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Background: Influenza has continued to be an important public health challenge, and the WHO recommends that countries consider vaccination for persons at high risk. Mexico has such a program, and we sought to determine its current situation., Material and Methods: This study has an ecological, longitudinal, and retrospective design based on secondary information on the acquisition and application of vaccines against influenza from official data from 2006 to 2022., Results: We found annual variability in the numbers of purchases and application of doses, with coverage of less than 90% of the total population every year; in addition, 17 million vaccines were not used in this period., Discussion: This study shows the situation of the program at the national level. Two institutions acquired fewer the vaccines, while one purchased more for its target population, but the necessary vaccinations were not acquired. On average, 1.7 million of the vaccines purchased annually were not used, but in some years, more vaccines were applied than were purchased in all of the institutions. We also observed that, between institutions, the vaccine coverage was very different, from 21% to 180%. On average, 6.2 million people were not vaccinated annually, between 16% and 22% of the target population, demonstrating low coverage. When we compared the coverage data that we calculated to the data published by the institutions, a great difference was observed., Conclusions: We found inconsistencies in the data, indicating their unreliability and potential disorganization within the program, as the target populations of each institution were not clear. In addition, the application data may have had reporting errors. Adequate coverage was not achieved, and the coverage was different from that reported in the official sources. We propose the implementation of different systems for control, evaluation, and access to the information of the program.

Introduction: The impact of the coronavirus disease 2019 (COVID-19) pandemic has globally challenged health services, especially because when the pandemic first reached Mexico, in February 2020, there was no known effective and safe treatment. A treatment scheme was offered by the Institute for the Integral Development of Health (IDISA) in Mexico City from March 2020 to August 2021 when there were many patients with COVID-19. This report summarizes the experience managing COVID-19 with this scheme., Materials and Methods: This is a descriptive, retrolective study. The data was obtained from the case files of the patients who attended the IDISA from March 2020 to August 2021 with COVID-19. All the cases were treated with the scheme consisting of nitazoxanide, azithromycin, and prednisone. Various laboratory blood tests and chest computerized tomography scan were done. When indicated, supplementary oxygen, and another specific treatment were used. A standardized clinical recording was conducted for 20 days based on symptoms and systemic symptoms., Results: Based on the World Health Organization criteria, the patients were classified according to the disease severity: 170 mild, 70 moderate, and 312 severe cases. The outcome was the discharge of 533 patients after their recovery, 16 were excluded from the study, and 6 died., Conclusions: The use of nitazoxanide, azithromycin, and prednisone proved to be effective as it resulted in improvement of symptoms and in successful outcomes for the management of COVID-19 outpatients., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2023 Raúl Romero-Cabello, Raúl Romero-Feregrino, Rodrigo Romero-Feregrino, Berenice Muñoz-Cordero, Samuel Sevilla-Fuentes.)

Background: In recent years in Mexico, a decreased Bacillus Calmette and Guérin (BCG) coverage has been observed concomitantly with new cases of tuberculosis., Material and Methods: This study is a descriptive and analytical evaluation regarding both BCG vaccine acquisition and coverage as reported by official sources over a 16-year period (2006-2021)., Results: We found that vaccine acquisition, dose application and coverage are highly variable each year. Coverage is 90% or higher, except for the 2017-2020 period., Discussion: According to our calculations, between 3,917,616 and 4,961,868 individuals did not receive the BCG vaccine. Coverage was lower than 90% during the last 4 years, whereas this value decreased to 21% in 2020. Except for the last 5 years, the amount of acquired doses surpassed the demand thus causing a considerable vaccine wastage., Conclusions: BCG vaccine coverage is low and many individuals remain unprotected. The access to this vaccine is difficult and the number of newly reported cases of tuberculosis have increased during the last years. Thus, it is necessary to establish vaccination campaigns aimed protect the population and also to deploy a nominal system to control coverage, acquisitions, and target population.

