National sex- and age-specific burden of blindness and vision impairment by cause in Mexico in 2019: a secondary analysis of the Global Burden of Disease Study 2019.

Background: Reliable national estimations for blindness and vision impairment are fundamental to assessing their burden and developing public health policies. However, no comprehensive analysis is available for Mexico. Therefore, in this observational study we describe the national burden of blindness and vision loss by cause and severity during 2019. Methods: Using public data from the Global Burden of Disease (GBD) study 2019, we present national prevalence and years lived with disability (YLDs) counts and crude and age-standardized rates (per 100,000 people) of total, severity- and cause-specific blindness and vision impairment with 95% uncertainty intervals (UIs) by sex and age group. Findings: In Mexico, the burden of blindness and vision impairment was estimated at 11.01 million (95% UI, 9.25-13.11) prevalent cases and 384.96 thousand (259.57-544.24) YLDs during 2019. Uncorrected presbyopia caused the highest burden (6.06 million cases, 4.36-8.08), whereas severe vision loss and blindness affected 619.40 thousand (539.40-717.73) and 513.84 thousand (450.59-570.98) people, respectively. Near vision loss and refraction disorders caused 78.7% of the cases, whereas neonatal disorders and age-related macular degeneration were among the least frequent. Refraction disorders were the main cause of moderate and severe vision loss (61.44 and 35.43%), and cataracts were the second most frequent cause of blindness (26.73%). Females suffered an overall higher burden of blindness and vision impairment (54.99% and 52.85% of the total cases and YLDs), and people >50 years of age suffered the highest burden, with people between 70 and 74 years being the most affected. Interpretation: Vision loss represents a public health problem in Mexico, with women and older people being the most affected. Although the causes of vision loss contribute differentially to the severity of visual impairment, most of the impairment is avoidable. Consequently, a concerted effort at different levels is needed to alleviate this burden. Funding: This study received no funding.

Incidence, Mortality, and Trends of Prostate Cancer in Mexico from 2000 to 2019: Results from the Global Burden of Disease Study 2019.

In 2019, the Global Burden of Disease (GBD) estimated that prostate cancer (PC) was the 16th most common cause of death globally in males. In Mexico, PC epidemiology has been studied by a number of metrics and over various periods, although without including the most up-to-date estimates. Herein, we describe and compare the burdens and trends of PC in Mexico and its 32 states from 2000 to 2019. For this study, we extracted online available data from the GBD 2019 to estimate the crude and age-standardized rates (ASR per 100,000 people) of the incidence and mortality of PC. In Mexico, PC caused 27.1 thousand (95% uncertainty intervals, 20.6-36.0 thousand) incident cases and 9.2 thousand (7.7-12.7 thousand) deaths in males of all ages in 2019. Among the states, Sinaloa had the greatest ASR of incidence, and Guerrero had the highest mortality. The burden of PC showed an increasing trend, although the magnitude of change differed between metrics and locations. We found both an increasing national trend and subnational variation in the burden of PC. Our results confirm the need for updated and timely estimates to design effective diagnostic and treatment campaigns in locations where the burden of PC is the highest.

Pooled molecular occurrence of Mycoplasma gallisepticum and Mycoplasma synoviae in poultry: A systematic review and meta-analysis.

Worldwide, Mycoplasma gallisepticum (MG) and M. synoviae (MS) are the main agents responsible for chronic respiratory disease in poultry. Therefore, we conducted a systematic review and meta-analysis to estimate their occurrence. We searched electronic databases to find peer-reviewed publications reporting the molecular detection of MG and MS in poultry and used meta-analysis to estimate their pooled global occurrence (combined flock and individual), aggregating results at the regional and national levels. We performed a subgroup meta-analysis for subpopulations (broilers, layers, breeders and diverse poultry including turkeys, ducks and ostriches) and used meta-regression with categorical modifiers. We retrieved 2294 publications from six electronic databases and included 85 publications from 33 countries that reported 62 studies with 22,162 samples for MG and 48 studies with 26,413 samples for MS. The pooled global occurrence was 38.4% (95% CI: 23.5-54.5) for MS and 27.0% (20.4-34.2) for MG. Among regions, Europe and Central Asia had the lowest occurrence for both pathogens, while MG and MS were highly prevalent in South Asia and sub-Saharan Africa, respectively. At the national level, MG occurrence was higher in Algeria, Saudi Arabia and Sudan, whereas China, Egypt and Ethiopia reported higher values of MS. Among the poultry subpopulations, MS and MG were more prevalent in the breeders and layers (62.6% and 31.2%, respectively) than in diverse poultry. The year of publication, the sample size and the level of ambient air pollution (measured indirectly by PM2.5) were associated with the occurrence of both mycoplasmas. Our study revealed high and heterogeneous occurrence values of MG and MS and justifies the need for early detection and improved control measures to reduce the spread of these pathogens.

