Clinical features and outcomes of mpox in people with and without HIV: a national comparative study.

BACKGROUND: People who live with HIV (PWLH) have been one of the most affected groups during the current mpox outbreak. They are hypothesized to have a more severe clinical course than people without HIV but comparative data is scarce. We aimed to compare clinical features and outcomes of mpox in people with and without HIV in Mexico. SETTING: Country-wide study in Mexico. METHODS: We performed an observational study using nation-wide epidemiological data. We included all people with confirmed mpox diagnosed between May and November 2022 in Mexico. Clinical and sociodemographic characteristics were compared between people with and without HIV. Multivariable logistic regression models were preformed to determine the association between HIV, clinical features, and outcomes and reported with odds ratios (ORs) and 95% confidence intervals (95% CI). ORs for rare outcomes were interpreted as risk ratios. RESULTS: Among 3291 people with mpox, 59% were PWLH. PWLH had an increased risk of severe mpox (OR 2.6, 2.4-2.9) and death (OR 10.8, 9.7-11.9). They also had a higher risk of otalgia, proctitis, and urethritis. Eleven individuals died, of whom ten were PWLH. All deaths were directly attributed to mpox. CONCLUSION: People with HIV have a higher risk of severe mpox and death due to mpox.

Integrated water quality assessment of two Rivers Basins from a semiarid region of Argentina.

The Tunuyán and Mendoza River Basins (Province of Mendoza, Argentina) have been selected as a representative semiarid region to test the applicability of an integrated water quality evaluation. To detect spatio-temporal variations of anthropic contamination, physicochemical and bacteriological parameters, as well as three ecotoxicological assays, were assessed in reference sites for 3 years. Bioassays based on the nematode Caenorhabditis elegans, the vascular plant Lactuca sativa, and the algae Pseudokirchneriella subcapitata were performed and toxicological categories were established. Our results showed that water quality, as well as water toxicity, deteriorates as both river systems run through urban areas. Interestingly, monitoring sites with good physicochemical and bacteriological qualities but with toxicity were identified, illustrating that traditional water quality studies do not predict potential toxic effects on living organisms. In addition, a multivariate statistical analysis was performed to detect clusters of monitoring sites according to the water quality status. In the context of climate change, this study provides information to support that integrated water monitoring is an essential tool to ensure sustainable water management and to guarantee economic growth, human health, food security, and environmental protection.

Predictors of laboratory-confirmed mpox in people with mpox-like illness.

OBJECTIVES: We aimed to identify predictors of confirmed monkeypox (mpox) among people with mpox-like illness and to develop a multivariable model for confirmed mpox. METHODS: We performed an observational study using national epidemiologic surveillance data in Mexico from May to November 2022. People with mpox-like illness were reported to the Mexican Ministry of Health and real-time polymerase chain reaction was performed in clinical samples to confirm mpox. Sociodemographic and clinical data were collected with a case report form. We performed univariable logistic regressions to estimate the predictive capability of individual characteristics, reported with ORs and 95% CIs. Variables of interest were included in multivariable logistic regression models and Akaike information criterion was used to retain variables for the final model. Discrimination and calibration of the model were estimated in bootstrap resamples. RESULTS: A total of 5078 people were reported with mpox-like illness. Of 5078 people, 3291 (64.8%) had confirmed mpox. The strongest clinical predictors of confirmed mpox in univariable models were proctitis (OR 6.54, 5.93-7.21), inguinal adenopathy (OR 5.91, 5.36-6.52), and anogenital lesions (OR 5.45, 4.94-6.02). The final model included being a man who has sex with men (8.75, 7.37-10.38), HIV diagnosis (3.04, 2.51-3.69), inguinal adenopathy (2.24, 1.81-2.77), anogenital lesions (2.32, 1.97-2.74), and pustules (1.55, 1.32-1.81). Discrimination capability was excellent (c-statistic 0.88, 95% CI 0.87-0.89) and it was well calibrated (calibration slope 1, 95% CI 0.95-1.05). DISCUSSION: A third of people with mpox-like illness do not have mpox. Factors such as being a man who has sex with men, HIV diagnosis, inguinal adenopathy, pustules, and anogenital lesions are associated with confirmed mpox.

