Evaluating Access to Health Care in Mothers and Caregivers of Children under Five Years of Age in Rural Communities of Yucatán, Mexico.

Populations in rural communities have more limited access to health care and attention than urban populations. The present study aimed to evaluate barriers to access to health care in mothers and caregivers of children under five years of age, twelve months after an educational intervention. The study was carried out from February to September 2022, and 472 mothers from eight communities in the state of Yucatán, in the southeast of the United Mexican States, participated. A comparative analysis was carried out on help-seeking times, obstacles to reaching it, and illnesses in children. The results revealed that the main barriers to access to care were long times to decide to seek help, lack of financial resources to pay for the transfer to another health unit, lack of someone to accompany the mother or caregiver when the child needed be transferred, and lack of transportation for the transfer. Disease knowledge remained at different levels in the eight communities; the significant differences occurred in four communities, one specifically for heart defects. It was concluded that, in the rural populations studied, there are barriers to access to health care which have to do with neglected social determinants, such as those related to conditions of gender, income, social support network, and the health system. Access to health care must be universal, so public health interventions should be aimed at reducing the barriers that prevent the population from demanding and using services in a timely manner.

Protective efficacy of the oral vaccine Tc24:Co1 produced in Schizochytrium sp. against Trypanosoma cruzi infection in a mouse model.

Trypanosoma cruzi parasite - causal Chagas disease agent - affects about 7 million people; no vaccine is available, and current medications have not been entirely effective. Multidisciplinary efforts are necessary for developing clinical vaccine prototypes. Thus, this research study aims to assess the expressed and whole-cell administration protection of the oral vaccine prototype Tc24:Co1 using Schizochytrium sp. microalga. High recombinant protein expression yields (675 µg/L) of algal culture were obtained. Additionally, Schizochytrium sp.-Tc24:Co1 resulted stable at 4 °C for up to six months and at 25 °C for three months. After receiving four oral doses of the vaccine, the mice showed a significant humoral immune response and a parasitemia reduction associated with a lack of heart inflammatory damage compared with the unvaccinated controls. The Schizochytrium sp.-Tc24:Co1 vaccine demonstrates to be promising as a prototype for further development showing protective effects against a T. cruzi challenge in a mouse model.

Trypanosoma cruzi Tc24 Antigen Expressed and Orally Delivered by Schizochytrium sp. Microalga is Immunogenic in Mice.

Chagas disease-caused by the parasite Trypanosoma cruzi-is a neglected tropical disease for which available drugs are not fully effective in the chronic stage and a vaccine is not available yet. Microalgae represent a promising platform for the production and oral delivery of low-cost vaccines. Herein, we report a vaccine prototype against T. cruzi produced in a microalgae platform, based on the candidate antigen Tc24 with a C terminus fusion with the Co1 peptide (Tc24:Co1 vaccine prototype). After modeling the tertiary structure, in silico studies suggested that the chimeric protein is antigenic, not allergenic, and molecular docking indicated binding with Toll-like receptors 2 and 4. Thus, Tc24:Co1 was expressed in the marine microalga Schizochytrium sp., and Western blot confirmed the expression at 48 h after induction, with a yield of 632 µg/L of algal culture (300 µg/g of lyophilized algal cells) as measured by the enzyme-linked immunosorbent assay (ELISA). Upon oral administration of whole-cell Schizochytrium sp. expressing Tc24:Co1 (7.5 µg or 15 µg of Tc24:Co1 doses) in mice, specific serum IgG and intestinal mucosa IgA responses were detected in addition to an increase in serum Th1/Th2 cytokines. In conclusion, Schizochytrium sp.-expressing Tc24:Co1 is a promising oral vaccine prototype to be evaluated in an animal model of Trypanosoma cruzi infection.

Immune Evaluation of Avian Influenza Virus HAr Protein Expressed in Dunaliella salina in the Mucosa of Chicken.

