Síntomas gastrointestinales, disfunción respiratoria, hepática y renal, principales factores asociados a letalidad por rickettsiosis trasmitida por garrapatas en Mexicali, Baja California, México / Gastrointestinal symptoms, respiratory, hepatic and renal dysfunction, main factors associated with lethality due to tickborne rickettsiosis in Mexicali, Baja California, Mexico

INTRODUCCIÓN: La rickettsiosis, enfermedad potencialmente mortal, es trasmitida por vectores como Rhipicephalus sanguineus, Dermacentor variabilis y D. andersonii, reservorios de Rickettsia rickettsii. En Baja California, México, es endémica, multifactorial, tiene alta letalidad, sus manifestaciones clínicas inespecíficas y ataque multisistémico dificultan el diagnóstico y tratamiento oportuno. OBJETIVO: Identificar los factores de riesgo asociados a la letalidad por rickettsiosis trasmitida por garrapatas en Mexicali, Baja California. PACIENTES Y MÉTODOS : Estudio observacional, analítico, transversal, retrospectivo, de 40 registros de pacientes con diagnóstico confirmado de rickettsiosis, periodo 2014 a 2018. Variables analizadas: sociodemográficas, clínicas, laboratorio clínico, evolución y desenlace. Se reportan frecuencias y medidas de asociación. RESULTADOS: 24 defunciones y 16 vivos. Más de 90% tuvo contacto conocido con garrapatas. Afectó en su mayoría a < 45 años en ambos grupos. La evolución antes del ingreso fue similar y la estancia hospitalaria fue mayor en los pacientes vivos (3,2 ± 4.7 vs 10,62 ± 7,6 p = 0,0002). Fiebre, cefalea, mialgias fueron predominantes. Datos asociados con letalidad: disfunción respiratoria (OR 38,33 IC95% 4,06-361,3 p < 0,0001), creatinina elevada (OR 15,4 IC95% 3,08-76,77 p < 0,0003), retardo del llenado capilar (OR 13,0 IC95% 2,73-61,78 p = 0,0005), dolor abdominal (OR 8,33, IC95% 1,90-36,44 p = 0,0029), AST (OR 7,5, IC95% 1,69-33,27 p = 0,005). CONCLUSIÓN: Esta enfermedad requiere de identificación temprana de factores que se asocian con letalidad para un tratamiento oportuno y adecuado.

BACKGROUND: Rickettsiosis, a potentially fatal disease, is transmitted by vectors such as Rhipicephalus sanguineus, Dermacentor variabilis and D. andersonii, reservoirs of Rickettsia rickettsii. In Baja California, Mexico, it is endemic, multifactorial, has high lethality, its nonspecific clinical manifestations and multisystem attack make diagnosis and timely treatment difficult. AIM: Identify the risk factors associated with lethality due to tick-transmitted rickettsiosis in Mexicali, Baja California. METHODS: Observational, analytical, cross-sectional, retrospective study of 40 records of patients with a confirmed diagnosis of rickettsiosis, period 2014 to 2018. Analyzed variables: sociodemographic, clinical, clinical laboratory, evolution and outcome. Frequencies and association measures are reported. RESULTS: 24 patients died and 16 survived. More than 90% had reported contact with ticks. It mostly affected ≤ 45 years in both groups. The evolution before admission was similar, and the hospital stay was longer in patients who lived (3.2 ± 4.7 vs 10.62 ± 7.6 p = 0.0002). Fever, headache, and myalgia are predominant. Data associated with lethality: respiratory dysfunction (OR 38.33 95% CI 4.06-361.3 p < 0.0001), elevated creatinine (OR 15.4 95% CI 3.08-76.77 p < 0.0003), delayed capillary refill (OR 13.0, 95% CI 2.73-61.78 p = 0.0005), abdominal pain (OR 8.33, 95% CI 1.90-36.44 p = 0.0029), AST (OR 7.5, 95% CI 1.69-33.27 p = 0.005). CONCLUSION: This disease requires early identification of factors that are associated with lethality for timely and adequate treatment.

[Direct costs associated to occupational accidents in Baja California, Mexico]. / Costos directos asociados a riesgos de trabajo en Baja California, México.