Prevalence, main serovars and anti-microbial resistance profiles of non-typhoidal Salmonella in poultry samples from the Americas: A systematic review and meta-analysis.

Poultry and poultry-derived products such as meat and eggs are among the main sources of non-typhoidal Salmonella (NTS) transmission to humans. Therefore, we performed a systematic review and used random-effects meta-analyses to (1) estimate the prevalence of NTS in poultry samples from birds, products and subproducts and environmental samples, (2) examine the diversity and frequency of their serovars and (3) estimate the prevalence and profiles of anti-microbial resistance (AMR) in NTS isolates reported in studies from the Americas. We included 157 studies from 15 countries comprising 261,408 poultry samples and estimated an overall pooled prevalence of 17.9% (95% Confidence Interval: 10.8-26.3) in birds, 21.8% (17.7-26.1) in products and subproducts and 29.5% (24.2-35.1) in environmental samples. At the national level, the prevalence of NTS was heterogeneous across countries with the highest values in Mexico, the United States and Canada. In total, 131 serovars were identified from 13,388 isolates; Heidelberg, Kentucky, Enteritidis and Typhimurium were the most prevalent in the overall top 10 ranking (range 6.5%-20.8%). At the national level, Enteritidis and Typhimurium were identified in most of the countries, though with national differences in their ranks. The prevalence of AMR increased from 24.1% for 1 antibiotic to 36.2% for 2-3 antibiotics and 49.6% for ≥ 4 antibiotics. Kentucky, Heidelberg, Typhimurium and Enteritidis were the serovars with the highest prevalence of AMR. Besides, tetracycline, ampicillin, streptomycin, ceftiofur and amoxicillin-clavulanic acid were the most frequent antibiotics to which NTS showed resistance. In conclusion, NTS was distributed through the avian production chain with high and heterogeneous values of prevalence in poultry samples. Besides, there were distinctive patterns of serovars distribution across countries and an alarming prevalence of AMR among zoonotic serovars.

Choque séptico por Mycobacterium tuberculosis / Septic shock due to Mycobacterium tuberculosis

Resumen: La tuberculosis típicamente se considera una enfermedad crónica, aunque puede manifestarse de forma aguda, cuya manifestación se revisa en este caso clínico. La patogenia de la tuberculosis aguda suele estar relacionada con factores epidemiológicos y genéticos del huésped. El choque séptico debido a Mycobacterium tuberculosis es poco frecuente, pero está bien reconocido, se comporta de manera similar al choque séptico bacteriano, conocido como sepsis tuberculosa gravissima. Nuestra paciente ingresó con afectación hemodinámica y diagnóstico de choque séptico que evolucionó a insuficiencia multiorgánica; a pesar del tratamiento antimicrobiano y antituberculoso establecido, falleció a los cinco días del ingreso a la unidad de cuidados intensivos. El espectro de la enfermedad por M. tuberculosis dificulta el diagnóstico, a menos que la sospecha clínica sea alta, pero la alta mortalidad exige su consideración. El inicio temprano del tratamiento es decisivo para optimizar el resultado clínico.

Abstract: Tuberculosis is typically considered a chronic disease, although it can be manifested acutely, whose form is reviewed in this clinical case. The pathogenesis of acute tuberculosis is usually related to epidemiological and genetic factors of the host. Septic shock due to Mycobacterium tuberculosis is rare, but it is well recognized, behaving similarly to bacterial septic shock, known as sepsis tuberculosa gravissima. Our patient was admitted with hemodynamic compromise and diagnosis of septic shock that evolved to multiorganic failure; despite antimicrobial and antituberculous management, patient died five days after admission to the intensive care unit. The spectrum of M. tuberculosis disease makes diagnosis difficult, unless clinical suspicion is high, but high mortality requires consideration. The early start of therapy is decisive to optimize the clinical outcome.

