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This is a case report of a young adult who died of COVID-19 twelve days after admission, with coronavirus nucleocapsid protein and lipofuscin found in the heart and kidney tissues, providing further evidence of the role of SARS-CoV-2 in cellular senescence.
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OBJECTIVES: We evaluated the VE and the mutations of the viruses present in the Mexican population at the beginning of 2018. METHODS: We diagnosed influenza in outpatients with a high-performance Rapid Influenza Diagnostic Test (RIDT) qRT-PCR. Descriptive statistics were used to describe the study population, while the chi-square test was used to determine clinical variables. VE was analyzed through a negative test design. We sequenced the hemagglutinin (HA) gene, performed a phylogenetic analysis, and analyzed the nonsynonymous substitutions both in and outside antigenic sites. RESULTS: Of the 240 patients analyzed, 42.5% received the trivalent vaccine, and 37.5% were positive for influenza. The VE for the general population for any influenza virus type or subtype was 37.0%, while the VE for the predominant influenza A(H3N2) subtype was the lowest (19.7%). The phylogenetic analysis of HA showed the co-circulation of clades and subclades 3C.2a1, 3C.2a1b, 3C.2a2, 3C.2a2re, 3C.2a3, and 3C.3a with identities approximately 97-98% similar to the vaccine composition. CONCLUSION: Low VE was related to the co-circulation of multiple clades and subclades of influenza A(H3N2), with sufficient genetic and phenotypic distance to allow for the infection of vaccinated individuals.
Subject(s)
Influenza Vaccines , Influenza, Human , Humans , Influenza, Human/diagnosis , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Influenza A Virus, H3N2 Subtype/genetics , Phylogeny , Seasons , Mexico/epidemiology , Vaccine Efficacy , Hemagglutinin Glycoproteins, Influenza Virus/genetics , RNA, Viral/genetics , Antigenic Variation , Hemagglutinins/geneticsABSTRACT
Resumen: Introducción: Existen indicadores de calidad tanto generales como específicos en medicina crítica. Los indicadores para procesos propios de unidades de cuidados intensivos respiratorios (UCIRs) son necesarios. Material y métodos: Un grupo de trabajo de las UCIRs de los servicios de tórax de los principales hospitales de tercer y cuarto nivel de atención sanitaria en México, siguiendo la metodología de los grupos de trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias y la Fundación Avedis-Donabedian, identificó aspectos relevantes del proceso del cuidado con relación a volumen, riesgo y complejidad, recabando información de 10 años de actividad asistencial para ser correlacionados y finalmente diseñar indicadores. Resultados: Con información de 2,776 pacientes atendidos del 1o de noviembre de 2009 al 1o de noviembre de 2019, se delimitó el campo de actuación con aspectos importantes como broncoscopia, neumonía, paciente inmunocomprometido, hemoptisis masiva, embolización de arterias bronquiales, cirugía de resección segmentaria/lobar o pulmonar, pleurocentesis y ultrasonido fueron identificados y correlacionados en consenso por el grupo de expertos, llevando al diseño de cuatro indicadores. Conclusiones: Este es el primer reporte de desarrollo de indicadores de calidad para UCIRs de servicios de tórax que servirán para la mejora de la calidad en este tipo de unidades.
Abstract: Introduction: There are both general and specific quality indicators in critical care medicine. Indicators for respiratory intensive care units (RICUs) processes are needed. Material and methods: Following the methodology of the working groups of the Spanish Society of Intensive, Critical Care and Coronary Units and the Avedis-Donabedian Foundation, a working group of the RICUs belonging to departments of chest medicine of the main hospitals of third and fourth level of care in Mexico identified relevant aspects of the care process in relation to volume, risk and complexity, collecting information from ten years of clinical activity to be correlated and finally to design indicators. Results: Delimitation of the field of action was made accounting with information on 2,776 patients treated from November 1, 2009 to November 1, 2019. Important aspects such as bronchoscopy, pneumonia, immunocompromised patient, massive hemoptysis, bronchial artery embolization, segmental/lobar or pulmonary resection surgery, thoracentesis and ultrasound were identified and correlated in consensus by the group of experts leading to the design of four indicators. Conclusions: This is the first report on the development of quality indicators for RICUs belonging to departments of chest medicine that will serve to improve quality in this type of units.