BACKGROUND: Occupational accidents represent an important problem that affects workers, families, society, industry, social security institutions and the nation as a whole, which affects directly the global economy. OBJECTIVE: To assess the direct costs of occupational accidents at the Baja California Local Office of the Instituto Mexicano del Seguro Social (IMSS -Mexican Institute for Social Security-) in 2017. MATERIAL AND METHODS: Cross-sectional descriptive study; the information was obtained from IMSS 2017 Statistical Memory and Baja California Local Office database. We analyzed 26,657 cases of work-related accidents and diseases. Years of potential productive life lost were calculated with the years of potential productive life lost indicator and the accumulated years of potential productive life lost indicator. RESULTS: 97,901 certificates of temporary incapacity for work were issued in Baja California with a total amount of 150,284,001 Mexican pesos. 1593 permanent disabilities were granted with an average monthly amount of 3830 pesos and a total of 8982 accumulated years of potential productive life lost. 38 death certificates by work-related risks were issued and accounted for a total of 1048 years of potential productive life lost and 182 491 pesos for funeral expenses. CONCLUSIONS: Direct costs of occupational accidents and diseases in the Baja California Local Office of IMSS have an impact on economic growth. Concerted efforts are needed to achieve a progressive reduction of work-related fatalities, accidents and diseases.

INTRODUCCIÓN: los riesgos de trabajo constituyen un problema importante que repercute en el trabajador, su familia, la sociedad, el sector industrial, instituciones de seguridad social y la nación, lo que afecta directamente a la economía global. OBJETIVO: evaluar los costos directos asociados a riesgos de trabajo en la Delegación Baja California del Instituto Mexicano del Seguro Social (IMSS) en el año 2017. MATERIAL Y MÉTODOS: estudio descriptivo transversal para el que se consultó la base de datos de la Delegación Baja California del IMSS y la memoria estadística del 2017. Se extrajo y se analizó la información de 26 657 riesgos de trabajo. Se determinaron los años laborales perdidos mediante el indicador de años de vida productiva potencial perdidos (AVPPP) y el indicador de años acumulados de vida productiva potencial perdidos (AAVPPP). RESULTADOS: en Baja California se expidieron 97 901 certificados de incapacidad temporal para el trabajo con un importe total de 150 284 001 pesos mexicanos. Se otorgaron 1593 incapacidades permanentes con una cuantía mensual promedio de 3830 pesos y un total de 8982 AAVPPP. Se realizaron 38 dictámenes de defunción por riesgos de trabajo y se estimaron un total de 182 491 pesos en ayudas para gastos funerarios y 1048 AVPPP. CONCLUSIONES: los costos directos asociados a riesgos de trabajo en la Delegación Baja California del IMSS son altos, repercuten fuertemente en el sector industrial y aumentan el gasto público en salud. Se necesita de esfuerzos concertados para lograr una reducción progresiva de los riesgos de trabajo.

Respiratory viruses detected in Mexican children younger than 5 years old with community-acquired pneumonia: a national multicenter study.

BACKGROUND: Acute respiratory infections are the leading cause of mortality in children worldwide, especially in developing countries. Pneumonia accounts for 16% of all deaths of children under 5 years of age and was the cause of death of 935000 children in 2015. Despite its frequency and severity, information regarding its etiology is limited. The aim of this study was to identify respiratory viruses associated with community-acquired pneumonia (CAP) in children younger than 5 years old. METHODS: One thousand four hundred and four children younger than 5 years of age with a clinical and/or radiological diagnosis of CAP in 11 hospitals in Mexico were included. Nasal washes were collected, placed in viral medium, and frozen at -70°C until processing. The first 832 samples were processed using the multiplex Bio-Plex/Luminex system and the remaining 572 samples using the Anyplex multiplex RT-PCR. Clinical data regarding diagnosis, clinical signs and symptoms, radiographic pattern, and risk factors were obtained and recorded. RESULTS: Of the samples tested, 81.6% were positive for viruses. Respiratory syncytial virus (types A and B) was found in 23.7%, human enterovirus/rhinovirus in 16.6%, metapneumovirus in 5.7%, parainfluenza virus (types 1-4) in 5.5%, influenza virus (types A and B) in 3.6%, adenovirus in 2.2%, coronavirus (NL63, OC43, 229E, and HKU1) in 2.2%, and bocavirus in 0.4%. Co-infection with two or more viruses was present in 22.1%; 18.4% of the samples were negative. Using biomass for cooking, daycare attendance, absence of breastfeeding, and co-infections were found to be statistically significant risk factors for the presence of severe pneumonia. CONCLUSIONS: Respiratory syncytial virus (types A and B), human enterovirus/rhinovirus, and metapneumovirus were the respiratory viruses identified most frequently in children younger than 5 years old with CAP. Co-infection was present in an important proportion of the children.