Síndrome de Guillain-Barré concomitante con infección por virus Zika / Guillain-Barre syndrome associated with Zika virus infection

Resumen OBJETIVOS Comunicar una serie de casos de síndrome de Guillain-Barré y describir las características clínicas de una posible asociación con infección previa por virus Zika. MATERIAL Y MÉTODO Estudio descriptivo de serie de casos en el que se recolectaron datos clínicos, bioquímicos y demográficos de los pacientes con síndrome de Guillain-Barré tratados en el Hospital General Acapulco con antecedente reciente de síndrome viral agudo sospechoso de infección por virus Zika, del 24 de julio al 24 de agosto de 2016, con realización de estudio de líquido cefalorraquídeo y comprobación de disociación albúmino-citológica. Se estableció diagnóstico de certeza de síndrome de Guillain-Barré según los criterios de Asbury-Cornblath y Brighton. RESULTADOS Se estudiaron 10 pacientes con síndrome de Guillain-Barré y antecedente reciente de síndrome viral agudo compatible con infección por virus Zika; la edad media de los sujetos en estudio fue de 47.8 años, 4 eran hombres. Los déficits motor y sensitivo sobrevinieron en una mediana de 4.5 y 4.3 días, respectivamente, después del inicio de los síntomas de infección viral. Hubo complicaciones, como neumonía asociada con ventilación mecánica, infección de vías urinarias en tres casos y disautonomía en dos casos. CONCLUSIONES Todos los casos de este brote de síndrome de Guillain-Barré tenían antecedente reciente de infección sospechosa por virus Zika, lo que refuerza la evidencia existente de la asociación entre el síndrome de Guillain-Barré y la infección por virus Zika.

Abstract OBJECTIVES To communicate a series of cases of Guillain-Barre syndrome and to describe the clinical characteristics related to a possible association with previous infection due to Zika virus. MATERIAL AND METHOD A descriptive study of series of cases in which clinical, biochemical and demographic data were collected from patients with Guillain-Barre syndrome treated at the Hospital General Acapulco with a recent history of acute viral syndrome suspected of infection due to Zika virus, performed from July 24 to August 24, 2016, with conducting study of cerebrospinal fluid and ascertainment of cytological albuminous dissociation. A certainty diagnosis was established for Guillain-Barre syndrome according to the criteria of Asbury-Cornblath and Brighton. RESULTS Ten patients with GBS and a recent history of acute viral syndrome compa-tible with Zika virus infection were included. The mean age was 47.8 years, 4 were male. The motor and sensitive deficits were developed at a median of 4.5 and 4.3 days, respectively after the onset of symptoms of viral infection. The complications found were ventilator-associated pneumonia, urinary tract infection and dysautonomia. CONCLUSIONS All cases of this outbreak of Guillain-Barre syndrome had a recent history of suspected infection due to Zika virus, reinforcing the evidence for the association between Guillain-Barre syndrome and infection due to Zika virus.

Phototherapy with Narrow-Band UVB in Adult Guttate Psoriasis: Results and Patient Assessment.

BACKGROUND: Acute guttate psoriasis (AGP) is a distinctive clinical entity with good response to treatment with narrow-band ultraviolet B (NB-UVB). OBJECTIVE: To investigate the results of NB-UVB phototherapy in adult patients with adult guttate psoriasis. MATERIAL AND METHODS: We carried out a prospective, open, and observational study. Patients over 18 years with more than 5% of body surface area affected were included. The PASI was assessed prior to and after treatment. The follow-up period was 18 months. After treatment, patients completed a simple questionnaire to assess their overall impression of the treatment. RESULTS: The 67 adult patients with AGP included in this study had an initial PASI of 8.55 (SD 5.03). Patients were treated with a mean of 19.9 sessions (SD 13.5) and mean doses of 14 mJ/cm2 (SD 10.5). Of the 67 patients, 52 achieved PASI90 with 96.15% of PASI reduction, and of these, 46 (88%) maintained PASI90 during the 18 months of follow-up. Patients were very satisfied with the treatment. DISCUSSION: AGP is a defined clinical entity with a variable course. Phototherapy with NB-UVB appears to be a very good option for treatment of AGP because of the good results obtained and patient satisfaction.

Treatment of moderate and severe adult chronic atopic dermatitis with narrow-band UVB and the combination of narrow-band UVB/UVA phototherapy.