We present a single-centre, retrospective study (1985-2012) of 22 cases of mucormycosis in children. A total of 158 mucormycosis cases were identified, of which 22 (13.96%) were children. The mean age of the children was 10.3 years (range: 6 months-18 years), and 59% of the infections occurred in males. The rhinocerebral form was the main clinical presentation (77.27%), followed by the primary cutaneous and pulmonary patterns. The major underlying predisposing factors were diabetes mellitus in 68.18% of the patients and haematologic diseases in 27.7% of the patients. The cases were diagnosed by mycological tests, with positive cultures in 95.4% of the patients. Rhizopus arrhizus was the foremost aetiologic agent in 13/22 cases (59.1%). In 21 cultures, the aetiologic agents were identified morphologically and by molecular identification. In 10 cultures, the internal transcribed spacer region of the ribosomal DNA was sequenced. Clinical cure and mycological cure were achieved in 27.3% cases, which were managed with amphotericin B deoxycholate and by treatment of the underlying conditions., (© 2014 Blackwell Verlag GmbH.)

Strongyloidiasis is caused by Strongyloides stercoralis, which commonly produces gastrointestinal problems. If immune systems are compromised, the nematode larvae may spread and produce Strongyloides hyperinfection. Diagnosis of strongyloidiasis is based on the observation of larvae in coproparasitological studies. We present a case of a 49-year-oldman, VIH, who developed Strongyloides hyperinfection, diagnosed postmortem. Our patient reached the dissemination stage, which resulted in severe damage to the stomach and intestine, perforation of the intestinal wall, as well as sepsis due to the dissemination of bacteria. The diagnosis is difficult because of the low larvae excretion in stools. It is usually performed by the microscopic examination of fresh and fixed enriched stool samples. Serology was reported to be useful for screening and follow-up after treatment. This case reaffirms that HIV immunosuppression favours the dissemination of S stercoralis larvae. Thus, a search for intestinal parasites should be considered in similar cases.

Primary liver sarcomas make up 2% of all malignant neoplasms of the liver; of these, angiosarcoma is the most common type. Primary liver tumours rarely cause fulminant hepatic failure (FHF), which is most frequently caused by non-neoplasmic pathologies. In the case of neoplasms, the most frequent are lymphoma and metastatic carcinomas. We describe the case of a 76-year-old man who suffered from FHF as a result of a liver angiosarcoma and we present a review of the medical literature in which we found only two cases of liver angiosarcomas linked to FHF.

Sporotrichosis is a subacute or chronic infection caused by Sporothrix schenckii. It is a primary cutaneous infection and it has different clinical forms: disseminated by lymphatic vessels (75%), localised cutaneous form (20%), disseminated cutaneous and extracuteus rarely. The systemic disseminated sporotrichosis is considered a severe opportunistic infection. The best diagnostic test is the culture. The authors report a case of a 36-year-old man, originally from Puebla, Mexico, with a diagnosis of disseminated sporotrichosis. Differential diagnosis with other pathologies includes leishmaniasis, chromoblastomycosis, tuberculosis verrucose and lymphangitis. The development of unusual presentations in immunocompromised patients has been reported.

Background: Vulvovaginitis caused by Candida sp is one of the most frequent infections., Objectives: To culture and to identify the fungi related to clinical manifestations of patients based on a suspected diagnosis of vulvovaginal candidiasis., Patients and Methods: A prospective, transversal and comparative study was performed on 181 women older than 18 years with vulvovaginitis by Candida sp. A correlation was made between the clinical characteristics of this entity and mycological tests such as direct examination and cultures., Results: The direct exam or fresh vaginal exam and cervical sample was positive for the different microscopic forms of Candida (blastoconidia, pseudohyphye or pseudomycelia) in 60.8% (110 women); at the same time that cultures were positive for Candida sp in 51.9% (94 patients)., Conclusions: The direct examination and the cultures of vaginal and cervical exudate are mandatory tests for diagnosis of Candida sp in women with vulvovaginitis.