[Cytomegalovirus: congenital infection and clinical presentation in infants with respiratory distress syndrome]. / Citomegalovirus: infección congénita y presentacion clínica en recién nacidos con síndrome de dificultad respiratoria.

BACKGROUND: Respiratory distress syndrome (RDS) is a multifactorial and common disease that varies from 15 to 50 % in the newborn, causing 50 % of mortality. The RDS may be associated with bacterial and viral infections, and one of the most common viral agents is the cytomegalovirus (CMV). In the neonatal period the virus incidence goes from 0.4 to 2.5 % with a seroprevalence of 50 to 75 %; the incidence of infection in newborn with RDS is unknown. The objective was to determine the frequency of CMV infection in neonates with RDS and identify the risk factors associated with infection. METHODS: The CMV-DNA was identified in plasma by quantitative PCR; maternal and neonatal variables that defined the clinical findings were analyzed by logistic regression.The CMV-DNA was identified in plasma by quantitative PCR; maternal and neonatal variables that defined the clinical findings were analyzed by logistic regression. RESULTS: The frequency of CMV infection in 197 infants with RDS was 8.6 % (95 % CI, 4.7-12.5). The significant variables in newborn were: neutropenia (p = 0.012), thrombocytopenia (p = 0.021), mottled skin (p = 0.03), and the maternal significant variable was cervicovaginitis (p = 0.05). CONCLUSIONS: We reported for the first time the highest frecuency of CMV infection in newborns with RDS and the association of various risk factors with CMV infection.

Introducción: el síndrome de dificultad respiratoria (SDR) es una enfermedad común multifactorial que varía del 15 al 50 % en el recién nacido (RN), y la mortalidad es de 50 %. Puede estar asociado a infecciones bacterianas y virales, una de las más frecuentes: el citomegalovirus (CMV). En el periodo neonatal la incidencia de infección por CMV es de 0.4 a 2.5 % y la seroprevalencia de 50 a 75 %; se desconoce la incidencia de infección en los RN. El objetivo fue determinar la frecuencia de infección por CMV en recién nacidos con SDR e identificar factores de riesgo asociados a infección. Métodos: el DNA-CMV fue identificado en plasma por reacción en cadena de la polimerasa (PCR) cuantitativa, y las variables maternas y neonatales que definieron el cuadro clínico fueron analizadas por regresión logística. Resultados: la frecuencia de infección por CMV en 197 RN con SDR fue de 8.6 % (IC 95 % 4.7-12.5). Las variables significativas en los RN fueron: neutropenia (p = 0.012), trombocitopenia (p = 0.021), piel marmórea (p = 0.03) y la variable materna significativa fue cervicovaginitis (p = 0.05). Conclusiones: se reporta por primera vez la frecuencia más alta de infección por CMV en RN con SDR y la asociación de varios factores de riesgo con la infección por CMV.

[Relationship of food groups intake and C-reactive protein in healthy adults from Mexicali, Baja California, México]. / Relación de la ingesta de grupos de alimentos con la proteina C-reactiva en adultos sanos en la ciudad de Mexicali, Baja California, méxico.

The high sensitivity C-reactive protein (hs-CRP) is an important biomarker in inflammatory processes. The objective was to analyze the relationship between the concentrations of hs-CRP in adults from a northern Mexico region with their typical food intake patterns. A sample of 72 university professors underwent clinical and anthropometric assessments and their hs-CRP levels were quantified with an immunoenzymometric assay. Additionally, they filled out a food intake frequency questionnaire, from which the servings of different food groups were obtained with the ESHA software. The average age of participants was 49.75 +/- 10.05 years and the average hs-CRP concentration was 1.66 (0.97, 3.52) mg/L. The value of the association between fruit consumption and hs-CRP level was protective, according to the logistic regression analysis, being the Odds Ratio (OR) 0.23 (95% CI: 0.05, 1.03); while for vegetables the OR was 0.66 (95% CI: 0.12, 3.68). Furthermore, high protein content foods, dairy products, oils and fats were associated with elevated levels of hs-CRP. In conclusion, in our study, the intake of some food groups like fruits and vegetables, and to a lesser extent cereals, were associated with low values of hs-PCR.

