Report of the Influenza Vaccination Program in Mexico (2006-2022) and Proposals for Its Improvement.

BACKGROUND: Influenza has continued to be an important public health challenge, and the WHO recommends that countries consider vaccination for persons at high risk. Mexico has such a program, and we sought to determine its current situation. MATERIAL AND METHODS: This study has an ecological, longitudinal, and retrospective design based on secondary information on the acquisition and application of vaccines against influenza from official data from 2006 to 2022. RESULTS: We found annual variability in the numbers of purchases and application of doses, with coverage of less than 90% of the total population every year; in addition, 17 million vaccines were not used in this period. DISCUSSION: This study shows the situation of the program at the national level. Two institutions acquired fewer the vaccines, while one purchased more for its target population, but the necessary vaccinations were not acquired. On average, 1.7 million of the vaccines purchased annually were not used, but in some years, more vaccines were applied than were purchased in all of the institutions. We also observed that, between institutions, the vaccine coverage was very different, from 21% to 180%. On average, 6.2 million people were not vaccinated annually, between 16% and 22% of the target population, demonstrating low coverage. When we compared the coverage data that we calculated to the data published by the institutions, a great difference was observed. CONCLUSIONS: We found inconsistencies in the data, indicating their unreliability and potential disorganization within the program, as the target populations of each institution were not clear. In addition, the application data may have had reporting errors. Adequate coverage was not achieved, and the coverage was different from that reported in the official sources. We propose the implementation of different systems for control, evaluation, and access to the information of the program.

Outpatient treatment of COVID-19: an experience with 552 cases in Mexico.

INTRODUCTION: The impact of the coronavirus disease 2019 (COVID-19) pandemic has globally challenged health services, especially because when the pandemic first reached Mexico, in February 2020, there was no known effective and safe treatment. A treatment scheme was offered by the Institute for the Integral Development of Health (IDISA) in Mexico City from March 2020 to August 2021 when there were many patients with COVID-19. This report summarizes the experience managing COVID-19 with this scheme. MATERIALS AND METHODS: This is a descriptive, retrolective study. The data was obtained from the case files of the patients who attended the IDISA from March 2020 to August 2021 with COVID-19. All the cases were treated with the scheme consisting of nitazoxanide, azithromycin, and prednisone. Various laboratory blood tests and chest computerized tomography scan were done. When indicated, supplementary oxygen, and another specific treatment were used. A standardized clinical recording was conducted for 20 days based on symptoms and systemic symptoms. RESULTS: Based on the World Health Organization criteria, the patients were classified according to the disease severity: 170 mild, 70 moderate, and 312 severe cases. The outcome was the discharge of 533 patients after their recovery, 16 were excluded from the study, and 6 died. CONCLUSIONS: The use of nitazoxanide, azithromycin, and prednisone proved to be effective as it resulted in improvement of symptoms and in successful outcomes for the management of COVID-19 outpatients.

Report of 16 Years of the BCG Vaccine under the Expanded Program on Immunizations in Mexico (2006-2021).

BACKGROUND: In recent years in Mexico, a decreased Bacillus Calmette and Guérin (BCG) coverage has been observed concomitantly with new cases of tuberculosis. MATERIAL AND METHODS: This study is a descriptive and analytical evaluation regarding both BCG vaccine acquisition and coverage as reported by official sources over a 16-year period (2006-2021). RESULTS: We found that vaccine acquisition, dose application and coverage are highly variable each year. Coverage is 90% or higher, except for the 2017-2020 period. DISCUSSION: According to our calculations, between 3,917,616 and 4,961,868 individuals did not receive the BCG vaccine. Coverage was lower than 90% during the last 4 years, whereas this value decreased to 21% in 2020. Except for the last 5 years, the amount of acquired doses surpassed the demand thus causing a considerable vaccine wastage. CONCLUSIONS: BCG vaccine coverage is low and many individuals remain unprotected. The access to this vaccine is difficult and the number of newly reported cases of tuberculosis have increased during the last years. Thus, it is necessary to establish vaccination campaigns aimed protect the population and also to deploy a nominal system to control coverage, acquisitions, and target population.

Mucormycosis in children: a study of 22 cases in a Mexican hospital.

