: quantitative, descriptive, correlational, cross-sectional study of 83 informal caregivers of older adults with type 2 diabetes mellitus, from the northeast sector of Ciudad Obregón, Sonora, Mexico. The Zarit Scale was used to measure the overload degree, items regarding to sociodemographic characteristics were included. Results: the profile of the caregiver with tendency to overload was: woman (81.9%), housewife (47%), with an average age of 40 years, married (53%), daughter of the older adult (72.3%), low schooling (66.1%) and monthly income less than or equal to 6,799 mexican pesos (51.8%), from one to three years as caregiver (54.2%) and dedicating more than 17 hours per day to it (51.8%). The 48.2% of the caregivers showed intense overload, 44.6% absence of overload and 7.2% slight overload. A statistically significant association was found (p=0.02) between the degree of overload and the variables marital status and occupation. Conclusions: The significant association indicates that marital status and occupation is related to the caregivers perceived overload degree. It is relevant to propose interventions directed to these characteristics in order to reduce intense overload degree, which is a risk for caregiver's health with this profile, since it is related with greater odds of medical, psychiatric and social morbidity and mortality

Severe Respiratory Illness Associated with Human Metapneumovirus in Nursing Home, New Mexico, USA.

Human metapneumovirus is an emerging pathogen that causes upper and lower respiratory illness. Nursing home outbreaks of infection with this virus can cause severe illness and lead to poor patient outcomes. We report an outbreak investigation in a nursing home during 2018 and infection control guidelines to assist in disease control.

Severe Pertussis Infections in the United States, 2011-2015.

BACKGROUND: The incidence of pertussis in the United States has increased in recent years. While characteristics of severe pertussis infection have been described in infants, fewer data are available in older children and adults. In this analysis, we characterize pertussis infections in hospitalized patients of all ages. METHODS: Cases of pertussis with cough onset from 1 January 2011 through 31 December 2015 from 7 US Emerging Infections Program Network states were reviewed. Additional information on hospitalized patients was obtained through abstraction of the inpatient medical record. Descriptive and multivariable analyses were conducted to characterize severe pertussis infection and identify potential risk factors. RESULTS: Among 15942 cases of pertussis reported, 515 (3.2%) were hospitalized. Three hospitalized patients died. Infants aged <2 months accounted for 1.6% of all pertussis cases but 29.3% of hospitalizations. Infants aged 2-11 months and adults aged ≥65 years also had high rates of hospitalization. Infants aged <2 months whose mothers received acellular pertussis during the third trimester and children aged 2 months to 11 years who were up to date on pertussis-containing vaccines had a 43%-66% reduced risk of hospitalization. Among adolescents aged 12-20 years, 43.5% had a history of asthma, and among adults aged ≥65 years, 26.8% had a history of chronic obstructive pulmonary disease. CONCLUSIONS: Individuals at the extreme ends of life may be the most vulnerable to severe pertussis infections, though hospitalization was reported across all age groups. Continued monitoring of severe pertussis infections will be important to help guide prevention, control, and treatment options.

JAG1, MEF2C and BDNF polymorphisms associated with bone mineral density in women from Northern México

Introduction: Osteoporosis is characterized by a low bone mineral density. Genetic composition is one of the most influential factors in determining bone mineral density (BMD). There are few studies on genes associated with BMD in the Mexican population. Objective: To investigate the association of eight single nucleotide polymorphisms (SNP) of JAG1, MEF2C and BDNF genes with BMD in women of Northern México. Materials and methods: This study involved 124 unrelated Mexican women between 40 and 80 years old. BMD was determined by dual X-ray absorptiometry. Genotyping was performed using allelic discrimination by real time PCR. We analyzed the SNP of JAG1 (rs6514116, rs2273061, rs2235811 and rs6040061), MEF2C (rs1366594, rs12521522 and rs11951031), and BDNF (rs6265) and the data using linear regression. Results: The JAG1 SNP rs2235811 was associated with the BMD of the total body under the dominant inheritance model (p=0,024). Although the other SNPs were not associated with BMD in any of the inheritance models studied, a trend was observed. Conclusion: Our results suggest that the SNP rs2235811 in the JAG1 gene might contribute to the variation in BMD in women from northern México.

Polimorfismos de los genes JAG1, MEF2C y BDNF asociados con la densidad mineral ósea en mujeres del norte de México / JAG1, MEF2C and BDNF polymorphisms associated with bone mineral density in women from Northern México

Resumen Introducción. La osteoporosis se caracteriza por una baja densidad mineral ósea; la composición genética es uno de los factores que más influyen en ella, pero hay pocos estudios de genes asociados con esta condición en la población mexicana. Objetivo. Investigar la posible asociación de ocho polimorfismos de un solo nucleótido (Single Nucleotide Polymorphism, SNP) de los genes JAG1, MEF2C y BDNF con la densidad mineral ósea en mujeres del norte de México. Materiales y métodos. Participaron 124 mujeres de 40 a 80 años, sin parentesco entre ellas. Su densidad mineral ósea se determinó mediante absorciometría dual de rayos X y la genotipificación se hizo utilizando discriminación alélica mediante PCR en tiempo real; se estudiaron cuatro de los SNP del gen JAG1 (rs6514116, rs2273061, rs2235811 y rs6040061), tres del MEF2C (rs1366594, rs12521522 y rs11951031) y uno del BDNF (rs6265). El análisis estadístico de los datos obtenidos se hizo por regresión lineal. Resultados. El SNP rs2235811 presentó asociación significativa con la densidad mineral ósea de todo el cuerpo bajo el modelo de herencia dominante (p=0,024) y, aunque los otros SNP no tuvieron relación significativa con esta densidad, en ninguno de los modelos de herencia estudiados, se observó una tendencia hacia esta asociación. Conclusión. Los resultados sugieren que el SNP rs2235811 del gen JAG1 podría contribuir a la variación en la densidad mineral ósea de las mujeres del norte de México.

