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Abstract Background The management of febrile neutropenia (FN) in pediatric cancer patients has traditionally been conducted in a hospital setting. However, recent evidence has indicated that outpatient management of FN can be equally effective compared to inpatient care. Based on this evidence, we conducted a cost-minimization analysis (CMA) specifically focused on pediatric cancer patients in Mexico. Methods A piggy-back study was conducted during the execution of a non-inferiority clinical trial that compared outpatient treatment to inpatient treatment for FN in children with cancer. A CMA was performed from a societal perspective using patient-level data. In the previous study, we observed that step-down oral outpatient management of low-risk FN was as safe and effective as inpatient intravenous management. Direct and indirect costs were collected prospectively. The costs were adjusted for inflation and converted to US dollars, with values standardized to July 2022 costs. Statistical analysis using bootstrap methods was employed to obtain robust estimations for decision-making within the Mexican public health care system. Results A total of 117 FN episodes were analyzed, with 60 in the outpatient group and 57 in the inpatient group; however, complete cost data were available for only 115 FN episodes. The analysis revealed an average savings of $1,087 per FN episode managed on an outpatient basis, representing a significant 92% reduction in total cost per FN episode compared to inpatient treatment. Length of hospital stay and inpatient consultations emerged as the primary cost drivers within the inpatient care group. Conclusion This CMA demonstrates that the step-down outpatient management approach is cost-saving when compared to inpatient management of FN in pediatric cancer patients. The mean difference observed between the treatment groups provides support for decision-making within the public health care system, as outpatient management of FN allows for substantial cost savings without compromising patient health.

The gut microbiota harbors diverse bacteria considered reservoirs for antimicrobial resistance genes. The global emergence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (ESBL-PE) significantly contributes to healthcare-associated infections (HAIs). We investigated the presence of ESBL-producing Escherichia coli (ESBL-PEco) and ESBL-producing Klebsiella pneumoniae (ESBL-PKpn) in neonatal patients’ guts. Furthermore, we identified the factors contributing to the transition towards ESBL-PEco and ESBL-PKpn-associated healthcare-associated infections (HAIs). The study was conducted from August 2019 to February 2020, in a Neonatal Intensive Care Unit of the Hospital Infantil de México Federico Gómez. Rectal samples were obtained upon admission, on a weekly basis for a month, and then biweekly until discharge from the neonatology ward. Clinical data, culture results, and infection information were gathered. We conducted antimicrobial tests, multiplex PCR assay, and pulsed-field gel electrophoresis (PFGE) to determine the antimicrobial resistance profile and genetic relationships. A comparison between the group’s controls and cases was performed using the Wilcoxon and Student t-tests. Of the 61 patients enrolled, 47 were included, and 203 rectal samples were collected, identifying 242 isolates. In 41/47 (87%) patients, colonization was due to ESBL-PEco or ESBL-PKpn. And nine of them developed HAIs (22%, 9/41). ESBL-PEco resistance to cephalosporins ranged from 25.4% to 100%, while ESBL-PKpn resistance varied from 3% to 99%, and both bacteria were susceptible to carbapenems, tigecillin, and colistin. The prevalent blaCTX-M-group-1 gene accounted for 77.2% in ESBL-PEco and 82.2% in ESBL-PKpn, followed by blaTEM 50% and blaOXA-1 43.8% in ESBL-PEco and blaTEM 80.2% and blaSHV 76.2% in ESBL-PKpn. Analysis of clonality revealed identical colonizing and infection isolates in only seven patients. Significant risk factors included hospital stay duration, duration of antibiotic treatment, and invasive device usage. Our findings suggest high ESBL-PEco and ESBL-PKpn rates of colonization often lead to infection in neonates. Attention should be paid to patients with ESBL-PE.

IntroductionDespite the end of the COVID-19 pandemic being declared by the WHO, the economic consequences are far from over. One of these implications was the cost of inpatient care for health institutions. To date, some studies have examined the economic burden of COVID-19 in the adult population but only a few have focused on child populations.ObjectiveTo estimate the direct medical costs of COVID-19, focusing on children in Mexico.MethodData about resources consumed during hospital stays were extracted from the medical records of patients hospitalized at a Mexican tertiary healthcare institution. Other sources of information were the unit prices of inputs and the salaries of health personnel. A micro-costing methodology was used to obtain cost results by age group over different hospital areas. Data analysis was performed with descriptive statistics and regression models to evaluate the predictors of total cost.ResultsOne hundred and ten medical records were reviewed of which 57.3% corresponded to male patients and the mean age was 7.2 years old. The estimated average cost per patient was US$5,943 (95% CI: US$4,249–7,637). When the costs of the three clinical areas were summed, only the 5–10 years old group showed a maximum cost of US$14,000. The regression analysis revealed the following factors as significant: sex, age, staying at an emergency room, having a positive bacterial culture, and having comorbidities.DiscussionThe cost results were somewhat similar to those reported in children from the USA, but only regarding low severity COVID-19 cases. However, comparability between these types of studies should be done with caution due to the huge differences between the healthcare systems of countries. The study cost results may help public decision-makers in budget planning and as inputs for future cost-effectiveness studies about interventions regarding COVID-19.

