[Depression in health personnel associated with exposure to COVID-19]. / Depresión en personal de salud asociado a la exposición de la COVID-19.

Background: There are many working factors to do with depression. Objective: To determine the association between the exposure to COVID-19 and depression in physicians and nurses from the four hospitals at "Centro Médico Nacional Siglo XXI" (CMN SXXI) took part in: Oncology, Specialties, Cardiology and Pediatrics. Material and Methods: A cross-sectional study of 856 participants took place in January 2022, excluding workers, such as physicians and nurses from the CMN SXXI, disabled workers, staff with a union agreement, support staff and/or staff with less than one year of work labour. Through a self-administered questionnaire, the degree of occupational exposure to patients care with COVID-19, a history of COVID-19 infection, and the patient's health quiz were asked (PHQ-9). The analysis included simple frequency measurements, odds ratio (OR), Chi squared and multiple logistics regression with p ≤ 0.05. Results: The prevalence of depression in the medical and nursing staff at CMN SXXI was 32.2% (moderate to severe degree); In the multiple regression, an association was identified with not identifying support by the Institute (OR: 1.60, CI95%: 1.08-2.39, p = 0.02), high occupational exposure (OR: 8.35, CI95%: 3.02-23.09, p ˂ 0.0001), and more than 5 working days a week serving the COVID-19 patients (OR: 2.51, CI95%: 1.35-4.49, p = 0.004) and as a protective factor the fact that they have never had the COVID-19 (OR: 0.61, CI95%: 0.43-0.86, p = 0.01). Conclusions: The prevalence of depression was higher than expected being associated with the degree of occupational exposure in the COVID-19 patients´ assistance.

Introducción: existen factores laborales que influyen en la presencia de la depresión. Objetivo: determinar la asociación entre la exposición a la COVID-19 y la depresión en médicos y enfermeras de los cuatro hospitales del Centro Médico Nacional Siglo XXI (CMN SXXI): Oncología, Especialidades, Cardiología y Pediatría. Material y métodos: se realizó un estudio transversal, en enero del 2022, con 870 participantes pertenecientes a la población de médicos y enfermeras que laboraban en el CMN SXXI, se excluyó a los trabajadores que se encontraban con incapacidad, al personal temporal y/o con menos de un año de antigüedad laboral. A través de un cuestionario autoaplicable se interrogó sobre el grado de exposición laboral a la atención de pacientes con COVID-19, antecedentes de infección por la COVID-19 y el cuestionario de salud del paciente (PHQ-9). El análisis incluyo medidas de frecuencia simple y razón de Momios (RM), Chi cuadrada y regresión logística múltiple con p ≤ 0.05. Resultados: la prevalencia de depresión en personal médico y de enfermería del CMN SXXI fue del 32.2% (grado moderado a severo). En la regresión múltiple se encontró asociación con no identificar apoyo por parte del Instituto (RM: 1.60, IC95%: 1.08-2.39, p = 0.02), alta exposición laboral (RM: 8.35, IC95%: 3.02-23.09, p ˂ 0.0001) y más de 5 días laborados a la semana atendiendo pacientes con la COVID-19 (RM: 2.51, IC95%: 1.35-4.49, p = 0.004) y como factor protector el que nunca hayan enfermado de la COVID-19 (RM: 0.61, IC95%: 0.43-0.86, p = 0.01). Conclusiones: la prevalencia de depresión fue mayor a la esperada y se asoció con el grado de exposición laboral en la atención de pacientes con la COVID-19.

Clinical presentation of pediatric patients with symptomatic SARS-CoV-2 infection during the first months of the COVID-19 pandemic in a single center in Mexico City.