Resumo: Introdução: Existen indicadores de qualidade tanto gerais como específicos em medicina crítica. São necessários os indicadores para procesos própios das unidades de terapias intensivas respiratórias (UTIRs). Material e métodos: Um grupo de trabalho das UTIRs dos serviço de tórax dos principais hospitais de tercero e quarto níveis de atenção sanitária no México, seguindo a metodologia dos grupos de trabalho da Sociedade Espanhola de Terapia Intensiva, Crítica e Unidades Coronárias e a Fundação Avedis-Donabedian, identificou aspectos relevantes do processo de cuidado com relação ao volume, risco e complexidade, reunindo informações de 10 anos de atividade assistencial para ser correlacionada e, finalmente, desenhar indicadores. Resultados: Com informações de 2,776 pacientes atendidos de 1o de novembro de 2009 a 1o de novembro de 2019, o campo de atuação foi definido com aspectos importantes como broncoscopia, pneumonia, paciente imunocomprometido, hemoptise maciça, embolização de artérias brônquicas, cirurgia de ressecção segmentar/lobar ou pulmonar, pleurocentese e ultrassom foram identificados e correlacionados em consenso pelo grupo de especialistas, resultando no desenho de quatro indicadores. Conclusão: Este é o primeiro relatório de desenvolvimento de indicadores de qualidade para UTIRs do serviço de tórax que servirão para melhorar a qualidade neste tipo de unidade.
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With regards to the article "Workplace bullying during specialty training in a pediatric hospital in Mexico: a little-noticed phenomenon", this letter shows a reflection about the thin line between discipline and bullying in the teacher student relationships in medical education in Mexico.
En relación con el artículo "Acoso laboral durante la formación como especialista en un hospital de pediatría en México: un fenómeno poco percibido", el autor de esta carta reflexiona en torno a la delgada línea que hay entre la disciplina y el bullying en la relación profesor-estudiante en la educación médica en México.
Subject(s)
Bullying , Organizational Culture , Humans , Interprofessional Relations , MexicoABSTRACT
BACKGROUND: Early tuberculosis (TB) diagnostic is one of the critical steps to TB control. GeneXpert MTB/RIF has been widely proven for a prompt TB diagnosis. The use of GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy samples may increase diagnostic accuracy. We aim to assess the diagnostic of TB with GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy. METHODS: Patients with suspected diagnosis of TB and negative smear microscopies, with TB culture and GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy were included in this cross-sectional study. Participants were enrolled from 2016 to 2018 at National Institute of Respiratory Diseases, Mexico. RESULTS: We included 54 patients (77.8% males) aged 30 to 65 years. The sensitivity of the GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy was 81.3% (95% CI, 62.1-100%), with a specificity of 100% (95% CI, 100-100%) and a negative predictive value of 92.7% (95% CI, 84.7-100%). Twenty-two patients of the total population have HIV, the sensitivity of the test in these patients was 87.5% (95% CI, 64.6-100%). Also, 28 patients with a peripheral localized lesion which had a solid pattern were identified (51.9%). The sensitivity in patients with peripheral localized lesions was 88.9% (68.4-100%). CONCLUSIONS: The GeneXpert MTB/RIF assay with transbronchial lung cryobiopsy test is as efficient as broncho alveolar lavage for TB diagnosis. Transbronchial lung cryobiopsy increases a major diagnostic opportunity when the nature of illness is malignant. Transbronchial lung cryobiopsy is efficient in HIV patients, especially in patients with peripheral localized lesion.
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Health is not only a biological condition; it is configured as a social, cultural and legal good that the state can´t promote, improve or protect without the participation of health professionals, states and educational and research institutions; but, above all, it must have the active intervention of all citizens. The aim is for services to be carried out with equity, quality and social protection.