We present a single-centre, retrospective study (1985-2012) of 22 cases of mucormycosis in children. A total of 158 mucormycosis cases were identified, of which 22 (13.96%) were children. The mean age of the children was 10.3 years (range: 6 months-18 years), and 59% of the infections occurred in males. The rhinocerebral form was the main clinical presentation (77.27%), followed by the primary cutaneous and pulmonary patterns. The major underlying predisposing factors were diabetes mellitus in 68.18% of the patients and haematologic diseases in 27.7% of the patients. The cases were diagnosed by mycological tests, with positive cultures in 95.4% of the patients. Rhizopus arrhizus was the foremost aetiologic agent in 13/22 cases (59.1%). In 21 cultures, the aetiologic agents were identified morphologically and by molecular identification. In 10 cultures, the internal transcribed spacer region of the ribosomal DNA was sequenced. Clinical cure and mycological cure were achieved in 27.3% cases, which were managed with amphotericin B deoxycholate and by treatment of the underlying conditions.

Hyperinfection with Strongyloides stercoralis.

Strongyloidiasis is caused by Strongyloides stercoralis, which commonly produces gastrointestinal problems. If immune systems are compromised, the nematode larvae may spread and produce Strongyloides hyperinfection. Diagnosis of strongyloidiasis is based on the observation of larvae in coproparasitological studies. We present a case of a 49-year-oldman, VIH, who developed Strongyloides hyperinfection, diagnosed postmortem. Our patient reached the dissemination stage, which resulted in severe damage to the stomach and intestine, perforation of the intestinal wall, as well as sepsis due to the dissemination of bacteria. The diagnosis is difficult because of the low larvae excretion in stools. It is usually performed by the microscopic examination of fresh and fixed enriched stool samples. Serology was reported to be useful for screening and follow-up after treatment. This case reaffirms that HIV immunosuppression favours the dissemination of S stercoralis larvae. Thus, a search for intestinal parasites should be considered in similar cases.

Angiosarcoma of the liver as a cause of fulminant liver failure.

Primary liver sarcomas make up 2% of all malignant neoplasms of the liver; of these, angiosarcoma is the most common type. Primary liver tumours rarely cause fulminant hepatic failure (FHF), which is most frequently caused by non-neoplasmic pathologies. In the case of neoplasms, the most frequent are lymphoma and metastatic carcinomas. We describe the case of a 76-year-old man who suffered from FHF as a result of a liver angiosarcoma and we present a review of the medical literature in which we found only two cases of liver angiosarcomas linked to FHF.

Disseminated sporotrichosis.

Sporotrichosis is a subacute or chronic infection caused by Sporothrix schenckii. It is a primary cutaneous infection and it has different clinical forms: disseminated by lymphatic vessels (75%), localised cutaneous form (20%), disseminated cutaneous and extracuteus rarely. The systemic disseminated sporotrichosis is considered a severe opportunistic infection. The best diagnostic test is the culture. The authors report a case of a 36-year-old man, originally from Puebla, Mexico, with a diagnosis of disseminated sporotrichosis. Differential diagnosis with other pathologies includes leishmaniasis, chromoblastomycosis, tuberculosis verrucose and lymphangitis. The development of unusual presentations in immunocompromised patients has been reported.

[Correlation between clinical characteristics and mycological tests in the vulvovaginitis by Candida]. / Correlación clinico-micológica de la candidiasis vulvovaginal.

BACKGROUND: Vulvovaginitis caused by Candida sp is one of the most frequent infections. OBJECTIVES: To culture and to identify the fungi related to clinical manifestations of patients based on a suspected diagnosis of vulvovaginal candidiasis. PATIENTS AND METHODS: A prospective, transversal and comparative study was performed on 181 women older than 18 years with vulvovaginitis by Candida sp. A correlation was made between the clinical characteristics of this entity and mycological tests such as direct examination and cultures. RESULTS: The direct exam or fresh vaginal exam and cervical sample was positive for the different microscopic forms of Candida (blastoconidia, pseudohyphye or pseudomycelia) in 60.8% (110 women); at the same time that cultures were positive for Candida sp in 51.9% (94 patients). CONCLUSIONS: The direct examination and the cultures of vaginal and cervical exudate are mandatory tests for diagnosis of Candida sp in women with vulvovaginitis.

[Infection of the surgical site. Experience of two years in the gynecology and obstetric service of Mexican General Hospital]. / Infección del sitio quirúrgico. Experiencia de dos años en el servicio de ginecología y obstetricia del Hospital General de México.

OBJECTIVE: To know the incidence and causal agents of the surgical site infection at the Gynecology and Obstetrics Service of the Hospital General de Mexico. MATERIAL AND METHOD: A retrospective, descriptive and analytical study was performed on patients with surgical site infection at the Gynecology and Obstetrics Service of the Hospital General de Mexico during January 1st, 2000 to December 31st, 2001. RESULTS: A global low rate of surgical site infection was observed, with predominance on the third life decade patients and on obstetrics events (69.5%). The initial treatment consisting of 600 mg intravenous clindamycin every eight hours and 500 mg intravenous amikacin every 12 hours showed high efficacy. The mean time of hospital stay was nine days; 97% of the discharges were due to improvement, with a minimum rate of mortality. CONCLUSIONS: The index of surgical site infections for gynecological and obstetric procedures is lower than the accepted percentage, but it is more frequent in patients submitted to total abdominal hysterectomy.