Background: The clinical spectrum of COVID-19 is broad, from asymptomatic to severe cases and death. The objective of this study is to analyze the clinical course of patients attended during the first months of the SARS-CoV-2 pandemic in a third-level pediatric hospital. Methods: Design: prospective cohort study. Patients with viral respiratory disease or suspected cases of COVID-19 were evaluated at the Pediatric Hospital, National Medical Center XXI Century, Mexico City, from 21 March 2020 to 13 January 2021. Statistical analysis: Chi-square test and Fisher's exact test were used for comparisons; a logistic regression model was constructed to identify clinical or laboratory characteristics associated with critical disease. A p-value < 0.05 was considered statistically significant. Results: A total of 697 patients met the operational definition of viral respiratory disease or suspected cases of COVID-19 and underwent real-time reverse transcription polymerase chain reaction (rRT-PCR) SARS-CoV-2 testing. Patients with a positive result were included. Of the 181 patients (26%), 121 (66.8%) had mild disease and were treated as outpatients and 60 (33.1%) were hospitalized. A total of six patients met the criteria for multisystem inflammatory syndrome in children (MIS-C). Of the 60 inpatients, 65% were males, and 82% had one or more comorbidities. The main comorbidities were cancer (42%) and overweight (15%). The median hospital stay was 9 days. The inpatients had a higher frequency of fever, general malaise, dyspnea, chills, polypnea, and cyanosis than the outpatients (p < 0.05). Only 21.4% of the outpatients had one or more comorbidities, which were lower than in the hospitalized patients (p < 0.001). Laboratory data at admission were similar between critically ill and those with moderate and severe disease. The patients who developed pneumonia were at higher risk of critical disease, while older age was associated with a better prognosis. A total of 13 of the 60 inpatients died (mortality 7.1%). All but one had one or more comorbidities: four had cancer, four congenital heart disease, one chronic kidney disease and epilepsy, one Epstein-Barr virus-induced hemophagocytic lymphohistiocytosis, one obesity, and one diabetes mellitus. Conclusion: Hospital mortality is high, especially in children with comorbidities. Despite 2 years having passed since the beginning of the COVID-19 pandemic, the epidemiological and clinical data on children are still helpful to improve their prognosis.

Antimicrobial resistance and antibiotic consumption in a third level pediatric hospital in Mexico City.

INTRODUCTION: The increasing resistance to antibiotics is a public health problem and an imminent therapeutic challenge in hospitals. In this report we aimed to analyze the relationship between antimicrobial resistance and antibiotic consumption in a third-level pediatric hospital. METHODOLOGY: A cross-sectional analysis was conducted using the information from the microbiology and pharmacy databases of the Pediatric Hospital "Doctor Silvestre Frenk Freund", during the period 2015-2018. Prevalence of antimicrobial resistance by microorganisms and dispensed grams of selected antibiotics were calculated annually. Antibiotic resistance trend over the time was evaluated using the Chi-square trends test and to assess the correlation between the dispensed grams of antibiotics with their antimicrobial resistance prevalence, we calculated the Pearson's coefficient (r). RESULTS: A total of 4,327 isolated bacterial samples were analyzed (56.5% Gram-positive and 44.5% Gram-negative). Most frequently isolated microorganisms were coagulase-negative staphylococci (CoNS), E. coli, K. pneumoniae, P. aeruginosa and S. aureus. We found a significant increase in resistance to clindamycin and oxacillin for CoNS and significant decrease in nitrofurantoin and amikacin resistance for E. coli and K. pneumoniae. We observed a strong positive and statistically significant correlation between amikacin resistance prevalence and amikacin dispensed grams for P. aeruginosa (r = 0.95, p = 0.05). CONCLUSIONS: The antibiotic resistance profile showed by our study highlights the need of an appropriate antibiotic control use in the Hospital setting.

Human papillomavirus genotypes and P16INK4A expression in squamous penile carcinoma in Mexican patients.