Objective: To know the incidence and causal agents of the surgical site infection at the Gynecology and Obstetrics Service of the Hospital General de Mexico., Material and Method: A retrospective, descriptive and analytical study was performed on patients with surgical site infection at the Gynecology and Obstetrics Service of the Hospital General de Mexico during January 1st, 2000 to December 31st, 2001., Results: A global low rate of surgical site infection was observed, with predominance on the third life decade patients and on obstetrics events (69.5%). The initial treatment consisting of 600 mg intravenous clindamycin every eight hours and 500 mg intravenous amikacin every 12 hours showed high efficacy. The mean time of hospital stay was nine days; 97% of the discharges were due to improvement, with a minimum rate of mortality., Conclusions: The index of surgical site infections for gynecological and obstetric procedures is lower than the accepted percentage, but it is more frequent in patients submitted to total abdominal hysterectomy.

Objective: To determine the obstetrics outcomes of patients with systemic lupus erythematosus and pregnancy., Materials and Methods: A retrospective, analytic, and descriptive case of study is presented about of the obstetrics outcomes of patients with systemic lupus erythematosus and pregnancy attended in Hospital General de Mexico Obstetrics and Gynecology Service from June, 2000 to February, 2003., Results: Thirty-six records were reviewed. The mean age was 28 years. The most frequent maternal complications were the hypertensive disorders in association with pregnancy (27.5%). One patient had antiphospholipid syndrome, showed HELLP syndrome I and brain hemorrhage, she died in puerperium period. The main resolution of pregnancy was normal delivery. The median gestational age at delivery was 36 weeks (range of 24-40 weeks), and the mean birth weight was 2,389 g, median Apgar scores were 7 and 8 at 1 and 5 minutes of life respectively. There were 19 cases of low weight at birth and 7 preterm deliveries. There were no cases of neonatal lupus., Conclusion: The maternal-fetal morbid-mortality rates decrease when no lupic disease activity is reported. During the pregnancy stage, preterm delivery and intrauterine growth retardation grow in number as observed in all the study subjects. All pregnancies should still be considered high risk and be managed with a multidisciplinary team. Co-existing antiphospholipid syndrome is the poorer prognosis for pregnancy outcome.

Genital candidiasis is a frequent pathology among women. It has a 5% incidence rate of presenting itself in a recurrent way, which leads to a longer treatment. Candida gender has various species. The ones, which are the most usual and the cause of vaginal, cervicovaginal, and vulvovaginal candidiasis are: Candida albicans, C. glabrata and C. krusei. Their presence is related to further appearances. A case study was made to identify the species of Candida gender. It was based on the diagnostics made in three Mexico City hospitals on female genital candidiasis cases. The identified and isolated Candida species obtained were: albicans with a 71.91%, C. glabrata with a 11.80%, and C. tropicalis with a 7.87%.

A multicenter randomized study was performed. One hundred and seventy patients were selected. The patients were 18 years and older. They presented signs and symptoms of genital candidiasis and had positive smear culture for Candida. Eighty five patients were assigned to receive Cicloprox olamine 1%, and eighty five patients were assigned to receive Terconazol 0.8%. The treatment lasted six days with the objective to compare the clinical and antifungal efficiency and safety with both treatments. The result of mixed efficiency (clinical and microbiology) for Cicloprox olamine was 48 cases (62.3%) at the end of the treatment were cured--day 7-; and at the continuation--day 21-42 of them had the same result (55.3%); improvement was seen at the end in 25 cases (32.5%) and at the continuation 21 cases had the same result (27.6%). For Terconazol the result was 45 cases (61.6%) were cured at the end of the treatment, and at the continuation 39 had the same result (57.4%); improvement was seen at the end in 23 cases (31.5%) and at the continuation 22 cases had the same result (32.4%). We conclude that both treatments are effective and well tolerated for genital candidiasis treatment.

Cyclospora cayetanensis is an Apicomplexa protozoa which was found to cause gastroenteritis in humans in 1979. This paper reviews the laboratory diagnosis of the disease. The usefulness of direct examination of fresh fecal matter with special acid-fast stains is emphasized as well as the morphometric differentiation between this organism and other similar coccidia. The paper reviews the sporulation technique of Cyclospora cayetanensis for the recognition and differentiation of artifacts and green-blue algae. Another aspect discussed is the morphology of the parasite in histological sections and with electromicroscopic examination whereby tissue morphology changes caused by the microorganism can be identified. The experience of the Service and Laboratory of Parasitology of the Instituto Nacional de Pediatría of Mexico in the laboratory diagnosis of this protozoosis is described. The paper is oriented towards the inclussion of Cyclospora cayetanensis in the diagnostic protocols for the study of diarrheas in our health Institutions.