Avian influenza (AI) is a serious threat to the poultry industry worldwide. Currently, vaccination efforts are based on inactivated, live attenuated, and recombinant vaccines, where the principal focus is on the type of virus hemagglutinin (HA), and the proposed use of recombinant proteins of AI virus (AIV). The use of antigens produced in microalgae is a novel strategy for the induction of an immune response in the mucosal tissue. The capacity of the immune system in poultry, particularly in mucosa, plays an important role in the defense against pathogens. This system depends on a complex relationship between specialized cells and soluble factors, which confer protection against pathogens. Primary lymphoid organs (PLO), as well as lymphocytic aggregates (LA) such as the Harderian gland (HG) and mucosa-associated lymphoid tissue (MALT), actively participate in a local immune response which is mainly secretory IgA (S-IgA). This study demonstrates the usefulness of subunit antigens for the induction of a local and systemic immune response in poultry via ocular application. These findings suggest that a complex protein such as HAr from AIV (H5N2) can successfully induce increased local production of S-IgA and a specific systemic immune response in chickens.

Assessment of the quality of the vital registration system for under-5 mortality in Yucatan, Mexico.

INTRODUCTION: Vital registration is an important element in health information systems which can inform policy and strengthen health systems. Mexico has a well-functioning vital registration system; however, there is still room for improvement, especially for deaths of children under 5. This study assesses the quality of the vital registration system in capturing deaths and evaluates the quality of cause of death certification in under-5 deaths in Yucatan, Mexico. METHODS: We collected information on under-5 deaths that occurred in 2015 and 2016 in Yucatan, Mexico. We calculated the Vital Statistics Performance Index (VSPI) to have a general assessment of the vital registration performance. We examined the agreement between vital registration records and medical records at the individual and population levels using the chance-corrected concordance (CCC) and cause-specific mortality fraction (CSMF) accuracy as quality metrics. RESULTS: We identified 966 records from the vital registry for all under-5 deaths, and 390 were linked to medical records of deaths occurring at public hospitals. The Yucatan vital registration system captured 94.8% of the expected under-5 deaths, with an overall VSPI score of 87.2%. Concordance between underlying cause of death listed in the vital registry and the cause determined by the medical record review varied substantially across causes, with a mean overall chance-corrected concordance across causes of 6.9% for neonates and 46.9% for children. Children had the highest concordance for digestive diseases, and neonates had the highest concordance for meningitis/sepsis. At the population level, the CSMF accuracy for identifying the underlying cause listed was 35.3% for neonates and 67.7% for children. CONCLUSIONS: Although the vital registration system has overall good performance, there are still problems in information about causes of death for children under 5 that are related mostly to certification of the causes of death. The accuracy of information can vary substantially across age groups and causes, with causes reported for neonates being generally less reliable than those for older children. Results highlight the need to implement strategies to improve the certification of causes of death in this population.

Transformation of Dunaliella salina by Agrobacterium tumefaciens for the Expression of the Hemagglutinin of Avian Influenza Virus H5.

Avian influenza (AI) is one of the main threats to the poultry industry worldwide. Vaccination efforts are based on inactivated, live attenuated, and recombinant vaccines, where the virus hemagglutinin (HA) is the main component of any vaccine formulation. This study uses Dunaliella salina to express the AIV HA protein of an H5 virus. D. salina offers a system of feasible culture properties, generally recognized as safe for humans (GRAS), with N-glycosylation and nuclear transformation by Agrobacterium tumefaciens. The cloning and transformation of D. salina cells with the H5HA gene was confirmed by polymerase chain reaction (PCR). SDS-PAGE and Western blot confirmed HA5r protein expression, and the correct expression and biological activity of the HA5r protein were confirmed by a hemagglutination assay (HA). This study proves the feasibility of using a different biological system for expressing complex antigens from viruses. These findings suggest that a complex protein such as HA5r from AIV (H5N2) can be successfully expressed in D. salina.

Plant-Based Vaccines: Antigen Design, Diversity, and Strategies for High Level Production.