Abstract Background ALL is the most frequent hematological tumor in children, so during remission induction chemotherapy protocol (RICP) adverse events (AEs) may appear. The public program in Mexico in charge of financial support to oncologic children without social security delivered a fix amount for ALL chemotherapy, but additional money needed to treat any other unexpected condition should be taken from the budget of the oncologic healthcare providers. So the purpose of our study was to estimate and evaluate the direct medical costs associated to EAs during RICP in children with ALL. Methods This study was retrospective, longitudinal, and observational based on medical records review of patients in RICP. The CTCAE was used to identify and classify AEs according to a SOC category. We focused on extracting resources data that were consumed both for inpatients and outpatients AEs. A micro-costing approach was adopted which involve quantification of each healthcare resource consumed by the hospital multiplying them by unit cost. The probability distributions of data were evaluated to identify the appropriated statistical tests to be used for comparisons between groups that were performed with Wilcoxon rank sum test. Generalized linear models (GLM) were adjusted to evaluate the effects of patient characteristics on total cost. Results Forty patients accumulated 204 inpatient and 81 outpatient AEs during RICP. Comparison of total costs between groups showed an incremental cost of $7,460.23 likewise attributable to AEs. The total cost of a pediatric patient undergoing RICP without adverse events was $3,078.36 and the total cost of a patient with AEs exceeds it threefold. Conclusions The costs associated with AEs during RICP in Mexican children with ALL representing a high burden for the healthcare provider. Generalized linear models showed that variables such as sex, risk category and alive status are associated with the total costs of AEs. This is the first study aiming to analyze the effect of ALL-related AEs on health care costs in pediatric population, so our results may help not only to local decision making but also it may contribute to the research agenda in this field.

ObjectiveTo identify the type of infections and risk factors for infection-related mortality (IRM) after allogeneic hematopoietic stem cell transplantation (HSCT).MethodsRetrospective cohort study of patients ResultsData for 99 pediatric patients were analyzed. The myeloablative conditioning was the most used regimen (78.8%) and the hematopoietic stem cell source was predominantly peripheral blood (80.8%). Primary graft failure occurred in 19.2% of patients. Frequency of acute graft-versus-host disease was 46.5%. Total of 136 infectious events was recorded, the most common of which were bacterial (76.4%) followed by viral infection (15.5%) and then fungal infection (8.1%). The best predictors for infection subtypes where the following: a) for bacterial infection (the age groups of 10.1-15 years: aHR = 3.33; 95% CI: 1.62-6.85 and. >15 years: aHR = 3.34; 95% CI: 1.18-9.45); b) for viral infection (graft versus host disease: aHR = 5.36; 95% CI: 1.62-17.68), however, for fungal infection statistically significant predictors were not identified. Related mortality was 30% (n = 12). Increased risk for infection-related mortality was observed in patients with unrelated donor and umbilical cord stem cells recipients (HR = 3.12; 95% CI: 1.00-9.85).ConclusionsFrequencies of infections and infection-related mortality appear to be similar to those reported. Unrelated donors and stem cells from umbilical cord recipients were associated with a high risk of mortality.

Argemone ochroleuca Sweet (Papaveraceae) is used in folk medicine as a sedative and hypnotic agent. This study aimed to evaluate the anxiolytic-like, sedative, antidepressant-like, and anticonvulsant activities of a dichloromethane extract of A. ochroleuca stems (AOE), chemically standardized using gas chromatography–mass spectrometry (GC–MS), and its active compound dihydrosanguinarine (DHS). The anxiolytic-like, sedative, antidepressant-like, and anticonvulsant activities of the AOE (0.1–50 mg/kg p.o.) and DHS (0.1–10 mg/kg p.o.) were evaluated using murine models. A possible mechanism for the neurological actions induced by the AOE or DHS was assessed using inhibitors of neurotransmission pathways and molecular docking. Effective dose 50 (ED50) values were calculated by a linear regression analysis. The AOE showed anxiolytic-like activity in the cylinder exploratory test (ED50 = 33 mg/kg), and antidepressant-like effects in the forced swimming test (ED50 = 3 mg/kg) and the tail suspension test (ED50 = 23 mg/kg), whereas DHS showed anxiolytic-like activity (ED50 = 2 mg/kg) in the hole board test. The AOE (1–50 mg/kg) showed no locomotive affectations or sedation in mice. A docking study revealed the affinity of DHS for α2-adrenoreceptors and GABAA receptors. The anxiolytic-like and anticonvulsant effects of the AOE are due to GABAergic participation, whereas the antidepressant-like effects of the AOE are due to the noradrenergic system. The noradrenergic and GABAergic systems are involved in the anxiolytic-like actions of DHS.

Sexually transmitted infections [STI] represent a serious public health problem, which triggers different biological, economic and social complications, which is also related to migration, prostitution, and other factors. The present investigation was carried out with the aim of establishing an endemic channel on Sexually Transmitted Infections and its association with migration, vacation periods and other factors of risk. Methods. A retrospective descriptive observational study was carried out from a bibliographic review of the subject on the internet network retrospectively from 2016 to 2010 collected from SUIVE, in order to establish the endemic ITS channel of the Santa Ana Batha region, Chilcuautla Municipality, Hidalgo, compared with the influx of spas in the study region, it was also taken into account that the region is a migration step from the south to the north, and the epidemiological weeks were also related to the vacation periods. Results. it was obtained as a result that during these periods the number of cases increased considerably and exceeded the alert zone. Conclusion. The results obtained allow to establish as risk factors for STI the phenomenon of migration, the vacation periods and the influx to spas during vacation periods. This study allows us to establish that if we do not pay attention to risk factors, STIs will continue to mean negative results in the health of those involved.