To know the situation of the toxoplasmosis in Comitán Chiapas, we made a serological indirect inmunofluorecent antibody test (IFA) to the population of this city and to fifty women with abortion in evolution. The results show us that around five percent of the population in general have positive title of antitoxoplasma gondii antibiodies, and 18% in the women with abortion evolution case. The statistics concluded that seropositive for this parasitic disease is real higher between cases of abortion than population in general (P < 0.006), as well as it is significantly higher in abortion cases than women of the general population of Comitán Chiapas (P < 0.01).

Presently study included 3 groups of 20 women with tricomoniasis demonstrated parasitologicaly for oozing vaginal, the first group received treatment with vaginal ova with metronidazol for 10 days, the second group ova of secnidazol for 3 days and the third group ova of secnidazol for 7 days. The results showed that the clinical manifestations dimanished significantly and the presence of Trichomonas vaginalis disappeared from the vaginal cavity, therefore cure was achieved parasitological in all the cases. We concluded that they are equally useful the metronidazol for 10 days, and the secnidazol for 3 or 7 days, without the presence of adverse effects.

A study to evaluate the efficacy and safety of nitazoxanide as a single agent for the treatment of a broad spectrum of mixed parasitic infections, both protozoa and helminths, was conducted at a primary school in San Pedro Tolimán, Querétaro, Mexico. Three faecal samples from 1824 adults and children were screened for the presence of oocysts, cysts, trophozoites, eggs or larvae of intestinal protozoa or helminths. Two hundred and forty-six adults and children infected with at least one protozoan and 2 helminths were given 7.5 mg/kg of nitazoxanide (500 mg to adults and 200 mg to children less than 12 years old) every 12 h for 3 consecutive days. Faecal samples were examined on days 6, 7, 8, 13, 14 and 15 (+/- 1) following initiation of treatment, using formalin-ether concentration and Kato-Katz egg counting. Treatment with nitazoxanide was 71-100% effective in eliminating evidence of infection with Entamoeba histolytica/E. dispar, Giardia duodenalis, Blastocystis hominis, Isospora belli, Enterobius vermicularis, Ascaris lumbricoides, Trichuris trichiura and Hymenolepis nana. Haematology and clinical chemistry values obtained before and after treatment remained unaffected by nitazoxanide. The drug was well tolerated, with only 15 patients (6.1%) reporting mild abdominal pain that lasted less than 24 h.

Cervical intraepithelial neoplasies (CIN), are very frequent in women with active sexual life who present risk factors. In this paper 220 exfoliative cytology reports from the National Cancer Register of the Direction of Epidemiology, Health Secretory, taken to women from eight Political Delegations in Mexico City, were revised. 134 cases presented CIN. 70.2% were grade III, corresponded to the age group between 26 and 35 years old; more than three pregnancies (47.76%) and more than three births (46.80%). Viral genital infections were related with CIN grades II and III. There are another risk factors that have been poorly analyzed in the national existent literature, therefore, it is necessary to effect further studies to determine the development of CIN in women with active sexual life.

An analytic relationship between positivity of the indirect immunofluorescent test (IIFT) for toxoplasmosis and clinical findings in a population of 328 children with cerebral infantile palsy (CIP) was performed. Children were distributed by age in one of four groups: I (0-2 years); II (3-6 years); III (7-12 years) and IV (13-18 years). One control group of 168 children with no PCI clinical findings was included. 125 sera were positive at 1:64 dilutions. The study of the binomial mother-child of 40 cases rendered 26 mothers with significant titer values. The majority of positive mothers to IIFT correlated with the youngest children (Groups I, II and III), mainly with group I (70.0%), which showed the highest titer ranges. Correlation between positive IIFT and clinical features was as high as 100.0%.