Vaccines for human use have conventionally been developed by the production of (1) microbial pathogens in eggs or mammalian cells that are then inactivated, or (2) by the production of pathogen proteins in mammalian and insect cells that are purified for vaccine formulation, as well as, more recently, (3) by using RNA or DNA fragments from pathogens. Another approach for recombinant antigen production in the last three decades has been the use of plants as biofactories. Only have few plant-produced vaccines been evaluated in clinical trials to fight against diseases, of which COVID-19 vaccines are the most recent to be FDA approved. In silico tools have accelerated vaccine design, which, combined with transitory antigen expression in plants, has led to the testing of promising prototypes in pre-clinical and clinical trials. Therefore, this review deals with a description of immunoinformatic tools and plant genetic engineering technologies used for antigen design (virus-like particles (VLP), subunit vaccines, VLP chimeras) and the main strategies for high antigen production levels. These key topics for plant-made vaccine development are discussed and perspectives are provided.

Impact of the Salud Mesoamerica Initiative on delivery care choices in Guatemala, Honduras, and Nicaragua.

BACKGROUND: The Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. We assess the impact of SMI on the staffing and availability of equipment and supplies for delivery care, the proportion of institutional deliveries, and the proportion of women who choose a facility other than the one closest to their locality of residence for delivery. METHODS: We used a quasi-experimental design, including baseline and follow-up measurements between 2013 and 2018 in intervention and comparison areas of Guatemala, Nicaragua, and Honduras. We collected information on 8754 births linked to the health facility closest to the mother's locality of residence and the facility where the delivery took place (if attended in a health facility). We fit difference-in-difference models, adjusting for women's characteristics (age, parity, education), household characteristics, exposure to health promotion interventions, health facility level, and country. RESULTS: Equipment, inputs, and staffing of facilities improved after the Initiative in both intervention and comparison areas. After adjustment for covariates, institutional delivery increased between baseline and follow-up by 3.1 percentage points (ß = 0.031, 95% CI -0.03, 0.09) more in intervention areas than in comparison areas. The proportion of women in intervention areas who chose a facility other than their closest one to attend the delivery decreased between baseline and follow-up by 13 percentage points (ß = - 0.130, 95% CI -0.23, - 0.03) more than in the comparison group. CONCLUSIONS: Results indicate that women in intervention areas of SMI are more likely to go to their closest facility to attend delivery after the Initiative has improved facilities' capacity, suggesting that results-based aid initiatives targeting poor populations, like SMI, can increase the use of facilities closest to the place of residence for delivery care services. This should be considered in the design of interventions after the COVID-19 pandemic may have changed health and social conditions.

Epidemiología de la hipertensión arterial en adultos mexicanos: diagnóstico, control y tendencias. Ensanut 2020 / Epidemiology of hypertension in Mexican adults: diagnosis, control and trends. Ensanut 2020

Resumen: Objetivo: Describir la prevalencia de hipertensión arterial (HTA) en adultos mexicanos, la proporción que tiene tensión arterial (TA) controlada y la tendencia en el periodo 2018-2020. Material y métodos: Se midió la TA a 9 844 adultos en la Encuesta Nacional de Salud y Nutrición (Ensanut) 2020. Se consideró que tenían HTA o TA controlada cuando cumplían los criterios del Seventh Joint National Committee (JNC-7) o American Heart Association (AHA). Resultados: La prevalencia de HTA fue 49.4% (según AHA), de los cuales 70% desconocía su diagnóstico. Según la clasificación JNC-7 30.2% de los adultos tenía HTA y 51.0% ignoraba su diagnóstico. Entre adultos con diagnóstico previo de HTA, 54.9% tuvo TA controlada. Entre el periodo 2018-2020 no se observaron cambios en las prevalencias. Conclusiones: Al menos un tercio de los adultos mexicanos tiene HTA y de ellos al menos la mitad no habían sido diagnosticados. Debe evaluarse la pertinencia de los actuales programas de diagnóstico de HTA porque el subdiagnóstico y mal control pueden ocasionar complicaciones y la muerte.