BACKGROUND: Approximately 50% of cases of penile carcinoma (PeCa), a rare neoplasm worldwide, are associated with human papillomavirus (HPV). However, the detection of HPV-DNA is not sufficient to consider it the etiological factor in the development of this type of cancer. Currently, the overexpression of P16INK4A is used as a surrogate biomarker of HPV carcinogenesis. Information on PeCa in Mexico is scarce, particularly regarding cases related to HPV and genotype frequency. OBJECTIVE: To evaluate the presence of HPV, its genotypes, and the presence of multiple genotypes, and the expression of P16INK4A, as well as its clinical and histopathological parameters. METHODS: For HPV-DNA detection and P16INK4A expression, we used the INNO-LiPA® test and immunohistochemistry, respectively. RESULTS: Sixty cases of PeCa were evaluated, of which 75% were HPV-non-related histological variants. We found that 58.9% (33/56) of PeCa cases were HPV-DNA positive, while 30.9% of the cases evaluated (17/55) were positive for P16INK4A. HPV16 was the main genotype in 42.9% of the cases, followed by HPV52 in 7.1% and HPV18 in 5.4%. Within the HPV-positive cases, 27.3% had multiple genotypes. All HPV-positive patients under the age of 45 years were positive only for HPV16. CONCLUSIONS: HPV16 was the most commonly detected genotype in PeCa. HPV 31, 35 and 39 were infrequent; however, they were related to a single infection and P16INK4A overexpression; thus, they seem to be relevant in PeCa carcinogenesis. Our results suggest that P16INK4A overexpression could be useful for the classification of HPV-related PeCa. The role of multiple HPV genotypes in the development and prognosis of PeCa is still not completely understood. Thus, it is necessary to define criteria to establish reliable ways to classify HPV-related PeCa that could lead to optimal therapeutic approaches.

[Microorganisms responsible of nosocomial infections in the Mexican Social Security Institute]. / Los microorganismos causantes de infecciones nosocomiales en el Instituto Mexicano del Seguro Social.

BACKGROUND: The prevention and control of the nosocomial infections involve the knowledge of the most frequent type of microorganism isolated. In Mexico there are not national statistics to identify the main microorganisms that cause a nosocomial infection. METHODS: It was conducted an analysis of all the culture results of the nosocomial infections reported by the Sistema de Vigilancia Epidemiológica Hospitalaria (Epidemiological Surveillance System) of the Instituto Mexicano del Seguro Social during the year 2013. The most frequent and relevant microorganisms were reported. RESULTS: 48 377 results from cultures of nosocomial infections were studied. Of these 13 207 (27.3 %) were from 25 high specialty medical units and 35 170 (72.6 %) from 197 second level medical units. The most frequently isolated microorganism was Escherichia coli with 8192 results (16.9 %), followed by the group of Coagulase-negative Staphylococci with 6771 cultures (14 %) and Pseudomonas aeruginosa with 5275 results (19.9 %). Slight differences between levels of care and specialized hospitals were observed. CONCLUSION: This study identifies the Escherichia coli, the group of Coagulase-negative Staphylococci and the Pseudomonas aeruginosa as the main microorganisms to prevent.

Introducción: la prevención y el control de las infecciones nosocomiales requiere el conocimiento del tipo de microorganismo que es más frecuentemente aislado. En México se carece de una estadística nacional que identifique el principal microorganismo causante de infecciones nosocomiales. Métodos: se estudiaron todos los resultados positivos de los cultivos de las infecciones nosocomiales reportadas por el sistema de Vigilancia Epidemiológica Hospitalaria del Instituto Mexicano del Seguro Social durante el año 2013. Se reportaron los microorganismos más frecuentes y los de mayor relevancia epidemiológica. Resultados: se estudiaron 48 377 resultados de cultivos de infecciones nosocomiales; de estos, 13 207 (27.3 %) correspondieron a las 25 unidades médicas de alta especialidad y 35 170 (72.6 %) a las 197 unidades médicas de segundo nivel. El microorganismo más frecuentemente aislado fue la Escherichia coli con 8192 (16.9 %), seguido del grupo de los Staphylococcus coagulasa-negativos con 6771 (14 %) y la Pseudomonas aeruginosa 5275 (19.9 %). Se observaron diferencias ligeras entre los niveles de atención y entre los hospitales monotemáticos. Conclusiones: el presente estudio identifica a la Escherichia coli, a los Staphylococcus coagulasa-negativos y a la Pseudomonas aeruginosa como los principales microorganismos que se deben combatir.