We report 29 new localities with Triatominae in the Republic of México; these Triatominae belong to 8 different species. Infection by Trypanosoma cruzi in the majority of these localities with high rates of positivity was found. Biological observations concerning the collected Triatominae are given. The necessity of continued work in relation to geographical distribution, ecology, frequency of infection by T. cruzy, and the role played by Triatominae of the Republic of México in the transmission of the infection to the man is stressed.

An open, randomized study was carried out with 100 children to compare the efficacy and security of albendazole and metronidazole to eradicate Giardia lamblia. We included 100 patients in primary school age with giardiasis confirmed by parasitoscopic test who had not received treatment during the 2 previous months. A complete clinical study was performed. By using an aleatory code, the children were distributed in 2 groups: A and B. The clinical data was corroborated and the following tests were made: cell blood count, blood chemistry, direct and concentrated coproparasitoscopic study. Both groups were given an antiparasite treatment consisting of albendazole for group A or metronidazole for group B. Clinical, parasitological and blood controls were conducted before, during and after the treatment. A therapeutic efficacy of 94% and 98% for group A and B, respectively, was found. We concluded that albendazole and metronidazole are equally effective in a 5 days treatment period, but some undesirable effects may occur with metronidazole.

Very few uncertain and not trustworthy reports about the frequency of intestinal helminthiases found in humans have been made in México. However, with the few trustful studies carried out from 1981 to 1992, it is possible in México to verify that ascariasis, trichuriasis, hookworm infection and hymenolepiasis are present with significant percentages of infected people 11.2%, 1.7%, 0.15% and 1.8%, respectively. With the information obtained from the researches analyzed in this article, one can conclude that human infections by intestinal helminths in México, at the present time are almost as frequent as in past decades. Without any doubt, this occurs because still remain the factors that contribute to the persistence and spreading of the intestinal helminths, such as fecalism, poor hygienic and alimentary habits within deficient environmental sanitary conditions.

Severe complicated measles has a high mortality rate and no specific treatment. Ten patients with complicated measles - 9 infants with respiratory failure and a 15 year old boy with encephalitis - received immunotherapy with Non-specific Transfer Factor (NTF). The patients had variable degrees of undernourishment and were severely ill when immunotherapy was started. 8/9 cases with respiratory failure were cured. One died of bronchoaspiration while recovering from the measles. The case with encephalitis showed no neurological sequelae two weeks after receiving the last dose of NTF. Treatment of complicated measles with NTF in these patients seemed very effective and deserves further trial.

The present integral clinical and laboratory study was carried out in 325 children infected with Hymenolepis nana. Results showed that H. nana is found among the top five intestinal parasitosis in school children in Mexico City, in the majority of the cases associated with protozoans and other helminths, especially and with Giardia lamblia. Although the amount of parasites found is small, the clinical manifestations vary very little with larger amounts. The most important and more constant clinical manifestations in those solely infected with H. nana and with other combinations are: abdominal pain, hyporexia and irritability. We have seen that in patients infected solely with H. nana, there is weight loss, meteorism and flatulences. In those associated with G. lamblia, diarrhea is one of the most frequent manifestations. Hymenolepiasis is an important disease in our environment due to its high frequency among pre-school and school children and its constant identifiable clinical manifestations.

This paper describes the general conditions of the social and economic dynamics of the rural area, with emphasis on the development of the factors that affect health in Mexico, and briefly analyzes the system for the education and training of manpower for health care. The author presents arguments in support of an alternative proposal for the training of the "community health technician" as a professional produced by four years of study following graduation from secondary school, and trained to take measures that contribute to the integral development of the community by acting upon the factors involved in the occurrence of pathological states, and to be the first contact for persons with medical problems. The course of training is described in terms of its ultimate purpose, which is improvement of the health status of a rural community, and of the general objectives in the "community development" and "medical care" areas. The course is administered in 25 modules as follows: four introductory modules to acquaint the student with the requirements for dealing with the areas, 11 modules on community development, eight modules on first-contact medical care, and the last two for practical exercises and community work, in which the student is required to bring all his knowledge to bear on a given community. Lastly, the course content of each semester is described together with the distribution of the theoretical and practical work in each module, and the outlook for its success, which points to the possibility of incorporating this resource into programs for extending coverage to rural areas.