Abstract: Objective: To describe the prevalence of hypertension in Mexican adults, the proportion with controlled blood pressure (BP), and the trend in the 2018-2020 period. Materials and methods: BP was measured in 9 844 adults who participated in the National Health and Nutrition Survey (Ensanut, in Spanish) 2020. They were considered to have hypertension or BP controlled when adults met the Seventh Joint National Committee (JNC-7) or American Heart Association (AHA) criteria. Results: The prevalence of hypertension was 49.4% (according to AHA), of which 70.0% were unaware of their diagnosis. When using JNC-7 criteria, 30.2% of the adults had hypertension and 51.0% were unaware of your diagnosis. Among adults with a previous diagnosis of hypertension, 54.9% had controlled BP. Between the 2018-2020 period, no changes in prevalences were observed. Conclusions: At least a third of Mexican adults have hypertension and of them, at least half have not been diagnosed. The relevance of current hypertension diagnostic programs should be evaluated because underdiagnosis and poor control can lead to complications and death.

Infección por Helicobacter pylori y factores asociados en adultos con sospecha clínica de úlcera duodenal / Helicobacter pylori infection and associated factors in adults with a clinical suspicion of duodenal ulcer

RESUMEN Introducción: la infección por Helicobacter pylori es la enfermedad bacteriana crónica que afecta con mayor prevalencia al ser humano. Objetivo: identificar la frecuencia de infección por Helicobacter pylori y su relación con variables consideradas factores de riesgo de esta infección. Materiales y métodos: estudio de corte transversal realizado en el Policlínico Docente Camilo Cienfuegos, del municipio Habana del Este, durante el año 2018, en un universo de 42 pacientes con 18 años y más de edad, con sospecha clínica y hallazgo endoscópico de úlcera duodenal e informe del resultado de estudio histológico para el diagnóstico de la infección. Se confeccionó una planilla de recolección de datos que incluyó variables como hacinamiento, agua de consumo, lugar de nacimiento, estancia en una institución, contacto con animales y antecedentes familiares. Se determinó relación entre variables con la prueba de chi cuadrado (c2) con significación estadística ɒ = 0,05, y se identificaron variables cuyos coeficientes fueron significativamente diferentes de 0 (p < 0,05). La fuerza de asociación se determinó mediante odds ratio. Resultados: la prevalencia fue de 59,5 %. Se encontró asociación estadística y constituyeron factores de riesgo de infección por Helicobacter pylori, el hacinamiento (c2 = 4,37; OR = 3,89), el agua de consumo (c2 = 4,92; OR = 3,43), el contacto con animales (c2 = 7,41; OR = 6,17) y los antecedentes familiares (c2 = 13,18; OR = 13). Conclusiones: el estudio permitió determinar la prevalencia de infección por Helicobacter pylori y las principales variables asociadas, coincidiendo con otros estudios revisados que tratan el tema (AU).

ABSTRACT Introduction: the infection by Helicobacter pylori is the chronic bacterial disease that affects the human being with greater prevalence. Objective: to identify the frequency of the infection by Helicobacter pylori and its relationship with variables considered risk factors for this infection. Materials and methods: a cross-sectional study was carried out in the teaching Polyclinic Camilo Cienfuegos, municipality Habana del Este, during 2018. In a universe of 42 patients aged 18 years and over, with clinical suspicion and endoscopic diagnosis of duodenal ulcer and histological study report for the diagnosis of the infection. A data collection form was made, which included variables such as: overcrowding, consumption water, place of birth, staying in an institution, contact with animals, and family history. The relationship within variables was found using the chi-square test (c2) with statistical significance ɒ = 0.05, and there were identified variables significantly different from 0 (p < 0.05). The association strength was determined through odds ratio. Results: the prevalence was 59.5%. Statistical association was found and overcrowding (c2 = 4.37, OR = 3.89), consumption water (c2 = 4.92; OR = 3.43), contact with animals (c2 = 7.41, OR = 6.17) and family history (c2 = 13.18, OR = 13) were found risk factors for Helicobacter pylori infection. Conclusions: the study allowed to determine the prevalence of Helicobacter pylori infection and the main associated variables, coinciding with other reviewed studies dealing with the subject (AU).

Performance of passive case detection for malaria surveillance: results from nine countries in Mesoamerica and the Dominican Republic.