BackgroundInfluenza cause a clinical and economic burden for health systems and society. It is necessary to know the cost of the disease in order to perform cost-effectiveness assessments of preventive or treatment interventions.ObjectiveAssess the costs of the care of children with influenza in a third level hospital in Mexico.MethodsLongitudinal retrospective study based on the review of clinical files of children hospitalized with influenza. The use of resources used during their hospitalization in the emergency room, general ward, or PICU was logged, and the amount of supplies were multiplied by their corresponding prices to calculate the direct medical expenses. Descriptive statistics were used, and a GLM was adjusted in order to assess the effect of the clinical characteristics of the patients on the cost. Goodness of fit tests were performed.Results132 files were reviewed, out of which 95% were of subjects who had comorbidities. Subjects admitted at the PICU generates the highest cost (mean $29,608.62 USD), when analyzing the total cost summarizing the three clinical areas (Emergency room, general ward and PICU) by age group, the highest cost was for patients over age 10 (mean $49,674.53 USD). Comorbidities increase the cost of hospitalization by $10,000.00 USD.ConclusionsInfluenza causes a significant financial burden on the health system. Children with comorbidities increase the costs and children over 10 years uses a significant amount of resources and they are not a priority in immunization program. It is necessary to perform studies on the use of resources in the first and second attention levels, which represent the highest incidence of the disease.

Pseudomonas aeruginosa has different resistant mechanisms including the constitutive MexAB-OprM efflux pump. Single nucleotide polymorphisms (SNPs) in the mexR, nalC, and nalD repressors of this efflux pump can contribute to antimicrobial resistance; however, it is unknown whether these changes are mainly related to genetic lineages or environmental pressure. This study identifies SNPs in the mexR, nalC, and nalD genes in clinical and environmental isolates of P. aeruginosa (including high-risk clones). Ninety-one P. aeruginosa strains were classified according to their resistance to antibiotics, typified by multilocus sequencing, and mexR, nalC, and nalD genes sequenced for SNPs identification. The mexAB-oprM transcript expression was determined. The 96.7% of the strains were classified as multidrug resistant. Eight strains produced serine carbapenemases, and 11 strains metallo-β-lactamases. Twenty-three new STs and high-risk clones ST111 and ST233 were identified. SNPs in the mexR, nalC, and nalD genes revealed 27 different haplotypes (patterns). Sixty-two mutational changes were identified, 13 non-synonymous. Haplotype 1 was the most frequent (n = 40), and mainly identified in strains ST1725 (33/40), with 57.5% pan drug resistant strains, 36.5% extensive drug resistant and two strains exhibiting serin-carbapenemases. Haplotype 12 (n = 9) was identified in ST233 and phylogenetically related STs, with 100% of the strains exhibiting XDR and 90% producing metallo-β-lactamases. Haplotype 5 was highly associated with XDR and related to dead when compared to ST1725 and ST233 (RRR 23.34; p = 0.009 and RRR 32.01; p = 0.025). A significant relationship between the mexR-nalC-nalD haplotypes and phylogenetically related STs was observed, suggesting mutational changes in these repressors are highly maintained within genetic lineages. In addition, phylogenetically related STs showed similar resistant profiles; however, the resistance was (likely or partly) attributed to the MexAB-OprM efflux pump in 56% of the strains (only 45.05% showed mexA overtranscription), in the remaining strains the resistance could be attributed to carbapenemases or mechanisms including other pumps, since same SNPs in the repressor genes gave rise to different resistance profiles.

The pandemic caused by the new coronavirus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is currently affecting more than 200 countries. The most lethal clinical presentation is respiratory insufficiency, requiring attention in intensive care units (ICU). The most susceptible people are over 60 years old with comorbidities. The health systems organization may represent a transcendental role in survival.Objective: To analyze the correlation of sociodemographic factors, comorbidities and health system organization variables with survival in cases infected by SARS-CoV-2 during the first 7 months of the pandemic in Mexico.Methods: The cohort study was performed in a health system public basis from March 1st to September 30th, 2020. The included subjects were positive for the SARS-CoV-2 test, and the target variable was mortality in 60 days. The risk variables studied were: age, sex, geographic distribution, comorbidities, health system, hospitalization, and access to ICU. Bivariate statistics (X2-test), calculation of fatality rates, survival analyses and adjustment of confusing variables with Cox proportional-hazards were performed.Results: A total of 753,090 subjects were analyzed, of which the 52% were men. There were 78,492 deaths (10.3% of general fatality and 43% inpatient). The variables associated with a higher risk of hospital mortality were age (from 60 years onwards), care in public sectors, geographic areas with higher numbers of infection and endotracheal intubation without management in the ICU.Conclusions: The variables associated with a lower survival in cases affected by SARS-CoV-2 were age, comorbidities, and respiratory insufficiency (with endotracheal intubation without care in the ICU). Additionally, an interaction was observed between the geographic location and health sector where they were treated.