Abstract Introduction: Osteoporosis is characterized by a low bone mineral density. Genetic composition is one of the most influential factors in determining bone mineral density (BMD). There are few studies on genes associated with BMD in the Mexican population. Objective: To investigate the association of eight single nucleotide polymorphisms (SNP) of JAG1, MEF2C and BDNF genes with BMD in women of Northern México. Materials and methods: This study involved 124 unrelated Mexican women between 40 and 80 years old. BMD was determined by dual X-ray absorptiometry. Genotyping was performed using allelic discrimination by real time PCR. We analyzed the SNP of JAG1 (rs6514116, rs2273061, rs2235811 and rs6040061), MEF2C (rs1366594, rs12521522 and rs11951031), and BDNF (rs6265) and the data using linear regression. Results: The JAG1 SNP rs2235811 was associated with the BMD of the total body under the dominant inheritance model (p=0,024). Although the other SNPs were not associated with BMD in any of the inheritance models studied, a trend was observed. Conclusion: Our results suggest that the SNP rs2235811 in the JAG1 gene might contribute to the variation in BMD in women from northern México.

Síntomas depresivos y niveles séricos de ácidos grasos poliinsaturados omega-3 y omega-6 en universitarios del norte de México / Depressive symptoms and serum levels of polyunsaturated fatty acids omega-3 and omega-6 among college students from Northern Mexico

Introducción: estudios previos sugieren que un bajo consumo de ácidos grasos poliinsaturados (AGPI) omega-3 y razón omega-6/omega-3 alta, así como niveles séricos bajos, se asocian con trastornos depresivos, sin embargo, los resultados no son concluyentes. Objetivos: evaluar los niveles séricos de AGPI omega-3 (ácido eicosapentaenoico [EPA], docosahexaenoico [DHA], alfalinolenico [ALA]) y la razón omega-6 (ácido araquidónico [AA])/EPA, en relación a los síntomas depresivos en universitarios del norte de México. Material y métodos:estudio transversal que incluyó 60 participantes (18 a 24 años de edad) de ambos sexos, con determinaciones séricas de EPA, DHA, ALA y AA, quienes respondieron la escala de depresión del Centro de Estudios Epidemiológicos (CES-D) validada para estudiantes mexicanos. La relación de los AGPI omega-3 y omega-6 con los síntomas depresivos se evaluó con modelos de regresión lineal. Resultados: los niveles séricos de EPA, DHA y razón EPA/DHA no se correlacionaron con síntomas depresivos, un incremento en ALA sérico se correlacionó con menos síntomas depresivos antes y después de ajustar por confusores; sin embargo, los resultados no fueron estadísticamente significativos. En mujeres, la escala CES-D incrementó 5,5 puntos (p = 0,57) por 1% de incremento en EPA y disminuyó 6,7 puntos (p = 0,39) por 1% de incremento en ALA. Conclusiones: nuestros resultados no confirman la asociación entre los niveles séricos de AGPI omega-3 y razón omega-6/omega-3 con síntomas depresivos. La correlación negativa del nivel sérico de ALA con síntomas depresivos necesita ser confirmada en estudios de seguimiento (AU)

Introduction: Previous studies suggest that low consumption as well as low serum levels of polyunsaturated fatty acids (PUFA) omega-3 and a high omega-6/omega-3 ratio may be implicated in the etiology of depressive disorders, however, epidemiologic evidence is inconclusive. Objective: To assess the relationship of serum levels of omega-3 fatty acids (docosahexaenoic [DHA], eicosapentaenoic [EPA], alpha-linolenic fatty acid [ALA]) and the omega-6 (arachidonic acid [AA])/EPA ratio with depressive symptoms among Mexican college students. Material and methods: A cross-sectional study that included 60 male and female participants (ages 18 to 24 years) with serum levels of EPA, DHA, ALA and AA. Depressive symptoms were ascertained with the Center for Epidemiologic Studies Depression (CES-D) scale validated for Mexican students. Linear regression was used to assess the relationship between depressive symptoms and serum PUFA omega-3 and omega-6. Results: Serum levels of EPA, DHA and EPA/DHA ratio were not related to depressive symptoms, high serum ALA was related with lower depressive symptoms before and after covariate adjustment; however, these results were not statistically significant. Among women, 1% increase in EPA resulted in 5.5. (p = 0.57) increase in the depressive scale scores while 1% increase in ALA resulted in 6.7 decrease (p = 0.39) in the scores. Conclusions: Our results did not confirm the relationship of serum levels of PUFA omega-3 and omega-6/omega-3 ratio with depressive symptoms; the negative correlation of serum ALA with depressive symptoms remains to be confirmed in prospective studies (AU)