BACKGROUND: In malaria elimination settings, available metrics for malaria surveillance have been insufficient to measure the performance of passive case detection adequately. An indicator for malaria suspected cases with malaria test (MSCT) is proposed to measure the rate of testing on persons presenting to health facilities who satisfy the definition of a suspected malaria case. This metric does not rely on prior knowledge of fever prevalence, seasonality, or external denominators, and can be used to compare detection rates in suspected cases within and between countries, including across settings with different levels of transmission. METHODS: To compute the MSCT, an operational definition for suspected malaria cases was established, including clinical and epidemiological criteria. In general, suspected cases included: (1) persons with fever detected in areas with active malaria transmission; (2) persons with fever identified in areas with no active transmission and travel history to, or residence in areas with active transmission (either national or international); and (3) persons presenting with fever, chills and sweating from any area. Data was collected from 9 countries: Belize, Colombia (in areas with active transmission), Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, and Panama (September-March 2020). A sample of eligible medical records for 2018 was selected from a sample of health facilities in each country. An algorithm was constructed to assess if a malaria test was ordered or performed for cases that met the suspected case definition. RESULTS: A sample of 5873 suspected malaria cases was obtained from 239 health facilities. Except for Nicaragua and Colombia, malaria tests were requested in less than 10% of all cases. More cases were tested in areas with active transmission than areas without cases. Travel history was not systematically recorded in any country. CONCLUSIONS: A statistically comparable, replicable, and standardized metric was proposed to measure suspected malaria cases with a test (microscopy or rapid diagnostic test) that enables assessing the performance of passive case detection. Cross-country findings have important implications for malaria and infectious disease surveillance, which should be promptly addressed as countries progress towards malaria elimination. Local and easy-to-implement tools could be implemented to assess and improve passive case detection.

Two strains of a novel begomovirus encoding Rep proteins with identical ß1 strands but different ß5 strands are not compatible in replication.

Geminiviruses have genomes composed of single-stranded DNA molecules and encode a rolling-circle replication (RCR) initiation protein ("Rep"), which has multiple functions. Rep binds to specific repeated DNA motifs ("iterons"), which are major determinants of virus-specific replication. The particular amino acid (aa) residues that determine the preference of a geminivirus Rep for specific iterons (i.e., the trans-acting replication "specificity determinants", or SPDs) are largely unknown, but diverse lines of evidence indicate that most of them are closely associated with the so-called RCR motif I (FLTYP), located in the first 12-19 aa residues of the protein. In this work, we characterized two strains of a novel begomovirus, rhynchosia golden mosaic Sinaloa virus (RhGMSV), that were incompatible in replication in pseudorecombination experiments. Systematic comparisons of the Rep proteins of both RhGMSV strains in the DNA-binding domain allowed the aa residues at positions 71 and 74 to be identified as the residues most likely to be responsible for differences in replication specificity. Residue 71 is part of the ß-5 strand structural element, which was predicted in previous studies to contain Rep SPDs. Since the Rep proteins encoded by both RhGMSV strains are identical in their first 24 aa residues, where other studies have mapped potential SPDs, this is the first study lending direct support to the notion that geminivirus Rep proteins contain separate SPDs in their N-terminal domain.

Caracterización clínico epidemiológica de la infección por Helicobacter pylori en pacientes con úlcera péptica / Clinical-Epidemiological Characterization of Helicobacter pylori Infection in Patients with Peptic Ulcer

Introducción: La infección por H. pylori es considerada como la enfermedad bacteriana crónica más prevalente en el ser humano, pues infecta a más del 50 por ciento de la población mundial. Objetivo: Describir las características clínico epidemiológicas de la infección por H. pylori en pacientes con diagnóstico endoscópico de úlcera péptica. Métodos: Estudio descriptivo realizado en el Policlínico Camilo Cienfuegos; durante el año 2018, en 42 pacientes de 18 y más años, con diagnóstico endoscópico de úlcera péptica e informe del resultado de estudio histológico para el diagnóstico de infección por H. pylori. Se revisaron las historias clínicas y se confeccionó una planilla de recolección de datos que incluyó las variables: grupo de edades, sexo, manifestaciones clínicas, tipo de úlcera, número de lesiones, úlcera activa y metaplasia intestinal. Se utilizó la media y la desviación estándar (DE) y se identificaron los límites de clases superior e inferior. Se calcularon los porcentajes con IC = 95 por ciento. Se estimó la prevalencia general y específica de infección por H. pylori por grupo de edades y sexo. Resultados: El promedio de edad fue de 46,7 años ± 12,02 años. La prevalencia fue de 59,5 por ciento, superior en mayores de 65 años y en hombres. Conclusiones: El estudio permitió describir las características clínico epidemiológicas de la infección por H. pylori en pacientes con diagnóstico endoscópico de úlcera péptica. Fue más frecuente la presencia de síndrome dispéptico, con una única úlcera duodenal en fase activa y sin metaplasia intestinal(AU)