Abstract Background Helicobacter pylori is a major aetiologic agent associated with gastritis. H. pylori infections increase the expression of the Toll-like receptor (TLR), which in turn modulates the expression of microRNA (miRNA)-146a and miRNA-155. The objective of this study was to compare the expression of miRNA-146a and miRNA-155 in gastric lesions of paediatric and adult patients with different pathologies and in Mongolian gerbils (Meriones unguiculatus) infected with H. pylori 26,695. Methods Quantification of miRNA expression was performed by quantitative real-time polymerase chain reaction (qRT-PCR) of paraffin-embedded gastric lesions of children with or without an infection (n = 25), adults with follicular gastritis and metaplasia (n = 32) and eight-week-old M. unguiculatus males (Hsd:MON) infected with H. pylori 26,695 for 0, 3, 6, 12 and 18 months (n = 25). The genes RNU48 and RNU6 were used as endogenous controls for data normalization. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney, ANOVA and Student’s t-test. Results The expression of miRNA-146a and miRNA-155 in infected children increased by 247.6- and 79.4-fold (on average), respectively, compared to that observed in the control group. However, these results were not significant (p = 0.12 and p = 0.07 respectively). In some children a gradual increase in expression was observed, while in others, expression was very high. Additionally, the expression levels of miRNA-146a and miRNA-155 increased by an average of 21.7- and 62-fold, respectively, in adult patients with follicular gastritis when compared to those of the controls. In M. unguiculatus infected with H. pylori 26,695, the expression of both miRNAs increased as the infection progressed. Conclusion This is the first report to show differences in the expression of miRNA-146a and miRNA-155 in paediatric and adult patients with gastritis who were infected with H. pylori. In addition, in M. unguiculatus infected with H. pylori, miRNA expression was associated with the progression of infection and the ability of the bacteria to adapt to the host.

Purpose: Limited data describe the delivery of pediatric cancer care in Mexico. We report a nationwide survey of pediatric cancer units. Methods: An electronic survey was distributed to 74 pediatric cancer units in Mexico to describe case volumes; organization of care; and availability of medical/surgical specialists, supportive care, complex therapies, and diagnostic services. Centers were classified as low (< 30 new patients/year), medium (30 to 59/year) and high (≥ 60/year). Results: Sixty-two centers completed the survey (response rate, 84%). The median annual new case volume per center was 50 (interquartile range [IQR], 23 to 81). Thirty-four percent (n = 21), 26% (n = 16), and 40% (n = 25) of units were low-, medium-, and high-volume centers, respectively. Treatment units reported a median of two pediatric oncologists (IQR, 2) and one pediatric hematologist (IQR, 1 to 2). Availability of medical and surgical subspecialists varied by center size, with substantially more specialist support at higher-volume centers (P < .01). Multidisciplinary tumor boards are available at 29% (six of 21), 56% (nine of 16), and 76% (19 of 25) of low- to high-volume centers, respectively (P = .005). Radiation and palliative care services are available at 42% (n = 26) and 63% (n = 36) of all centers, which did not vary by center volume. Educational support for hospitalized children and school reintegration programs are available at 56% (n = 36) and 58% (n = 36) of centers, respectively. One third (38% [n = 23]) of centers reported that at least one half of patients were lost to follow-up during the transition from pediatric to adult programs. Conclusion: A large variation exists in annual case volumes across Mexican pediatric cancer centers. Additional efforts to increase access to multidisciplinary, supportive, and palliative care across all pediatric cancer units in Mexico are required.

Unhealthy diets are recognized as a major risk factor for many diseases. The decrease in costs of industrialized products, as well as the possible misinformation about a healthy diet, has led to new behaviors in the dietary patterns of the pediatric population. The costs of dietary patterns have not been estimated in our population, so the objective of this study was to determine the cost associated with dietary patterns in Mexican children and adolescents, hypothesizing that a healthy diet is not necessarily more economically expensive. This study analyzed data from a population-based cross-sectional study of healthy children and adolescents in Mexico City. Data were collected from a food frequency questionnaire and the meal cost of habitual food shopping. Eating patterns were obtained by using principal component analysis. A micro-costing technique was performed to obtain the direct costs of each pattern. When comparing the healthy pattern with the transition and non-healthy patterns, it was observed that there were no statistically significant differences between the dietary patterns (p = 0.8293). The cost of the healthy pattern only takes up 16.6% of the total biweekly income of a salaried Mexican. In this study, no differences were observed between the costs of a healthy and a less healthy diet.

Xyleborus sp beetles are types of ambrosia beetles invasive to the United States and recently also to Mexico. The beetle can carry a fungus responsible for the Laurel Wilt, a vascular lethal disease that can host over 300 tree species, including redbay and avocado. This problem has a great economic and environmental impact. Indeed, synthetic chemists have recently attempted to develop new neonicotinoids. This is also due to severe drug resistance to “classic” insecticides. In this research, a series of neonicotinoids analogs were synthesized, characterized, and evaluated against Xyleborus sp. Most of the target compounds showed good to excellent insecticidal activity. Generally, the cyclic compounds also showed better activity in comparison with open-chain compounds. Compounds R-13, 23, S-29, and 43 showed a mortality percent of up to 73% after 12 h of exposure. These results highlight the enantioenriched compounds with absolute R configuration. The docking results correlated with experimental data which showed both cation-π interactions in relation to the aromatic ring and hydrogen bonds between the search cavity 3C79 and the novel molecules. The results suggest that these sorts of interactions are responsible for high insecticidal activity.