Human papillomavirus infections in Mexican women with normal cytology, precancerous lesions, and cervical cancer: type-specific prevalence and HPV coinfections.

The prevalence and genotype distribution of human papillomavirus (HPV) provides the basis for designing HPV prevention programs. The prevalence rates of type-specific HPV and coinfections in samples of Mexican women were investigated in 822 women aged 18-87 years. HPV detection was performed using a Linear Array™ genotyping test. HPV infection was found in 12.4% of controls, 46.3% of those with cervical intraepithelial neoplasia 1, and 100% of those with cervical intraepithelial neoplasia 3 or cervical cancer. HPV 16 was the most prevalent type in all diagnosis groups. The HPV types most frequently found in cervical cancers were 16, 18, 45, 52, 58, and 39; HPV types 16, 62, 51, 84, 18, 53, and CP6108 were the most prevalent in control women. Considering HPV-positive samples only, coinfections occurred most often in controls (63%) and were less frequent in those with cervical cancer (26%). The most frequent viral types in coinfections with HPV 16 in control women were HPV 62, 51, and 84; in women with cervical cancers, HPV 18, 39, and 70 were most common. In conclusion, in addition to HPV types 16 and 18, types 45, 39, 58, 52, and 71 were found in cervical cancers in Mexican women (78%); among them, only 65% were attributable to HPV types 16 and 18. Therefore, it is necessary to consider these viral types in the design of new vaccines, and to determine whether certain HPV types coinfecting with HPV 16 in precursor lesions determine tumor progression or regression.

Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy.

Previous reports suggest that renal involvement before pregnancy or active renal disease during pregnancy may be associated with poor fetal and maternal outcomes in systemic lupus erythematosus (SLE) women. We report our experience of fetal and maternal complications in pregnant lupus women with and without previous lupus nephritis. We analyzed the clinical records of pregnant SLE patients attended in a tertiary reference center during a 5-year period. Patients were allocated into two groups according to the presence or absence of previous lupus nephritis. Women were evaluated monthly during pregnancy and at least 1 month postpartum. Maternal and fetal outcomes of pregnancy were abstracted. We included 95 pregnancies in 92 patients. Compared with pregnant women without lupus nephritis (n = 60), pregnancies with previous lupus nephritis (n = 35) were associated with a higher risk of maternal complications (88.5% vs. 43.3%, p = 0.00001), higher rate of lupus flares (54.2% vs. 25%, p = 0.004), and renal flares (45.7% vs. 6.6%, p = 0.00001), but most of which in most instances were reversible. On the other hand, fetal outcome was similar in both groups. Multivariate analysis showed that previous lupus nephritis and active lupus at conception were predictors of adverse maternal outcome. Pregnancies in women with previous lupus nephritis had a higher rate of maternal complications in comparison with those without. However, fetal prognosis was similar in both groups.

Prevalence and resistance pattern of genotype G and H in chronic hepatitis B and HIV co-infected patients in Mexico.