The phototherapy is a safe and effective technique for the treatment of adult patients with atopic dermatitis (AD). The treatment of chronic forms of the disease is most often done with narrow-band UVB (NB-UVB). There also exist effective phototherapy options against the AD. The aim of this study was to asses if the combination of NB-UVB with UVA was more effective than the treatment with only NB-UVB against adult chronic AD. We carried out a prospective and observational study. Adult patients with chronic AD with more than 50% of the total body surface area affected (TBSA) were included. The affected TBSA was calculated using the so-called "rule of nines." Patients with a clearance rate >75% of the initial affected TBSA or complete clearance rate were considered as complete response (CR). An analogue scale from 0 to 10 was used to measure the improvement grade of the pruritus. The treatments were repeated three times a week. The initial doses of NB-UVB and UVA were determined by patient's phototype. The treatments were performed using a phototherapy booth (UV7002, Walmann, Villingen-Schwenningen, Germany(®) ) with TL01 and UVA fluorescent lamps. Statistical analysis was performed with SPSS(®) (IBM, New York, NY) for Windows 21.0. A total of 26 patients with adult chronic AD were included in the study, 16 patients were treated with UVB-BE and 10 patients with the combined treatment option NB-UVB/UVA. The mean value of cumulative doses and the mean number of performed treatments were similar between both groups of patients (p > 0.05). The mean value of duration of response was significantly higher in the patients treated only with NB-UVB, 101 versus 6.8 months (p ≥ 0.05). No differences were observed for the patients that showed complete response (p = 0.42) and in the analogue scale of pruritus (p > 0.005). In our study, the patients treated with the combination of NB-UVB and UVA were similar to the patient that were only treated with NB-UVB e. Further prospective and controlled studies have to be performed in order to determine the dosing regimens of phototherapy in adult patients with AD.

Dorsal and medial raphe nuclei participate differentially in reproductive functions of the male rat.

BACKGROUND: Innervation of the hypothalamus and median eminence arise from the dorsal and medial raphe nuclei (DRN and MRN, respectively). The hypothalamus regulates the secretion of gonadotropins, which in turn regulate the reproductive function of males and females. However, it is not known the role of raphe nuclei in male reproductive function. Our goal was to investigate the role of the DRN and MRN in the regulation of the testicular function and secretion of gonadotropins in prepubertal rats. METHODS: Dihydroxytryptamine (5,6-DHT) in ascorbic acid was used to chemically lesion the DRN or MRN. Rats were treated at 30 days-of-age and sacrificed at 45 or 65 days-of-age. Sham-treated controls were injected with ascorbic acid only. Negative controls were untreated rats. The damage induced by the 5,6-DHT was monitored in coronal serial sections of DRN and MRN; only the animals in which lesion of the DRN or MRN was detected were included in this study. As output parameters, we measured the concentrations of noradrenaline (NA), dopamine (DA) and serotonin (5-HT) in the anterior (AH) and medial (MH) hypothalamus by high performance liquid chromatography (HPLC); whereas, circulating concentrations of gonadotropins and sexual steroids were measured by radioimmunoassay. Seminiferous epithelium and sperm quality were also evaluated. RESULTS: Lesion of DRN or MRN does not induced changes in concentrations of LH, progesterone, and testosterone. Compared with the control group, the sham or lesion of the DRN or MRN did not modify noradrenaline or dopamine concentrations in the AH and MH at 45 or 65 days of age. Meanwhile, serotonin concentrations decreased significantly in lesioned rats. Lesion of DRN induced significantly lower concentrations of FSH regardless of age; similar lesion in the MRN had no impact on FSH levels. Sperm concentration and motility were significantly decreased in the same animals. The lesion of the MRN does not induced changes in the seminiferous epithelium or gonadotropin levels. Our results suggest that raphe nuclei regulate differentially the male reproductive functions. CONCLUSIONS: The DRN but not the MRN regulates the secretion of gonadotropins and testicular function.

Primary cutaneous marginal zone B-cell lymphoma: An atypical case.

Primary cutaneous marginal zone B-cell lymphoma (PCMZBCL) is an entity with an indolent behavior, which clinically appears as erythematous papules, nodules, or plaques, solitary or multiple, on the trunk or upper extremities. It has been associated with autoimmune diseases and infections. We present the case of a 77-year-old woman with an atypical PCMZBCL with extracutaneous spread and associated autoimmune hemolytic anemia.