There is evidence that high circulating levels of IL-6 and IL-8 are markers of a poor prognosis in various types of cancer, including NB. The participation of these cytokines in the tumor microenvironment has been described to promote progression and metastasis. Our objective was to evaluate the prognostic role of genetic polymorphisms and serum levels of IL-6 and IL-8 in a cohort of Mexican pediatric patients with NB. The detection of the SNPs rs1800795 IL-6 and rs4073 and rs2227306 IL-8 was carried out by PCR-RFLP and the levels of cytokines were determined by the ELISA method. We found elevated circulating levels of IL-8 and IL-6 in NB patients compared to the control group. The genotype frequencies of the rs1800795 IL-6 and rs4073 IL-8 variants were different between the patients with NB and the control group. Likewise, the survival analysis showed that the GG genotypes of rs1800795 IL-6 (p = 0.014) and AA genotypes of rs4073 IL-8 (p = 0.002), as well as high levels of IL-6 (p = 0.009) and IL-8 (p = 0.046), were associated with lower overall survival. We confirmed the impact on an adverse prognosis in a multivariate model. This study suggests that the SNPs rs1800795 IL-6 and rs4073 IL-8 and their serum levels could be promising biomarkers of a poor prognosis, associated with overall survival, metastasis, and a high risk in Mexican children with NB.

Drug-drug interactions (DDIs) detected in a patient may not be clinically apparent (potential DDIs), and when they occur, they produce adverse drug reactions (ADRs), toxicity or loss of treatment efficacy. In pediatrics, there are only few publications assessing potential DDIs and their risk factors. There are no studies in children admitted to emergency departments (ED). The present study estimates the prevalence and describes the characteristics of potential DDIs in patients admitted to an ED from a tertiary care hospital in Mexico; in addition, potential DDI-associated risk factors are investigated.A secondary analysis of data from 915 patients admitted to the ED of the Hospital Infantil de México "Federico Gómez" was conducted. The Medscape Drug Interaction Checker software was used to identify potential DDIs. The results are expressed as number of cases (%), means (95% CI) and medians (25-75th percentiles). Count data regressions for number of total and severity-stratified potential DDIs were performed adjusting for patient characteristics, number of administered drugs, days of stay, presence of ADRs and diagnoses.The prevalence of potential DDIs was 61%, with a median of 4 (2-8). A proportion of 0.2% of potential DDIs was "Contraindicated", 7.5% were classified as "Serious", 62.8% as "Significant" and 29.5% as "Minor". Female gender, age, days of stay, number of administered drugs and diagnoses of Neoplasms (C00-D48), Congenital malformations (Q00-Q99), Diseases of the Blood, Blood-forming Organs and Immunity (D50-D89) and Diseases of the nervous system (G00-G99) were significantly associated with potential DDIs.The prevalence of potential DDIs in the ED is high, and strategies should therefore be established to monitor patients' safety during their stay, in addition to conducting investigations to estimate the real harm potential DDIs inflict on patients.

Los diseños de investigación clínica, cuyo propósito es responder preguntas sobre causalidad, se pueden clasificar en relación con cuatro ejes: el número de grupos de estudio, la aplicación de una maniobra experimental, la direccionalidad causa-efecto y la fuente de la que se recaban los datos. Los diseños básicos más utilizados en epidemiología son el ensayo clínico, el estudio de cohortes, el estudio de casos y controles y la encuesta transversal. Este texto pretende facilitar la identificación y comprensión de cada uno de estos diseños mediante ejemplos relacionados con la asociación entre la vacunación con rotavirus y la invaginación intestinal.

Economic evaluation of lenalidomide (Revlimid®) for the treatment of mielodysplastic syndrome with 5q deletion at low/intermediate-1 riskBackgroundLenalidomide is an effective treatment for patients with lower risk myelodysplastic syndrome (MDS) del5q. It reduces disease-related transfusion requirements, inhibits the malignant clone and causes a delay in tumor growth. There are also benefits in terms of quality of life and use of other health care resources.ObjectiveTo perform an economic evaluation of lenalidomide for transfusion-dependent patients with Low/Intermediate-1-risk MDS del 5q from the perspective of the public health care sector in Mexico.Material and methodsWe developed a cost-effectiveness analysis using a Markov model of 5 stages: MDS transfusion-dependence, MDS transfusion-independence, complications from transfusion, acute myeloid leukemia, and death. The analyzed period was 5 years. Discount rate of 5% after year 1 was applied. Efficacy was elicited from a phase III clinical trial, MDS-004, which shows lenalidomide benefit in patients achieving transfusion-independence. There were also benefits with lenalidomide related to extended overall survival and decreased risk of acute myeloid leukemia. Unitary cost are from public price list of IMSS, and resources use was calculated from a Delphi panel methodology with clinical hematologists. A multivariate sensitivity analysis using a Monte Carlo technique was performed.ResultsOver a 5-year period, each patient on lenalidomide avoided 487 days of transfusion, on average. The incremental cost per life-year without transfusion dependence is USD$14,072 (Exchange Rate = 1USD = 17.55 MXN). According to the sensitivity analysis the model is robust. If all expected patients are treated, their cost would be wUSD$19.7 million, which represents 0.18% of the total budget in the public health sector.ConclusionsLenalidomide provides important clinical benefits in the treatment of patients with lower risk myelodysplastic syndromes with del5q, with a limited economic impact and with a cost per life living without blood transfusions is within 3 times of the Mexican GDP (Gross Domestic Product).