Epidemiological and clinical characteristics of patients with human monkeypox infection in Mexico: a nationwide observational study.

Background: Human monkeypox, a zoonosis historically endemic to West and South Africa, has led to a worldwide outbreak driven by human-to-human transmission resulting in an international public health emergency. Endemic and outbreak monkeypox cases may differ in their affected populations, clinical features, and outcomes. Thus, profiling cases of the current monkeypox outbreak worldwide is crucial. Methods: We performed a nationwide observational surveillance-based study from May 24 to September 5, 2022. Patients that met the operational clinical definition of monkeypox or symptomatic close contacts of confirmed cases were tested by real-time polymerase chain reaction. Clinical data were collected with a standardized case-report form. We report epidemiologic, sociodemographic, and clinical characteristics of confirmed cases. Findings: Five-hundred and sixty-five human monkeypox confirmed cases were analysed; 97.2% were men, of whom 59.5% identified as men who have sex with men, and 54.5% had human immunodeficiency virus infection. The median age was 34 years. All patients but one had rash (99.8%), 78.9% had fever, and 47.8% reported myalgia. The anogenital area was the most commonly affected one by rash (49.6%), and proctitis occurred in 6.2% of patients. Six patients required hospitalization, of which one died due to causes unrelated to monkeypox. Interpretation: The 2022 monkeypox outbreak in Mexico is mainly driven by middle-aged men who have sex with men, of which a large proportion are persons who live with human immunodeficiency virus infection. Clinical features such as the high proportion of anogenital lesions suggest sexual contact is a pivotal transmission mechanism in this outbreak. Funding: This research was supported by grant A1-S-18342 from Consejo Nacional de Ciencia y Tecnología (CONACyT), Mexico (to S.I.V.-F.).

Incidence of Intestinal Infectious Diseases due to Protozoa and Bacteria in Mexico: Analysis of National Surveillance Records from 2003 to 2012.

BACKGROUND: According to national epidemiological surveillance records, in Mexico six intestinal infectious diseases (IID) are among the top infectious communicable diseases. However, their incidence, relative importance, and spatial patterns have not been studied in detail. AIMS: We examine the epidemiology of IID due to bacteria and protozoa to identify which diseases are most important at two spatial scales, what is their integrated importance locally, and how their incidence correlates with Human Development Index (HDI). METHODS: We retrieved yearly number of new cases of eight IID from the national epidemiological morbidity report from 2003 to 2012 at the national level, by state, and to assess such information at a higher spatial resolution we included the municipalities for Mexico City. However, no comparisons were made to other municipalities due to unavailability of data. We compared incidence, obtained the disease-specific relative importance, and inspected spatial patterns for the integrated incidence. Finally, we tested whether HDI is correlated with incidence. RESULTS: We found that, except for two diseases, the relative importance of the other six IID contrasted not only between the national level and Mexico City, but also among states and municipalities in Mexico City. Besides, at both scales the distribution of the incidence showed disease-specific spatial patterns. Finally, there was a lack of consistent correlation between HDI and individual IID at both scales. CONCLUSION: Our results emphasize the need for local disease-focused selective models for control and prevention of IID. The maps displaying our analyses of epidemiological similarities may be used in orienting such effort.

Viral kinetics during the first month of treatment in patients with genotype 1 chronic hepatitis C.