La salud no es únicamente una condición biológica, sino que se configura como un bien social, cultural y jurídico que el Estado no puede promover, mejorar ni proteger sin la participación de los profesionales de la salud, las entidades federativas y las instituciones educativas y de investigación; pero, sobre todo, debe contar con la intervención activa de todos los ciudadanos. Se busca que los servicios de salud se realicen con equidad, calidad y protección social.
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Forecasting , HumansABSTRACT
El sismo ocurrido el 19 de septiembre del presente año en la ciudad de México, a 32 años del ocurrido en la misma fecha y en el mismo lugar, ha motivado una respuesta intensa de voluntariado en la generación llamada millenials; las redes sociales invitaron a participar y localizar las áreas geográ ficas más necesitadas de apoyo de brigadistas e insumos, y el poder de convocatoria y el espíritu de solidaridad fue ejemplar, incluso rebasando el número solicitado para dichas actividades. Analizando este fenómeno, es de considerar la respuesta a la siguiente pregunta: ¿la generación millenial es la más prepa rada para afrontar un desastre de esta magnitud?
The earthquake that occurred on September 19 of this year in Mexico City, 32 years after that occurred on the same date and in the same place, has motivated an intense volunteer response in the generation called millennials; Social networks invited people to participate and locate the geographic areas most in need of support from brigades and supplies, and the convening power and spirit of solidarity was exemplary, even exceeding the number requested for such activities. Analyzing this phenomenon, it is necessary to consider the answer to the following question: is the millennial generation the most prepared to face a disaster of this magnitude?
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Humans , Adult , Stress Disorders, Post-Traumatic , Volunteers , Power, Psychological , Richter Scale , Earthquakes , Social Networking , MexicoABSTRACT
It has been 50 years since the first description of the respiratory distress syndrome or acute respiratory distress syndrome (ARDS), advances from the physiopathological view are immense, unfortunately, the case fatality rate has had little variation, it is important to disseminate the knowledge to achieve the proper diagnosis and treatment.
Han pasado 50 años desde la descripción original del síndrome de distrés respiratorio o síndrome de dificultad respiratoria aguda (SDRA), los avances desde el punto de vista fisiopatológico son inmensos, desgraciadamente la letalidad ha tenido poca variación, por ello sigue siendo importante difundir el conocimiento requerido para lograr el diagnóstico y tratamiento adecuados.
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Respiratory Distress Syndrome , History, 20th Century , Humans , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/history , Respiratory Distress Syndrome/prevention & control , Time FactorsABSTRACT
Although it is sometimes considered that the master's and doctorate degrees are only for enlightened people, students belonging to a medical specialty may have the academic skills and tools necessary to hold one of these degrees.
Aunque en ocasiones se considera que los títulos de maestría y doctorado son únicamente para ilustrados, los estudiantes de una especialidad médica pueden contar con las habilidades y herramientas académicas necesarias para ostentar uno de estos grados.
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Education, Medical, Continuing , Education, Medical, Graduate , Specialization , HumansABSTRACT
Thanks to the Oscar-winning picture of Alfonso Cuaron, many Mexicans have identified the importance that the IMSS has had in the daily lives of citizens for decades. This film takes us back to the most important time of the Institute and makes us reflect on the need of being recognized again as one of the most important health and social security institutions in the world.
Gracias a la oscarizada obra de Alfonso Cuarón, muchos mexicanos han identificado la importancia que, desde hace décadas, ha tenido el IMSS en la vida cotidiana de los ciudadanos. Esta película nos remonta a la época de mayor relevancia del Instituto y nos hace reflexionar acerca de la necesidad de que vuelva a ser reconocido como una de las instituciones de salud y seguridad social más importantes del mundo.
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Academies and Institutes , Motion Pictures , Social Security , Awards and Prizes , Humans , MexicoABSTRACT
The conferral of the medical specialty degree requires the presentation of a research project during the training period; however, most of these projects are never published. It is important to analyze the causes of this academic condition.
La obtención del grado de especialidad médica requiere la presentación de un trabajo de investigación durante el periodo de adiestramiento; sin embargo, la mayoría de ellos nunca se publican. Es importante analizar las causas de esta condición académica.