Background: The cow’s milk protein allergy is the most common food allergy among children under two years and is associated with other atopic diseases. Objective: To evaluate cow’s milk protein allergy frequency in patients sensitized to them, attended at the consultation of Immunology and Allergy in the Hospital Infantil de México Federico Gómez, and its association with other atopic diseases. Material and method: A cross-sectional, analytical and descriptive study that reviewed medical records of patients aged 0-19 years, attended at the consultation of Immunology and Allergy in the Hospital Infantil de México Federico Gómez, from January 2010 to January 2013, sensitized to the cow’s milk protein by in vitro or in vivo studies, mediated or not by IgE, to determine its association with other atopic diseases during the course of their clinical evolution. Results: We included 252 patients with symptoms suggestive of cow’s milk protein allergy, which was diagnosed only in 15.1% by oral challenge. In relation to respiratory symptoms, about two-thirds of patients had rhinorrhea, nasal obstruction and nasal itching. Regarding gastrointestinal symptoms, about a third had abdominal pain, diarrhea and abdominal distension, being statistically significant. The most common dermatologic symptom, statistically significant, was xerosis. The most frequently associated atopic diseases were food allergy (76.3%), allergic rhinitis (65.8%), asthma (47.4%) and atopic dermatitis (23%). Conclusions: The cow’s milk protein allergy can be associated with other atopic diseases, such as allergy to other foods, allergic rhinitis, asthma and atopic dermatitis.

OBJECTIVE: The study evaluated the incremental cost-effectiveness ratio (ICER) of the prophylaxis of palivizumab, for the reduction of complications associated to the respiratory syncytial virus in preterm patients in Mexico. MATERIAL AND METHODS: A decision tree was developed in preterm groups [OBJETIVO: El estudio evaluó la razón costo-efectividad incremental (RCEI) de profilaxis con palivizumab para reducción de complicaciones asociadas al virus sincicial respiratorio en prematuros en México. MATERIAL Y MÉTODOS: Se empleó un árbol de decisiones en los grupos pretérmino [

OBJECTIVE: The aim of this study was to determine the prevalence of asymptomatic nasopharyngeal carriage of Streptococcus pneumoniae, which is a major factor in the transmission of this bacterium. MATERIAL AND METHODS: Nasopharyngeal cultures were performed on children attending 32 day-care centers in 12 states in Mexico. RESULTS: Streptococcus pneumoniae was isolated from the nasopharynx of 829 out of 2 777(29.9%) subjects aged two months to six years. All children lived in urban areas and 80% spent more than six hours daily in a day-care center. Streptococcus pneumoniae serotypes most frequently identified were: 19F (23%), 6B (15.6%), 23F (11.2%) and 6A (14.9%). Thirty-six percent of the isolates were susceptible to penicillin. CONCLUSIONS: Serotype distribution suggests the possible benefits that could be obtained from the heptavalent pneumococcal conjugate vaccine.OBJETIVO: La intención de este estudio fue determinar la prevalencia de portadores nasofaríngeos asintomáticos de Streptococcus pneumoniae, el cual es el principal factor en la transmisión de esta bacteria. MATERIAL Y MÉTODOS: Los cultivos nasofaríngeos fueron realizados en niños que asisten a 32 estancias infantiles en 12 estados de México. RESULTADOS: Streptococcus pneumoniae fue aislado de la nasofaringe de 829 (29.9%) niños de los 2 777 incluidos en el estudio con un rango de edad de 2 meses a 6 años. Todos los niños vivían en áreas urbanas y 80% permanecían más de seis horas diarias en la estancia infantil. Los serotipos de Streptococcus pneumoniae más frecuentemente identificados fueron: 19F (23%), 6B (15.6%), 23F (11.2%) y 6 A (14.9%). Treinta y seis por ciento de los aislamientos fueron susceptibles a penicilina. CONCLUSIONES: La distribución de serotipos nos da una idea de los posibles beneficios que podrían obtenerse de la vacuna neumocóccica conjugada heptavalente.

El manzano (Malus x domestica Borkh) es un frutal importante en el sur de Coahuila, México; que para su floración necesita la acumulación de unidades frío (UF), las cuales no se logran cubrir con las UF de la región, lo que ocasiona baja producción. En los últimos años en la región se han detectado mutaciones que necesitan menores UF. El objetivo del presente trabajo fue determinar diferencias genéticas y bromatológicas en los mutantes del sur de Coahuila. El análisis bromatológico mostró que el mutante Vigas I presentó el menor contenido de fibra (4.91 g) y el mayor contenido de azúcares (10.73 g), lo que le da ventajas comerciales. El análisis de polimorfismos en la longitud de fragmentos amplificados (AFLP´s), mostró un mayor patrón de bandeado con la combinación: [EcoRI (+ACC +AGG) / MseI (+CTA)]. Obteniendose con esta combinación 123 bandas amplificadas, las cuales fueron 100 % polimórficas. El mutante más parecido al control fue Vigas II con una distancia genética de 0.16 unidades, mientras que el mutante con mayor diferencia fue Primicia. Los mutantes estudiados pueden ser una alternativa a la problemática de UF de algunas regiones manzaneras de país.