OBJECTIVE: We estimated the prevalence and identified the resistance pattern of HBV genotypes H and G in HBV monoinfected and HIV co-infected patients. MATERIAL AND METHODS: A cross-sectional prevalence and analytic study were performed in chronic hepatitis B patients at the Hospital de Infectología, La Raza National Medical Center in Mexico City. Chronic HBV monoinfected and HIV co-infected patients were included. HBeAg, HBV viral load and genetic analysis of mutations were collected; CD4+ cells count from HIV co-infected patients and HIV RNA were measured. We calculated the prevalence and exact 95% binomial confidence interval and the Odds ratios (OR) with 95% confidence intervals to assess the relationship between the presence of risk factors and HBV genotypes H or G. RESULTS: We enrolled 77 patients, 67 men and 10 women with 37 HIV co-infected patients. The distribution of HBV genotypes was: HBV genotype H 55 (71% [95% CI 60% to 80%]), HBV genotype G 16 (20.7%), HBV genotype F 4 (5.1%) and HBV genotype A 2 (2.6%). The most frequent mutations presented in 8 HIV co-infected patients and one mono-infected patient with antiretroviral therapy (ART) experience were rtM204V and six of them showed genotype G (6/9). Mono-infected HBV patients exposed more probability to HBV genotype H than co-infected HIV patients OR 13.0 (CI 95% 3.40-49.79), p = 0.0001. In contrast co-infected patients presented less possibility to have genotype H, 0.56 (CI 95% 0.42-0.75). CONCLUSIONS: This study confirms the high prevalence of HBV genotype H in Mexico; furthermore, our results suggest that HBV genotype G predominates in co-infected patients. As well, rtM204V and rtL180M mutations are common in HBV-HIV co-infected patients with genotype G and ART experience.

[Clinical features and contagiousness of influenza A(H1N1) in health care workers and hospitalized patients in a Mexico City hospital]. / Características y contagiosidad de influenza A(H1N1) y estacional en trabajadores sanitarios y pacientes de un hospital en la ciudad de México.

INTRODUCTION: Respiratory infections increased in Mexico in 2009 due to an epidemic of influenza. METHODS: To compare symptoms and infectivity of influenza A(H1N1) and seasonal influenza we evaluated epidemiological data and microbiological sampling of health workers (HW) and patients who probably had influenza. RESULTS: From April to November 2009 we studied 83 HW (29 with influenza A(H1N1) and 8 with seasonal influenza) and 71 patients (26 and 11, respectively). The subtypes of influenza had similar clinical data. CONCLUSIONS: Fifteen patients with immunosuppression or chronic diseases developed fatal pneumonia; the infectivity was greater for influenza A(H1N1).

Características y contagiosidad de influenza A(H1N1) y estacional entrabajadores sanitarios y pacientes de un hospital en la ciudad de México / Clinical features and contagiousness of influenza A(H1N1) in health care workers and hospitalized patients in a Mexico city hospital

Introducción: En 2009 se incrementaron las infecciones respiratorias en México por una epidemia de influenza. Métodos: Para comparar sintomatología y contagiosidad de influenza A(H1N1) e influenza estacional recogimos, entre abril y noviembre de 2009, datos clínico-epidemiológicos y muestras microbiológicas de Trabajadores sanitarios (TS) y pacientes con probable influenza. Resultados: De 83 TS, 29 tuvieron influenza A(H1N1) y 8 estacional; de 71 pacientes 26 y 11 respectivamente. Observamos cuadro clínico similar en ambos subtipos de influenza. Conclusiones: Quince pacientes con inmuno supresión y con enfermedades crónicas desarrollaron neumonía fatal; la contagiosidad fue mayor para influenza A(H1N1) (AU)

Introduction: Respiratory infections increased in Mexico in 2009 due to an epidemic of influenza. Methods: To compare symptoms and infectivity of influenza A(H1N1) and seasonal influenza we evaluated epidemiological data and microbiological sampling of health workers (HW) and patients who probably had influenza. Results: From April to November 2009 we studied 83HW(29 with influenza A(H1N1) and 8 with seasonal influenza) and 71 patients (26 and 11, respectively). The subtypes of influenza had similar clinical data. Conclusions: Fifteen patients with immuno suppression or chronic diseases developed fatal pneumonia; the infectivity was greater for influenza A(H1N1) (AU)