Miasis asociada a síndrome de complejo vascular periférico / Cutaneos myiais case asociated to a vascular cerebral disease

Se presenta un caso de miasis en un paciente masculino de 70 años de edad, cuyos antecedentes son: el habitar solo en malas condiciones de higiene y alimentación. A causa de una enfermedad vascular cerebral, presenta parálisis facial derecha y en las extremidades superior e inferior contralaterales. Inicia su padecimiento con una mácula eritematosa que evoluciona a úlcera en la región dorsal del pie izquierdo. A partir de esta úlcera se observa la salida de gusanos, que posteriormente se clasificaron como larvas de Dermatobia hominis. El tratamiento consistió en la eliminación de las larvas por desbridamiento y administración de antibióticos. Debido al grado de necrosis regional, se requirió la amputación supracondílea del pie izquierdo. El paciente evoluciona satisfactoriamente y es controlado a través de la consulta externa.

[Systemic lupus erythematous and pregnancy]. / Lupus eritematoso sistémico y embarazo.

OBJECTIVE: To determine the obstetrics outcomes of patients with systemic lupus erythematosus and pregnancy. MATERIALS AND METHODS: A retrospective, analytic, and descriptive case of study is presented about of the obstetrics outcomes of patients with systemic lupus erythematosus and pregnancy attended in Hospital General de Mexico Obstetrics and Gynecology Service from June, 2000 to February, 2003. RESULTS: Thirty-six records were reviewed. The mean age was 28 years. The most frequent maternal complications were the hypertensive disorders in association with pregnancy (27.5%). One patient had antiphospholipid syndrome, showed HELLP syndrome I and brain hemorrhage, she died in puerperium period. The main resolution of pregnancy was normal delivery. The median gestational age at delivery was 36 weeks (range of 24-40 weeks), and the mean birth weight was 2,389 g, median Apgar scores were 7 and 8 at 1 and 5 minutes of life respectively. There were 19 cases of low weight at birth and 7 preterm deliveries. There were no cases of neonatal lupus. CONCLUSION: The maternal-fetal morbid-mortality rates decrease when no lupic disease activity is reported. During the pregnancy stage, preterm delivery and intrauterine growth retardation grow in number as observed in all the study subjects. All pregnancies should still be considered high risk and be managed with a multidisciplinary team. Co-existing antiphospholipid syndrome is the poorer prognosis for pregnancy outcome.

[Study on Candida no-albicans species and its relation to recurrent vulvovaginal candidiasis]. / Estudio de especies de Candida no albicans y su relación con candidiasis vulvovaginal recurrente.

Genital candidiasis is a frequent pathology among women. It has a 5% incidence rate of presenting itself in a recurrent way, which leads to a longer treatment. Candida gender has various species. The ones, which are the most usual and the cause of vaginal, cervicovaginal, and vulvovaginal candidiasis are: Candida albicans, C. glabrata and C. krusei. Their presence is related to further appearances. A case study was made to identify the species of Candida gender. It was based on the diagnostics made in three Mexico City hospitals on female genital candidiasis cases. The identified and isolated Candida species obtained were: albicans with a 71.91%, C. glabrata with a 11.80%, and C. tropicalis with a 7.87%.

Neumonía eosinofílica secundaria a larva migrans visceral en un niño / Eosinophilic pneumonia secondary to visceral larva migrans in children

La infección por larvas de Toxocara sp puede presentarse en niños como un cuadro clínico de larva migrans visceral. La neumonía eosinofílica constituye una manifestación clínica de la enfermedad sistémica. Para el diagnóstico de laboratorio es de utilidad la presencia de hiperleucocitosis con eosinofilia elevada y la detección de anticuerpos anti-toxocara mediante ELISA. Se presenta el caso de un paciente de dos y medio años de edad con antecedentes de geofagia intensa que cursó con un cuadro caracterizado por fiebre, tos, polipnea, hepatomegalia, lesiones dérmicas, infiltrados pulmonares e hiperleucocitosis con eosinofilia en el que el diagnóstico de larva migrans visceral fue confirmado mediante ELISA. El paciente fue manejado con albendazol y esteroides con evolución satisfactoria. Se sugiere que como parte del diagnóstico de larva migrans visceral se busquen antecedentes de geofagia intensa, convivencia estrecha con perros o gatos, búsqueda específica de manifestaciones clínicas sistémicas o localizadas, radiodiagnóstico, ELISA y estudio de fondo de ojo.