We investigated whether maternal diabetes induced in rats using streptozotocin (STZ) on Day 5 of pregnancy affects the intrauterine developmental timeline. A total of 30 pregnant Sprague-Dawley diabetic rats (DRs) and 20 control rats (CRs) were used to obtain 21-day fetuses (F21) and newborn (NB) pups. Gestational age, weight, and body size were recorded as were the maxillofacial morphometry and morphohistological characteristics of the limbs. In DRs, pregnancy continued for ∼1.7 days, and delivery occurred 23 days postcoitus (DPC). In this group, the number of pups was lower, and 13% had maxillofacial defects. F21 in the DR group had lower weights and were smaller; moreover, the morphological characteristics of the maxillofacial structures, derived from the neural crest, were discordant with their chronological gestational age, resembling 18- to 19-day-old fetuses. These deficiencies were counterbalanced in NB pups. We conclude that hyperglycemia, which results from maternal diabetes and precedes embryo implantation, deregulates the intrauterine developmental timeline, restricts embryo-fetal growth, and primarily delays the remodeling and maturation of the structures derived from neural crest cells.

The Mezquital Valley (MV) hosts the largest unmanaged aquifer recharge scheme in the world. The metropolitan area of Mexico City discharges ~60 m3/s of raw wastewater into the valley, a substantial share of which infiltrates into the regional aquifer. In this work, we aim to develop a comprehensive approach, adapted from oil and gas reservoir modeling frameworks, to assess water supply sources located downgradient from unmanaged aquifer recharge zones. The methodology is demonstrated through its application to the Mezquital Valley region. Geological, geoelectrical, petrophysical and hydraulic information is combined into a 3D subsurface model and used to evaluate downgradient supply sources. Although hydrogeochemical variables are yet to be assessed, outcomes suggest that the newly-found groundwater sources may provide a long-term solution for water supply. Piezometric analyses based on 25-year records suggest that the MV is close to steady-state conditions. Thus, unmanaged recharge seems to have been regulating the groundwater balance for the last decades. The transition from unmanaged to managed recharge is expected to provide benefits to the MV inhabitants. It will also be likely to generate new uncertainties in relation to aquifer dynamics and downgradient systems.

Con el objetivo de determinar las variables más relacionadas con el rendimiento, así como los principales componentes de variación, se establecieron en campo, en Ramos Arizpe, Coahuila, 12 genotipos de melón, en un diseño de Bloques Completos al Azar, con cuatro repeticiones. La parcela experimental fue de dos surcos de cinco metros de largo sembrados a doble hilera. Los genotipos en estudio fueron: híbridos: Primo, Pronto, Challenger, Cheyenne, Hi-Line, Cruiser, Durango, Apache, Laguna, Caravelle y Main Pak, y la variedad Top Mark, testigo; las variables evaluadas fueron: rendimiento (11 variables: cuantitativas y cualitativas); fenológicas (tres variables); agroclimáticas (cinco Variables) y fisiológicas (cuatro variables). Se encontraron correlaciones significativas (p

El objetivo del presente trabajo fue determinar la adaptación de genotipos de tomate, bajo condiciones de invernadero. Los genotipos fueron: híbridos: Contessa, Summer Flavor 5000, Summer Flavor 6000, Celebrity, Bonita, Shady Lady, Sunbolt, Sunny, Heat Wave y Olympic; y la variedad FloraDade como testigo. Se evaluaron variables fisiológicas y de rendimiento. Las variables fisiológicas se determinaron en tres evaluaciones en el ciclo del cultivo, en tres horas del día y dos posiciones de hoja en cada evaluación. Se encontraron correlaciones significativas (p≤0,05) entre rendimiento en t/ha, y rendimiento promedio/ planta/corte, frutos/planta/corte y rendimiento/planta, y entre fotosíntesis y uso eficiente del agua. En el análisis de componentes principales, se encontró que los primeros cinco componentes tuvieron un Eigenvalor mayor a uno, explicando los tres primeros un 72% de la varianza total. El primer componente, con un 36% de la variación total, se debió a las características de rendimiento, el segundo componente, con un 23% de la variación total, se debió a las características de regulación interna de temperatura y el componente cinco, con un 7,4 % de la variación, a la producción eficiente de fotosintatos. El análisis de regresión lineal múltiple fue significativo (p≤0,01). El rendimiento en t/ha, se explica por una ecuación lineal múltiple (r2= 0,98) de cuatro variables

OBJECTIVE: To estimate the cost-effectiveness ratio of surfactant rescue treatment of premature infants with respiratory distress syndrome (RDS) who are covered by the Medical Insurance for a New Generation. MATERIALS AND METHODS: A cost-effectiveness evaluation was conducted from the third-payer perspective. Comparisons were made between the use of bovine surfactant (BS) therapy and without BS therapy. A decision tree model with a lifetime horizon was used where the measurements of effectiveness were life years gained (LYG) and quality-adjusted life years (QALYs). A 5% discount rate was considered for costs and health outcomes. All costs are expressed in Mexican pesos 2009. RESULTS: Incremental cost-effectiveness ratios (ICER) were MXN$136670 per LYG and MXN$125250 per QALY. CONCLUSION: Surfactant therapy was confirmed as a cost-effective strategy in accordance with World Health Organization criteria of three per capita gross domestic product (GDP) per QALY in premature infants with RDS in Mexico.OBJETIVO: Estimar la razón de costo efectividad incremental del tratamiento de surfactante de rescate en pacientes pretérmino con Síndrome de Dificultad Respiratoria (SDR) cubiertos por el Seguro Médico para una Nueva Generación. MATERIAL Y MÉTODOS: Evaluación de costo-efectividad desde la perspectiva del tercer pagador. Los comparadores fueron la terapia de surfactante bovino y la alternativa de no emplear ésta. Se utilizó un árbol de decisión que consideró la esperanza de vida como horizonte temporal y las medidas de efectividad fueron los años de vida ganados (AVG) y los años de vida ajustados por calidad de vida ( AVAC).Resultados en pesos mexicanos del 2009. RESULTADOS: Las RCEI por AVG y AVAC fueron de MXN$136670 y MXN$125250. CONCLUSIÓN: La razón de costo por AVG y AVAC para la terapia de surfactantes en pacientes prematuros con SDR en México fue menor a tres veces el PIB per cápita, por lo que es una estrategia costo-efectiva según los criterios de la OMS.