Relación de la ingesta de grupos de alimentos con la proteína C-reactiva en adultos sanos en la ciudad de Mexicali, Baja California, México / Relationship of food groups intake and C-reactive protein in healthy adults from Mexicali, Baja California, México

La proteína C-reactiva ultrasensible (PCR-us) es un biomarcador importante en procesos inflamatorios. El objetivo del estudio fue examinar la relación entre la concentración de la PCR-us de adultos aparentemente sanos, con su patrón alimentario característico del norte de México. A una muestra de 72 profesores universitarios se les realizó una valoración clínica y antropométrica y se les cuantificó la PCR-us con un ensayo inmunoenzimométrico (EIA). Los profesores además contestaron un cuestionario de frecuencia de consumo de alimentos, del cual se estimaron las raciones de grupos de alimentos con el programa ESHA. La edad promedio de los participantes fue 49,75 ±10,05 años y la concentración de PCR-us tuvo un promedio de 1,66 (0,97 a 3,52) mg/L. La magnitud de la asociación entre el consumo de frutas y el nivel de PCR-us fue protectora de acuerdo con el análisis de regresión logística cuya Razón de Momios (RM) fue de 0,23 (95% IC: 0,05 a 1,03), mientras que para los vegetales la RM fue de 0,66 (95% IC: 0,12 a 3,68). Por otro lado, los alimentos proteicos, lácteos, aceites y grasas se asociaron con niveles elevados de la PCR-us. En conclusión, la menor concentración de la PCR-us se asoció con la mayor ingesta de los grupos de frutas y vegetales, y en menor grado con los cereales.

The high sensitivity C-reactive protein (hs-CRP) is an important biomarker in inflammatory processes. The objective was to analyze the relationship between the concentrations of hs-CRP in adults from a northern Mexico region with their typical food intake patterns. A sample of 72 university professors underwent clinical and anthropometric assessments and their hs-CRP levels were quantified with an immunoenzymometric assay. Additionally, they filled out a food intake frequency questionnaire, from which the servings of different food groups were obtained with the ESHA software. The average age of participants was 49.75 ± 10.05 years and the average hs-CRP concentration was 1.66 (0.97, 3.52) mg/L. The value of the association between fruit consumption and hs-CRP level was protective, according to the logistic regression analysis, being the Odds Ratio (OR) 0.23 (95% CI: 0.05, 1.03); while for vegetables the OR was 0.66 (95% CI: 0.12, 3.68). Furthermore, high protein content foods, dairy products, oils and fats were associated with elevated levels of hs-CRP. In conclusion, in our study, the intake of some food groups like fruits and vegetables, and to a lesser extent cereals, were associated with low values of hs-PCR.

[Preeclampsia: main maternal risk factor for low weight in preterm newborn]. / Preeclampsia: principal factor de riesgo materno para bajo peso del recién nacido pretérmino.

BACKGROUND: In 3 to 8% of pregnancies there are preeclampsia, and it is considered an irreversible disease that affects several organs, and causes injuries in fetus and mother alike. OBJECTIVE: To identify maternal risk factors related to low birth weight in preterm newborns born at Hospital de Ginecología-Pediatría con Medicina Familiar no. 31 from IMSS, at Mexicali, BC, Mexico. PATIENTS AND METHOD: Case-control study (1:2 ratio) made in 114 prematures (38 cases and 76 controls) who were evaluated for socioeconomic and biological maternal risk factors influencing low birth weight in preterm newborns. Odds ratio and confidence intervals of 95% were used to calculate epidemiologic correlation, and logistic regression to specific importance of risks. RESULTS: Preeclampsia persists as a risk factor for low birth weight: OR 3.16 (95% CI 3.15-8.40, p = 0.00). In logistic regression meaningful variables were: preeclampsia 5.27 (95% CI 1.45-19.14, p = 0.01), and in premature newborn: thrombocytopenia 6.0 (95% CI 1.2-11.2, p = 0.00), and neonatal sepsis 4.31 (95% CI 1.73-10.70, p = 0.00). CONCLUSIONS: Preeclampsia was the major risk factor related to low birth weight and was associated with thrombocytopenia in preterm newborn. Neonatal sepsis is secondary to low birth weight. We need to observe and obey prenatal care of pregnant women in our hospital to reduce negative impact of low birth weight in preterm newborns.

