Trends in Mortality due to HIV/AIDS in children in Mexico: Towards the elimination of mother-tochild transmission

AIM OF THE STUDY

To examine mortality trends in children under 15 years of age due to HIV/AIDS in Mexico and describe their differences by insurance coverage.

METHODS

Time series analysis of deaths from 1990-2019 through a Bayesian poisson regression model with linear splines and knots in 1994, 1997, and 2003.

RESULTS

Overall, we observed a reduction in the mortality rate due to HIV from 2003 onwards, except in the group of 10-14 years. In the population covered with Social Security, mortality rates decreased in all age groups. However, in the group without Social Security or with Popular Security (subsidized system), mortality rates significantly decreased only for children below 5 years. of age.

CONCLUSIONS

Health insurance through the contributory system is associated with faster and larger reductions in HIV related infant mortality. Universal access to health insurance was not sufficient to close the gap in HIV-mortality among children under 15 years of age in Mexico.

Overview of acute diarrheal disease at the dawn of the 21st century: The case of Mexico

OBJECTIVE

To provide an overview of morbidity and mortality due to acute diarrheal disease in Mexico in order to understand its magnitude, distribution, and evolution from 2000 to 2016.

MATERIALS AND METHODS

We carried out a longitudinal ecological study with secondary sources of information. We used data from epidemiological surveillance, health services, and vital statistics. We calculated and mapped measures of utilization of health services rates and mortality due to diarrheal diseases.

RESULTS

Diarrhea morbidity decreased by 42.1% across the period. However, emergency department attendances increased by 50.7% in the Ministry of Health. The hospitalization rate and mortality among the general population decreased by 37.6 and 39.7%, respectively, and the infant mortality rate decreased by 72.3% among children under five years of age. Chiapas and Oaxaca had the highest mortality among the states of Mexico.

CONCLUSIONS

Cases of diarrhea, including rotavirus, have decreased in Mexico. However, in 2016, 3.4 per 100 000 people died due to diarrhea, which could have been avoided with health promotion.

State of Children Environmental Health Research in Latin America

Background:

Promotion of biomedical research along with the development of evidence-based prevention policies have been suggested as an effective way to reduce environmental risks for children’s health in Latin America. However, there is little information on the current state of childhood environmental health research, which might help identify its strengths and limitations, as well as to design a strategy to improve the future of child environmental health research in the region.

Objective:

To describe the current state of environmental health research on children exposed to environmental pollutants in Latin America.

Methodology:

We performed a comprehensive search of published peer-reviewed environmental health articles (1994–2014), dealing with the exposure of Latin American children to chemical compounds. We described the type of studies and their research topics, and identified networks of co-authors. We also analyzed the relationship between research funding sources and the impact factor (IF) of the journal where research was published.

Results:

The average number of publications was about 20 per year. Mexico and Brazil produced almost 70% of the 409 identified papers. The most studied contaminant was lead, but research on this element has declined since 2005. Retrospective studies were the most frequent, and also showed a decreasing trend. Most studies did not assess health effects. Four groups of leading investigators and two collaboration models for scientific production were identified. Except for Mexico, there was very little collaboration with North American and European countries. Compared to articles that did not report financial support, those that received international funding had on average an IF around 7, and those with national funding reached a mean IF near 3.

Conclusion:

There is a limited number of publications and insufficient collaboration between Latin-American scientists. It is necessary to identify strategies to stimulate South-South-North alliances and strengthen the scarce research on the environmental health of children in the region.

Zika virus infection estimates, Mexico

Objective

To assess the magnitude of the Mexican epidemic of Zika virus infection and the associated risk of microcephaly.

Methods

From the reported number of laboratory-confirmed symptomatic infections among pregnant women and the relevant birth rate, we estimated the number of symptomatic cases of infection that occurred in Mexico between 25 November 2015, when the first confirmed Mexican case was reported, and 20 August 2016. We used data from the birth certificates to compare mean monthly incidences of congenital microcephaly before (1 January 2010–30 November 2015) and after (1 December 2015–30 September 2017) the introduction of Zika virus, stratifying the data according to whether the mother’s place of residence was at an altitude of at least 2200 m above sea level. We used Poisson interrupted time series, statistical modelling and graphical analyses.