Introduction: Helicobacter pylori infection is considered the chronic bacterial disease most prevalent in humans, since it infects more than 50% of the world population. Objective: To describe the clinical-epidemiological characteristics of H. pylori infection in patients with an endoscopic diagnosis of peptic ulcer. Methods: Descriptive study carried out at Camilo Cienfuegos Polyclinic, during 2018. The study included 42 patients aged 18 and over who had an endoscopic diagnosis of peptic ulcer and a histological study result positive for H. pylori infection. The medical records were reviewed and a data collection form was prepared, which included the following variables: age group, sex, clinical manifestations, type of ulcer, number of lesions, active ulcer, and intestinal metaplasia. The mean and standard deviation (SD) were used, and the upper and lower class limits were identified. The percentages were calculated, with confidence interval at 95 percent. The general and specific prevalence of H. pylori infection was estimated by age group and sex. Results: The mean age was 46.7 years ± 12.02 years. The prevalence was 59.5 percent, higher among those over 65 years of age and among men. Conclusions: The study permitted to describe the clinical-epidemiological characteristics of H. pylori infection in patients with an endoscopic diagnosis of peptic ulcer. The presence of dyspeptic syndrome was more frequent, with a single duodenal ulcer in the active phase and no intestinal metaplasia(AU)

Characterizing a two-pronged epidemic in Mexico of non-communicable diseases and SARS-Cov-2: factors associated with increased case-fatality rates.

BACKGROUND: People with a previous diagnosis of non-communicable diseases (NCDs) are more likely to develop serious forms of COVID-19 or die. Mexico is the country with the fourth highest fatality rate from SARS-Cov-2, with high mortality in younger adults. OBJECTIVES: To describe and characterize the association of NCDs with the case-fatality rate (CFR) adjusted by age and sex in Mexican adults with a positive diagnosis for SARS-Cov-2. METHODS: We studied Mexican adults aged ≥20 years who tested positive for SARS-Cov-2 during the period from 28 February to 31 July 2020. The CFR was calculated and associations with history of NCDs (number of diseases and combinations), severity indicators and type of institution that treated the patient were explored. The relative risk (RR) of death was estimated using Poisson models and CFR was adjusted using logistic models. RESULTS: We analysed 406 966 SARS-Cov-2-positive adults. The CFR was 11.2% (13.7% in men and 8.4% in women). The CFR was positively associated with age and number of NCDs (p trend <0.001). The number of NCDs increased the risk of death in younger adults when they presented three or more NCDs compared with those who did not have any NCDs [RR, 46.6; 95% confidence interval (CI), 28.2, 76.9 for women; RR, 16.5; 95% CI, 9.9, 27.3 for men]. Lastly, there was great heterogeneity in the CFR by institution, from 4.6% in private institutions to 18.9% in public institutions. CONCLUSION: In younger adults, higher CFRs were associated with the total number of NCDs and some combinations of type 2 diabetes, chronic kidney disease, chronic obstructive pulmonary disease and cardiovascular disease.

Increased removal of cadmium by Chlamydomonas reinhardtii modified with a synthetic gene for γ-glutamylcysteine synthetase.