Genotype and phenotype of NAT2 and the occurrence of adverse drug reactions in Mexican individuals to an isoniazid-based prophylactic chemotherapy for tuberculosis.

Isoniazid (INH) is a drug extensively used as a prophylactic and therapeutic agent for human tuberculosis (TB). INH is metabolized by the enzymatic activity of N-acetyltransferase 2 (NAT2). Human NAT2, encoded by a highly polymorphic gene, is involved in the biotransformation of xenobiotics, including drugs and certain chemical carcinogens. Numerous studies have established the correlation between the acetylator phenotype and the NAT2 genotype in several populations; however, little is known regarding Latin-American populations and the pharmacogenetics of NAT2. Here, we report the molecular genotyping of the NAT2 gene, the acetylator phenotype, and the incidence of INH-related adverse reactions in a group of 25 Mexican individuals enrolled in a prophylactic protocol for TB. Using both the NAT2 genotyping and acetylation phenotyping approach, we found a ratio of 69.2 and 30.8% of slow and fast acetylators, respectively. Concordance of the NAT2 genotype and phenotype classification was 88% in the bimodal model. Regarding INH-related adverse reactions, only 2 individuals (8%) exhibited declared gastric intolerance. In our study group, we found an association between the NAT2 genotype and acetylator phenotype (OR=7.78, 95% CI, 0.87-87.98, Fisher's exact test, p<0.05), but did not find any genotype or phenotype association with the incidence of INH-related adverse reactions (Fisher's exact test, p>0.05).

Factores de riesgo asociados a morbilidad en hijos de adictos a drogas ilícitas en un hospital de segundo nivel de atención a la salud / Morbility-associated risk factors of infants with drug addict parents

Introducción. La drogadicción en Baja California se ha incrementado, afecta ambos sexos, independientemente de la edad, estado sociocultural o económico. Alteraciones del crecimiento y desarrollo, muerte súbita y maltrato en el niño se asocian con este problema. Objetivo: conocer los factores de riesgo asociados a la morbilidad observada en lactantes que ingresan al Hospital General de Mexicali, hijos de adictos a drogas. Material y métodos. Treinta y siete casos (uso de drogas en uno o ambos padres) y 33 controles fueron evaluados, se analizaron características demográficas, socioculturales, tipo de drogas y estado de salud de los padres; en los niños se evaluó parámetros de crecimiento, enfermedades motivo de ingreso, estancia hospitalaria, condición y destino al egreso. Resultados. La frecuencia de padres adictos fue de 6.3 por cada 100 ingresos al servicio; 38.1 por ciento de hijos de adictos vs 18.2 por ciento de los controles presentaron peso menor al percentil 5 para la edad (razón de momios [RM] 7.86, intervalo de confianza al 95 por ciento [IC95 por ciento] 0.84-10.12, P=0.05), la talla se afectó 3.83 veces más en los casos (IC95 por ciento 0.96-16.53, P=0.03). Desnutrición (RM 3.7, IC95 por ciento 0.55-28.1, P<0.05), diarrea crónica (21.6 vs 6 por ciento, P<0.05), candidiosis, síndrome de inmunodeficiencia adquirida y hepatitis B fueron las entidades presentes en los hijos de consumidores de droga, ocurriendo 2 defunciones en el mismo grupo; 2.7 por ciento de los niños de padres adictos egresó bajo custodia de la Procuraduría de Defensa del Menor. Hubo desintegración familiar en 44 por ciento de los usuarios vs 9.1 por ciento. La droga más utilizada por los padres fue cocaína (27 por ciento) y de 10 mujeres consumidoras de droga 60 por ciento utilizó heroína; un hecho común fue el uso de múltiples drogas.Conclusiones. La principal repercusión de este problema fue sobre el crecimiento y estado nutricional de los lactantes, consecuencia de posible negligencia en el cuidado y alimentación, mayor riesgo de enfermedad, maltrato o deprivación social.