El objetivo del presente trabajo fue determinar la adaptación de genotipos de tomate, bajo condiciones de invernadero. Los genotipos fueron: híbridos: Contessa, Summer Flavor 5000, Summer Flavor 6000, Celebrity, Bonita, Shady Lady, Sunbolt, Sunny, Heat Wave y Olympic; y la variedad FloraDade como testigo. Se evaluaron variables fisiológicas y de rendimiento. Las variables fisiológicas se determinaron en tres evaluaciones en el ciclo del cultivo, en tres horas del día y dos posiciones de hoja en cada evaluación. Se encontraron correlaciones significativas (p≤0,05) entre rendimiento en t/ha, y rendimiento promedio/ planta/corte, frutos/planta/corte y rendimiento/planta, y entre fotosíntesis y uso eficiente del agua. En el análisis de componentes principales, se encontró que los primeros cinco componentes tuvieron un Eigenvalor mayor a uno, explicando los tres primeros un 72% de la varianza total. El primer componente, con un 36% de la variación total, se debió a las “características de rendimiento”, el segundo componente, con un 23% de la variación total, se debió a las “características de regulación interna de temperatura” y el componente cinco, con un 7,4 % de la variación, a la “producción eficiente de fotosintatos”. El análisis de regresión lineal múltiple fue significativo (p≤0,01). El rendimiento en t/ha, se explica por una ecuación lineal múltiple (r2= 0,98) de cuatro variables.

Con el objetivo de determinar las variables más relacionadas con el rendimiento, así como los principales componentes de variación, se establecieron en campo, en Ramos Arizpe, Coahuila, 12 genotipos de melón, en un diseño de Bloques Completos al Azar, con cuatro repeticiones. La parcela experimental fue de dos surcos de cinco metros de largo sembrados a doble hilera. Los genotipos en estudio fueron: híbridos: Primo, Pronto, Challenger, Cheyenne, Hi-Line, Cruiser, Durango, Apache, Laguna, Caravelle y Main Pak, y la variedad Top Mark, testigo; las variables evaluadas fueron: rendimiento (11 variables: cuantitativas y cualitativas); fenológicas (tres variables); agroclimáticas (cinco Variables) y fisiológicas (cuatro variables). Se encontraron correlaciones significativas (p

Análisis de 40.000 fotofluorografias. Centro Epidemiológico No. 3. Bogotá Fue el profesor brasilero Manuel Abreu, quien inició los primeros trabajos sobre este método en 1924 y los presentó en forma definitiva en 1936. Posteriormente el doctor Hanker aplica la Abrengrafía al examen en serio de colectividades. Entre nosotros, fue el doctor Omar Benavides en 1940 quien presentó su trabajo de tesis sobre las primeras abreugrafías tomadas en un aparato ideado por él. En Bogotá, se inició la campaña por este sistema en enero de 1947 con la fundación del Centro Epidemiológico No 1, dirigido por el doctor Antonio Acosta Pinzón.

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(Datos tomados de la publicación que hizo el doctor Alfonso Reyes, profesor de la Universidad Externado de Colombia, sobre el Código y su traducción al castellano).Si un médico ha tratado un hombre libre con un cuchillo metálico por una herida grave, y lo ha curado, o por un tumor, y ha curado su ojo, recibirá diez siclos de plata.Si ha tratado el hijo de un plebeyo, recibirá cinco siclos de plata.Si ha tratado un esclavo, el amo de éste le entregará dos siclos de plata.Si un médico ha tratado un hombre con un cuchillo metálico por una herida grave, y le hacausado la muerte, o ha abierto un tumor en un hombre con un cuchillo metálico y le hadestruído un ojo, se le amputarán las manos.Si un médico ha tratado el esclavo de un plebeyo con un cuchillo metálico por una heridagrave y le ha provocado la muerte, entregará esclavo por esclavo.Si le ha abierto un tumor con un cuchillo metálico y le ha destruido un ojo, pagará la mitadde su precio en plata.Si el médico ha curado un hueso fracturado de un hombre libre o ha restaurado la carne enferma, el paciente entregará al médico cinco siclos de plata.Si fuere el hijo de un plebeyo, se le entregará tres siclos de plata.Si fuere el esclavo de un hombre, el amo del esclavo entregará al médico dos siclos de plata. Si un médico de bueyes o asnos ha tratado un buey o un asno por una herida grave y lo hacurado, el dueño del buey o asno entregará al médico un sexto de un siclo de plata como honorario...

En este número no se incluyeron resúmenes ni palabras clave.