Bioremediation with genetically modified microalgae is becoming an alternative to remove metalloids and metals such as cadmium, a contaminant produced in industrial processes and found in domestic waste. Its removal is important in several countries including Mexico, where the San Luis Potosi region has elevated levels of it. We generated a construct with a synthetic gene for γ-glutamylcysteine synthetase and employed it in the chloroplast transformation of Chlamydomonas reinhardtii. In dose-response kinetics with media containing from 1 to 20 mg/L of cadmium, both the transplastomic clone and the wild-type strain grew similarly, but the former removed up to 32% more cadmium. While the growth of both decreased with higher concentrations of cadmium, the transplastomic clone removed 20 ± 9% more than the wild-type strain. Compared to the wild-type strain, in the transplastomic clone the activity of glutathione S-transferase and the intracellular glutathione increased up to 2.1 and 1.9 times, respectively, in media with 2.5 and 10 mg/mL of cadmium. While 20 mg/L of cadmium inhibited the growth of both, the transplastomic clone gradually duplicated. These results confirm the expression of the synthetic gene gshA in the transformed strain as revealed in its increased removal uptake and metabolic response.

Evaluation of acute and chronic exposure to aflatoxin B1 in indigenous women of the Huasteca Potosina, Mexico.

Aflatoxin B1 (AFB1) is one of the most studied mycotoxins due to its high occurrence in food and its hepatotoxic, immunosuppressive, carcinogenic, childhood growth, genotoxic, mutagenic, and teratogenic effects in humans and animals. Exposure to AFB1 is reported to be both, acute and chronic; the main exposure pathway to AFB1 is through the intake of contaminated food. In Mexico, although the reports of several studies addressing the problem of aflatoxins in maize and other foods, the evidence has been centered on exposure to AFB1 and to the quantification of the Aflatoxins themselves, but there is null evidence about genotoxic effects of aflatoxins in vulnerable populations. Therefore, this study focused on assessing chronic AFB1 exposure through the AFB1-lys biomarker adduct and acute exposure through total AFB1-DNA adducts in women from a rural indigenous community in the Huasteca Potosina (Mexico). A hundred percent of the studied population presented total AFB1-DNA and AFB1-lys adducts in concentrations of 1.08 (0.48-1.34) µmol of adduct/mol of DNA and 2.33 (1.08-102.6) pg/mg of albumin respectively (median (min-max)). Thus, continuous monitoring and important changes in regulations are desired and recommended. The results in this study provide enough evidence to support the toxic effects that the exposure to AFB1 represents, as well as the population risk that it poses, and in the same sense, the current need to create an intervention program that directly influences the control of the sources of exposure in order to reduce it.

Assessing multidimensional care coverage for pre-eclampsia in the era of universal health coverage: A pre-post evaluation of the Salud Mesoamérica Initiative.

OBJECTIVE: To compare a multidimensional care package for pre-eclampsia/eclampsia in Central American health facilities, before and after implementation of the Salud Mesoamérica Initiative. METHODS: An evaluation study was conducted at 67 basic- and comprehensive-level health facilities serving the poorest areas in Honduras, Nicaragua, and Belize. Cases of severe pre-eclampsia or eclampsia were randomly sampled and relevant quality of care data extracted from medical records at baseline (n=111) from January 1, 2011, to March 31, 2013, and at second-phase follow-up (n=249) from June 1, 2015, to September 30, 2017. The primary outcome was evidence of the delivery of multidimensional care for the management of pre-eclampsia/eclampsia. RESULTS: The care of 360 women with severe pre-eclampsia or eclampsia was analyzed. Odds of multidimensional care for pre-eclampsia management (P=0.271) increased (although not significantly) in the second-phase follow-up compared to baseline. Multidimensional care was significantly associated with training (P<0.001), basic-level facilities (P<0.001), and higher in Honduras (P=0.001) and Belize (P=0.024) than the reference country of Nicaragua. CONCLUSION: Multidimensional care for pre-eclampsia management increased across all facility types, countries, and severity of disease. The Salud Mesoamérica Initiative is a promising model for achieving such quality of care interventions in the era of universal health coverage.

Utilisation of second-trimester spontaneous and induced abortion services in public hospitals in Mexico, 2007-2015.