Findings

Our estimated number of symptomatic cases of infection that may have occurred in the general population of Mexico between 25 November 2015 and 20 August 2016, 60 172, was 7.3-fold higher than the corresponding number of reported cases. The monthly numbers of microcephaly cases per 100 000 live births were significantly higher after the introduction of the virus than before (incidence rate ratio, IRR: 2.9; 95% confidence interval, CI: 2.3 to 3.6), especially among the babies of women living at altitudes below 2200 m (IRR: 3.4; 95% CI: 2.9 to 3.9).

Conclusion

The Mexican epidemic appears to be much larger than indicated by estimates based solely on counts of laboratory-confirmed cases, and to be associated with significantly increased risk of microcephaly.

[Carbapenem resistance in Pseudomonas aeruginosa isolated from urine cultures: prevalence and risk factors]

OBJECTIVE

Pseudomonas aeruginosa is a non-fermentative gram-negative bacillus with a great ability to develop resistance to multiple antibiotics, including carbapenems, which is a growing problem worldwide. The aim of this study was to analyse the prevalence of carbapenem-resistant P. aeruginosa (CRPA) in urine cultures and to determine the risk factors associated with the development of carbapanem resistance.

METHODS

Positive urine cultures to P. aeruginosa between September 2012 and September 2014 were identified. We excluded repetitive cultures from the same patient. We created a database with different variables, including antimicrobial resistance. The prevalence of carbapenem resistance and the risk factors for growth of CRPA were analysed.

RESULTS

Ninety-one patients with positive urine cultures to P. aeruginosa were included. The prevalence of CRPA was 22%. The risk factors to CRPA infection in the univariate analysis were: congestive heart failure (p=0.02), previous treatment with ampicillin (p=0.04), meropenem (p=0.04), piperacillin-tazobactam (p=0.01), trimethoprim-sulfamethoxazole (p= 0.01) and previous treatment with more than one antibiotic (p<0.01). Only congestive heart failure (p<0.01) and previous treatment with more than one antibiotic (p<0.01) showed statistically significant differences in the multivariate analysis.

CONCLUSIONS

The prevalence of CRPA in urine cultures is high in our population. We should assess the presence of risk factors as previous treatment with more than one antibiotic or comorbidities such as heart failure, in order to select an appropriate empirical treatment in patients with severe urinary tract infections.

Social network analysis to evaluate nursing interventions to improve self-care

OBJECTIVE

To explore the impact of an educational intervention for self-care of elders on their knowledge of acute respiratory infections and its incidence within their social networks.

METHOD

The intervention was based on seven educational sessions with elders from Jiutepec (Morelos, Mexico) conducted between September 2009 and January 2010 in the context of the influenza A(H1N1) pandemic. Egocentric social network analysis was used to explore the transmission of knowledge within elders' networks.

RESULTS

Knowledge of the correct use of antibiotics increased (p < .05). The total network was composed of 94 individuals, of which 22 presented with respiratory infection during the 4.5 months of follow-up. The measurements of infected individuals were in a degree similar to those not infected (p > .05). No differences in incidence were observed with respect to gender, kinship or sub-networks.

DISCUSSION

Elders increased their self-care and knowledge, but this did not decrease the incidence of cases in their social networks. This may be due to isolation and lack of recognition and credibility among close friends and relatives. Social network analysis can be used to understand and evaluate nursing self-care interventions.

[Fingerprint microcystic dystrophy: Episodes of irregular astigmatism and their topographical representation]

CASE STUDY

A 44 year-old male patient suffering from painless bouts of blurred vision and with no visible ophthalmological repercussions initially. After one of these clinical episodes we managed to visualise fingerprint images in the anterior pole, as well as corneal, pachymetric and topographical changes, which in turn produce the symptomatic refractive changes.

DISCUSSION

Fingerprint keratopathy is a condition diagnosed through recurring corneal erosion. The pathogenic origin of the condition-an altered epithelial basal membrane- may encourage the separation of the corneal epithelium from its underlying layers. Depending on whether this separation is partial or total, this will lead to spontaneous corneal erosion or, less frequently, episodes of blurred vision caused by oedema and corneal swelling.