OBJECTIVE: to identify predictive factors of response to pegylated interferon alpha-2b and ribavirin in patients with genotype 1 chronic hepatitis C. Viral kinetics were studied in weeks 2 and 4. METHODS: a prospective and consecutive study of patients with genotype 1 chronic hepatitis C referred to our Hepatology Clinic between January 2004 and October 2006 for antiviral treatment. Baseline data were recorded and viremia levels were determined hours before the weekly dose of pegylated interferon by qualitative and quantitative PCR. RESULTS: 57 patients were included in the study, although 3 of these were excluded during follow up; 65% were male (n = 35), with a mean age of 42 (26-65) years. Baseline viremia levels were > 800,000 IU/mL in 67% (n = 36). Liver biopsy was performed in 86% (n = 46), 22% (n = 12) had advanced fibrosis. Forty were naïve, 4 relapsing and 10 non-responders. Ribavirin dose was modified in one patient alone due to adverse effects. End treatment response and sustained virological response (SVR) were 59 and 41%, respectively. A univariate analysis revealed a statistically significant association of SVR with baseline viremia (p = 0.006), baseline GGT (p = 0.025), and a reduction in viremia > or =2 logs at 2, 4 and 12 weeks (p = 0.001). The extent of viremia reduction at week 2 was associated with 100% SVR, and at 4 weeks the positive predictive values was 84% and the negative predictive values was 96.5%. A subanalysis of the naïve group yielded analogous results. CONCLUSIONS: in our study, a reduction in viremia > or = 2 logs 2 weeks after treatment could ensure SVR. At 4 weeks, most non-responders could be identified.

Cinética viral durante el primer mes de tratamiento en pacientes con hepatitis crónica C genotipo 1 / Viral kinetics during the first month of treatment in patients with genotype 1 chronic hepatitis C

Objective: to identify predictive factors of response to pegylatedinterferon alpha-2b and ribavirin in patients with genotype 1chronic hepatitis C. Viral kinetics were studied in weeks 2 and 4.Methods: a prospective and consecutive study of patients withgenotype 1 chronic hepatitis C referred to our Hepatology Clinicbetween January 2004 and October 2006 for antiviral treatment.Baseline data were recorded and viremia levels were determinedhours before the weekly dose of pegylated interferon by qualitativeand quantitative PCR.Results: 57 patients were included in the study, although 3 ofthese were excluded during follow up; 65% were male (n = 35),with a mean age of 42 (26-65) years. Baseline viremia levels were> 800,000 IU/mL in 67% (n = 36). Liver biopsy was performedin 86% (n = 46), 22% (n = 12) had advanced fibrosis. Forty werenaïve, 4 relapsing and 10 non-responders. Ribavirin dose wasmodified in one patient alone due to adverse effects. End treatmentresponse and sustained virological response (SVR) were 59and 41%, respectively. A univariate analysis revealed a statisticallysignificant association of SVR with baseline viremia (p = 0.006),baseline GGT (p = 0.025), and a reduction in viremia >= 2 logs at2, 4 and 12 weeks (p = 0.001). The extent of viremia reduction atweek 2 was associated with 100% SVR, and at 4 weeks the positivepredictive values was 84% and the negative predictive valueswas 96.5%. A subanalysis of the naïve group yielded analogousresults.Conclusions: in our study, a reduction in viremia >= 2 logs2 weeks after treatment could ensure SVR. At 4 weeks, mostnon-responders could be identified(AU)

Objetivo: identificar qué factores predicen la respuesta al interferónpegilado alfa-2b y ribavirina en pacientes con hepatitiscrónica C genotipo 1. Se estudió la cinética viral en la semana 2 y4.Métodos: se evaluaron de forma prospectiva y consecutiva alos pacientes con hepatitis crónica C genotipo 1 remitidos a nuestraconsulta de hepatología entre enero de 2004 y octubre de2006, para tratamiento antiviral. Se recogieron datos basales y laviremia se determinó horas antes de la dosis semanal de interferónpegilado por PCR cualitativa y cuantitativa.Resultados: cincuenta y siete pacientes fueron incluidos aunque3 fueron excluidos durante el seguimiento. Un 65% fueronvarones (n = 35) con edad media de 42 (26-65) años. La viremiabasal fue > 800.000 UI/ml en 67% (n = 36). Se realizó biopsiahepática en 86% (n = 46), 22% (n = 12) tenían fibrosis avanzada.40 fueron naïves, 4 recidivantes y 10 no respondedores. La dosisde ribavirina se modificó por efecto secundario sólo en un paciente.La RFT y la RVS fueron de 59 y 41%, respectivamente. Elanálisis univariante mostró asociación estadísticamente significativacon RVS de la viremia basal (p = 0,006), GGT basal (p =0,025) y el descenso en la viremia >= 2 logaritmos a las 2, 4 y 12semanas (p = 0,001). El descenso de la viremia en la semana 2 seasoció con 100% de RVS y a las 4 semanas el VPP fue 84% y elVPN 96,5%. Se realizó un subanálisis en el grupo de pacientesnaïves con resultados superponibles.Conclusiones: en nuestro estudio el descenso de la viremia >= 2 logaritmos a las 2 semanas de tratamiento aseguró la RVS. Alas 4 semanas, identificamos a la gran mayoría de los pacientes norespondedores(AU)