BACKGROUND: Data on utilisation of in-facility second-trimester abortion services are sparse. We describe temporal and geographical trends in utilisation of in-facility second-trimester abortion services across Mexico. METHODS: We used 2007-2015 data from Mexico's Automated Hospital Discharge System (SAEH) to identify second-trimester abortive events (ICD O02-O08) in public hospitals across Mexico's 32 states. We described utilisation, calculated rates using population data, and used logistic regression to identify woman- and state-level factors (municipality-level marginalisation, state-level abortion law) associated with utilisation of second-trimester versus first-trimester services. RESULTS: We identified 145 956 second-trimester abortions, or 13.4% of total documented hospitalizations for abortion between 2007 to 2015. The annual utilisation rate of second-trimester abortion remained constant, between 0.5 to 0.6 per 1000 women aged 15-44 years. Women living in highly marginalised municipalities had 1.43 higher odds of utilising abortions services in their second versus their first trimester, when compared with women in municipalities with low marginalisation (95% CI 1.18 to 1.73). Living in a state with a health or fetal anomaly exception to abortion restrictions was not associated with higher utilisation of second-trimester abortion services. CONCLUSIONS: Our results suggest there is a need for all types of second-trimester abortion services in Mexico. To improve health outcomes for Mexican women, especially the most vulnerable, access to safe second-trimester abortion services must be ensured through the implementation of current legal exceptions and renewed attention to the training of healthcare providers.

Analysis of causes of death using verbal autopsies and vital registration in Hidalgo, Mexico.

INTRODUCTION: Verbal autopsy (VA) is a useful tool for evaluating causes of death, especially in places with limited or no vital registration systems. The Population Health Metrics Research Consortium (PHMRC) developed a validated questionnaire and a set of automated methods to determine the cause of death from a VA. However, the application of these methods needs to be tested in a community environment. OBJECTIVE: To estimate cause-specific mortality fractions (CSMFs) using VAs and compare them against those obtained in the vital statistics of the state of Hidalgo, Mexico. METHODS: A random sample of deaths occurred in 2009 was selected from vital statistics in the state of Hidalgo. The full PHMRC validated VA instrument was applied to the relatives of the deceased, and the cause of death was determined using Tariff's automated method. The causes of death were grouped into 34 causes for adults, 21 for children and 6 for newborns. Results were compared with cause of death on death certificates for all deaths. RESULTS: A total of 1,198 VAs were analyzed. The Tariff method was not able to assign a cause of death in only 9% of adults, 2% of children and 7% of neonatal deaths. The CSMFs obtained from the Tariff method were similar in some cases to those of vital statistics (e.g. cirrhosis), but different in others (e.g. sepsis). CONCLUSION: The application of VAs in a community sample, analyzed with the Tariff method, allowed assigning a cause of death to most of the cases, with results similar to those of vital statistics for most conditions. This tool can be useful to strengthen the quality of vital statistics.

Arsenic removal using Chlamydomonas reinhardtii modified with the gene acr3 and enhancement of its performance by decreasing phosphate in the growing media.

Arsenic contamination of groundwater is a significant problem in countries like Mexico, where San Luis Potosi is among the regions registering severe levels of it. Bioremediation with microalgae capable to absorb and metabolize metals or metalloids like arsenic reduces their toxicity and is a cost-effective approach compared to physical-chemical processes. We evaluated the capability of Chlamydomonas reinhardtii to remove arsenate and compared it with an acr3-modified recombinant strain, which we produced by transforming the wild-type strain with Agrobacterium tumefaciens using the construct pARR1 including a synthetic, optimized acr3 gene from Pteris vittata, a hyper-accumulator of arsenic. We monitored the growth of both strains in media with arsenate, containing a standard or a 10-fold decreased amount of phosphate. Comparing both strains in media initially with 0.5, 1, and 1.5 mg/L of arsenate, the acr3-modified strain removed 1.5 to 3 times more arsenic than the wild-type strain. Moreover, the arsenic uptake rate increased 1.2 to 2.3 times when growing the acr3-modified strain in media with decreased phosphate, while the uptake rate for the wild-type strain scarcely changed under the same conditions. These results confirm the expression of the acr3 gene in C. reinhardtii and its potential application to remove arsenic.