Búsqueda de Trichinella spiralis en carne de cerdo que se expende en carnicerías del Distrito Federal / Trichinella spiralis search in pork meat sold by butchers in Mexico City

Se realizó un estudio transversal de frecuencia con el objetivo de buscar larvas enquistadas viables de Trichinella spiralis en carne de cerdo que se comercializa en mercados públicos, carnicerías y tianguis (mercados ambulantes) de la ciudad de México. Se examinaron 500 muestras de carne de cerdo de l00 g cada una, 165 se obtuvieron en carnicerías establecidas, 208 en mercados públicos y 127 en tianguis ubicados en las 16 delegaciones políticas que conforman la ciudad de México. De cada muestra de carne se tomaron cinco fragmentos a diferentes niveles, todas las muestras fueron de 1 g cada una para su examen mediante triquinoscopía utilizando microscopios Carl Zeiss con objetivos seco-débil y seco-fuerte. Los 2 500 cortes de carne de cerdo examinados resultaron negativos a la presencia de larvas de Trichinella spiralis. Este resultado sugiere que es mínimo el riesgo de adquisición de triquinelosis para el consumidor de carne de cerdo que se expende en la ciudad de México.

Inmunoepidemiología de la triquinelosis en niños de la Ciudad de México / The immunoepidemiology of trichinellosis in children in Mexico City

La triquinelosis constituye una enfermedad zoonótica cosmopolita de origen alimentario, la causa el nemátodo Trichinella spiralis. En México se ignora su frecuencia a pesar de los numerosos brotes epidémicos que se han presentado. El presente trabajo tiene como objetivo determinar, mediante hemaglutinación indirecta (HAI), la prevalencia de anticuerpos específicos contra antígenos de Trichinella spiralis, que se encontraron en el suero de una muestra de escolares que viven en la ciudad de México. Se analizaron 211 sueros de escolares de seis a doce años de edad, 111 (52.6 por ciento) varones y 110 (47.4 por ciento) niñas. Se formaron seis grupos de estudio, uno por cada grado escolar. El análisis inmunológico de los sueros se realizó con la microtécnica de hemaglutinación indirecta (HAI).Siete (3.3 por ciento) de los 211 sueros analizados resultaron positivos con títulos de dilución de 1:32; cinco sueros correspondieron a alumnos de 10 años de edad que cursaban el quinto grado escolar: cuatro varones y una niña; los otros dos sueros pertenecieron a niñas de nueve años de edad, del cuarto grado escolar. No se observó diferencia de reactividad respecto del sexo.La seropositividad obtenida en este estudio (3.3 por ciento) constituye un indicador de que la transmisión de triquinelosis está afectando a los habitantes de la población estudiada. Se analizan las posibles causas que favorecen esa transmisión.

Leiomioma retroperitoneal: reporte de dos casos / Retroperitoneal leiomyoma: report of two cases

Los tumores benignos del músculo liso presentan una frecuencia alta en el tracto genitourinario y gastrointestinal, siendo poco frecuentes en retroperitoneo, situación que conduce a errores diagnósticos. La información acerca de leiomiomas retroperitoneales es escasa. Se presentan dos casos en mujeres de 37 y 35 años con diagnósticos de miomatosis uterina y tumor de ovario en los que los hallazgos quirúrgicos fueron leiomiomas retroperitoneales.

Frecuencia de parasitosis intestinales en asentamientos humanos irregulares / Frequency of enteral parasitosis in irregular human settlements

Objetivo: Determinar la frecuencia de las parasitosis intestinales y señalar algunas de las características poblacionales de importancia para su transmisión en asentamientos humanos irregulares.Material y método: Se realizaron exámenes coproparasitoscópicos de sedimentación por flotación a los habitantes de una comunidad con asentamientos humanos irregulares de la Delegación Magdalena Contreras en la Ciudad de México.Resultados y conclusiones: Las protozoosis frecuentemente encontradas fueron: giardiasis (29.98 por ciento) y entamebiasis por Entamoeba histolytica (7.29 por ciento) y Entamoeba coli que aun cuando no se considera un protozoo patógeno, presentó una cifra correspondiente al 14.71 por ciento. Las helmintiasis predominantes fueron: ascariasis (9.04 por ciento); himenolepiasis (5.53 por ciento); tricocefalosis (3.91 por ciento) y enterobiasis (1.48 por ciento). Las asociaciones más frecuentemente encontradas fueron: Giardia lamblia / Ascaris lumbricoides (4.18 por ciento) y Giardia lamblia / Entamoeba coli (3.64 por ciento). Las condiciones socioeconómicas de esta población favorecen la transmisión de las parasitosis intestinales.