Endoscopic follow-up of gastric ulcer in a population at intermediate risk for gastric cancer.

OBJECTIVES: Primary: to assess the necessity of a second endoscopy with a pathology study to confirm the healing of all gastric ulcers previously diagnosed through endoscopy in a population at intermediate risk for gastric cancer. Secondary: to assess correlation between endoscopic findings and pathology diagnosis. PATIENTS AND METHODS: a prospective analysis of patients diagnosed with gastric ulcer through endoscopy at Hospital General de Ciudad Real (Spain) over three years. We collected demographic, clinical, endoscopic, and pathological data for the first and subsequent endoscopies. We collected at least six biopsies obtained from ulcer margins, and assessed H. pylori infection. RESULTS: Three hundred and two patients were included in this study. H. pylori infection was diagnosed in 173 (57%), and 113 (37%) patients had used NSAIDs. The positive and negative predictive value for malignancy of endoscopic diagnosis regarding ulcer fold, base, and margins were 34 and 97%, respectively. Only one patient was diagnosed with a tumor during the second endoscopy. At the end of follow-up, the etiology of the ulcer was considered as peptic in 276 patients; Crohn s disease-related in one, and neoplastic in 25 patients (21 adenocarcinomas, 4 lymphomas). CONCLUSIONS: in an intermediate-risk population for gastric cancer a second endoscopy is not justified for gastric ulcer patients when endoscopy and biopsy results do not suggest malignancy.

Seguimiento endoscópico de la úlcera gástrica en una población de riesgo intermedio de cáncer gástrico / Endoscopic follow-up of gastric ulcer in a population at intermediate risk for gastric cancer

Objetivos: Primario: valorar la necesidad de una segunda endoscopia con estudio anatomopatológico para confirmar la curación de todas las úlceras gástricas diagnosticadas previamente mediante endoscopia, en una población de riesgo intermedio de cáncer gástrico. Secundario: correlacionar el juicio diagnóstico del endoscopista y el diagnóstico anatomopatológico. Pacientes y métodos: análisis prospectivo de todos los pacientes diagnosticados de úlcera gástrica mediante endoscopia en el Hospital General de Ciudad Real durante tres años. Se recogieron datos demográficos, clínicos, endoscópicos y anatomopatológicos de la primera y sucesivas endoscopias. Se tomaron al menos seis muestras de biopsia del nicho y se valoró la presencia de H. pylori. Resultados: se incluyeron 302 pacientes. Se diagnosticó infección por H. pylori en 173 (57%) y se documentó la toma de AINE en 113 (37%). El valor predictivo positivo y negativo para malignidad del diagnóstico endoscópico atendiendo a los pliegues, fondo y bordes del nicho fue de 34 y 97%, respectivamente. La segunda endoscopia sólo diagnosticó un paciente. Al final del seguimiento, el diagnóstico etiológico fue de 276 casos de úlcera péptica, 1 de úlcera por enfermedad de Crohn y 25 de úlcera neo-plásica (21 adenocarcinomas, 4 linfomas). Conclusiones: en una población de riesgo intermedio de cáncer gástrico, no está indicada la realización sistemática de una segunda endoscopia en pacientes con úlcera gástrica en los que la visión endoscópica y la biopsia del nicho no indican malignidad(AU)

Objectives: Primary: to assess the necessity of a second endoscopy with a pathology study to confirm the healing of all gastric ulcers previously diagnosed through endoscopy in a population at intermediate risk for gastric cancer. Secondary: to assess correlation between endoscopic findings and pathology diagnosis. Patients and methods: a prospective analysis of patients diagnosed with gastric ulcer through endoscopy at Hospital General de Ciudad Real (Spain) over three years. We collected demographic, clinical, endoscopic, and pathological data for the first and subsequent endoscopies. We collected at least six biopsies obtained from ulcer margins, and assessed H. pylori infection. Results: Three hundred and two patients were included in this study. H. pylori infection was diagnosed in 173 (57%), and 113 (37%) patients had used NSAIDs. The positive and negative predictive value for malignancy of endoscopic diagnosis regarding ulcer fold, base, and margins were 34 and 97%, respectively. Only one patient was diagnosed with a tumor during the second endoscopy. At the end of follow-up, the etiology of the ulcer was considered as peptic in 276 patients; Crohn's disease-related in one, and neoplastic in 25 patients (21 adenocarcinomas, 4 lymphomas). Conclusions: in an intermediate-risk population for gastric cancer a second endoscopy is not justified for gastric ulcer patients when endoscopy and biopsy results do not suggest malignancy(AU)

Colitis linfocítica y enfermedad celiaca / Lymphocitic colitis and celiac disease

No disponible

Proyecto QUALI: un estudio de la calidad de la estructura en los equipos de atención primaria (EAP) de Cataluña / QUALI PROJECT: a study of the quality of the structure of primary care teams in catalonia

Objetivo. Analizar el nivel de cumplimiento de los criterios de calidad en atención primaria de salud de la Comissió de Millora de la Qualitat de la Societat Catalana de Medicina Familiar i Comunitària (SCMFiC). Diseño. Estudio descriptivo tranversal. Emplazamiento. Centros de Atención Primaria (CAP) reformados de Cataluña (186), de los cuales cumplimentaron el disquete con los resultados 73 (39,2 por ciento). Mediciones y resultados principales. Un total de 202 criterios -distribuidos en 5 apartados (estructura y recursos materiales, recursos humanos, organización del trabajo, sistemas de registro y accesibilidad, continuidad, confidencialidad y participación)- fueron autoevaluados en cada CAP. Estos criterios están definidos como básicos u óptimos y se valora su grado de cumplimiento de 1 a 4. El 72,8 por ciento de los criterios se cumplían totalmente, el cumplimiento parcial fue del 7,4 por ciento y un 19,7 por ciento se incumplían. Los criterios básicos presentaron un cumplimiento total del 74 por ciento, mientras que el de los óptimos fue del 51,9 por ciento. Los grupos con menor cumplimiento (suma del total más el parcial) fueron sistemas de registro (68,6 por ciento) y recursos humanos (73,5 por ciento). El mejor cumplimiento lo presenta el grupo de organización (85,5 por ciento). Por subgrupos el mayor cumplimiento se detecta en intimidad (93,7 por ciento), atención directa (89,2 por ciento) y registro de actividad (89,1 por ciento). Los subgrupos con mayor incumplimiento fueron tratamientos de larga duración (61,8 por ciento), vacunas (46,4 por ciento) y almacén (42 por ciento). De los 18 criterios que se incumplen en la mitad o más, 8 se consideran responsabilidad del equipo. Se observa un cumplimiento total del 37,8 por ciento y parcial en el 24 por ciento de los criterios que hacen referencia a la formación específica de los profesionales de AP. Se han obtenido incumplimientos de hasta el 80 por ciento en cuanto a calidad de registros de prescripción crónica, vacunas y almacén. Conclusiones. Cabe destacar el alto grado de cumplimiento de los apartados que más dependen de los profesionales (accesibilidad-continuidad y organización). Este estudio supone una aproximación al conocimiento de la situación de calidad de la estructura de la AP en Cataluña y permite establecer propuestas de mejora (AU)

[The long-term efficacy of fibrinolytic treatment in the acute phase of a myocardial infarct. A comparison with a control group]. / Eficacia a largo plazo del tratamiento fibrinolítico en la fase aguda del infarto de miocardio. Comparación con un grupo control.

BACKGROUND: The follow-up of patients with an acute myocardial infarction treated with fibrinolysis and that of patients treated with conventional therapy was analyzed. PATIENTS AND METHODS: The study cohort included: 1) 214 patients with a first acute infarction of < or = 4 hours and with < or = 70 years of age who participated in a randomized study comparing the effects of streptokinase (SK, n: 110) vs conventional treatment (control, n: 104), and 2) a total of 361 patients with a myocardial infarction of < or = 6 hours and < or = 75 years old treated with fibrinolytic agents. RESULTS: In-hospital mortality in the randomized study was 11% for the control group and 7% for the SK group, and 8.8% for the rest of patients treated with fibrinolysis. Mortality during follow-up in the randomized study (7.0 +/- 1.5 years) was 10.7% for the SK group and 19.3% for the control group. Ejection fraction was significantly lower in non survivors than in survivors (36.7% vs 50.8%, (p < 0.0001) and among patients with an ejection fraction < 50%, follow-up mortality was significantly lower in those with a complete recanalization (TIMI 3) than in those with an absent or incomplete recanalization (TIMI 0-2) (98% vs 22%). Follow-up mortality for the rest of patients treated with fibrinolysis (2.6 +/- 1.6 years) was 9%. CONCLUSIONS: 1) The reduction of in-hospital mortality by fibrinolysis appears to increase in the long-term follow-up, and 2) the long-term survival seems to be related not only to the left ventricular function but also to the extent of angiographic recanalization.

[Problem in the management of arterial hypertension resistent to drug treatment. Study of 28 cases]. / Problemas en el manejo de la hipertensión arterial resistente al tratamiento farmacológico. Estudio de 28 casos.

The antihypertensive effect of the following therapeutic regimens: diuretic alone (DA), diuretic plus sympathetic inhibitor (DSI), diuretic plus betablocker (DB) and diuretic plus, betablocker plus vasodilator (DBV) was studied for 34.1 +/- 5.4 months in 28 patients with resistant essential hypertension (REH). Depending of treatment tolerability and the optimal antihypertensive action of drugs 21, 24, 26 and 10 cases were treated continuously or alternately with DA (9.9), DSI (15.0), DB (4.8), and DBV (14.6), respectively (in paragraph average duration of treatment in months). On admission the 89.3% and 42.8% of population had electrocardiographic signs of left ventricular hypertrophy or past-history of cardio-vascular complications, respectively. Arithmethic average and standard deviation of individual changes of systolic and diastolic blood pressure obtained during DA, DSI, DB and DBV treatment were -32.4 +/- 31.8, -19.3 +/- 27.2, -18.9 +/- 15.9 and -18.2 +/- 21.3 for systolic and -35.8 +/- 20.2, -12.3 +/- 17.2, -15.1 +/- 16.9 and -15 +/- 13.1 (mm. de Hg.) for diastolic blood pressure respectively. Average blood pressure before treatment was 222.4 +/- 30.3/128.0 +/- 20.8 (mm of Hg) and under the most effective treatment was 175.5 +/- 21.8/106.5 +/- 12.1 with a p less than or equal to 0.001 for either sistolic and diastolic pressure. There were not significant regressive electrocardiographic changes during the therapeutic period, neither significant changes in urea and creatinine blood values. 46.4% and 25% of cases exhibited collateral drug symptoms and cardio-vascular no fatal complications, respectively. Three of the last group patients died outside of the Hospital (2 sudden deaths and 1 renal insufficiency death). RH still constitutes a challenge to medical therapy. Nevertheless individualized therapy may modify the natural history of this hypertensive variety.