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Hyperinflammation present in individuals with severe COVID-19 has been associated with an exacerbated cytokine production and hyperactivated immune cells. Endoplasmic reticulum stress leading to the unfolded protein response has been recently reported as an active player in inducing inflammatory responses. Once unfolded protein response is activated, GRP78, an endoplasmic reticulum–resident chaperone, is translocated to the cell surface (sGRP78), where it is considered a cell stress marker; however, its presence has not been evaluated in immune cells during disease. Here we assessed the presence of sGRP78 on different cell subsets in blood samples from severe or convalescent COVID-19 patients. The frequency of CD45+sGRP78+ cells was higher in patients with the disease compared to convalescent patients. The latter showed similar frequencies to healthy controls. In patients with COVID-19, the lymphoid compartment showed the highest presence of sGRP78+ cells versus the myeloid compartment. CCL2, TNF-α, C-reactive protein, and international normalized ratio measurements showed a positive correlation with the frequency of CD45+sGRP78+ cells. Finally, gene expression microarray data showed that activated T and B cells increased the expression of GRP78, and peripheral blood mononuclear cells from healthy donors acquired sGRP78 upon activation with ionomycin and PMA. Thus, our data highlight the association of sGRP78 on immune cells in patients with severe COVID-19.

Background Febrile neutropenia (FN) is an early indicator of infection in oncology patients post-chemotherapy. We aimed to determine clinical predictors of septic shock and/or bacteremia in pediatric cancer patients experiencing FN and to create a model that classifies patients as low-risk for these outcomes. Methods This is a retrospective analysis with clinical data of a cohort of pediatric oncology patients admitted during July 2015 to September 2017 with FN. One FN episode per patient was randomly selected. Statistical analyses include distribution analysis, hypothesis testing, and multivariate logistic regression to determine clinical feature association with outcomes. Results A total of 865 episodes of FN occurred in 429 subjects. In the 404 sampled episodes that were analyzed, 20.8% experienced outcomes of septic shock and/or bacteremia. Gram-negative bacteria count for 70% of bacteremias. Features with statistically significant influence in predicting these outcomes were hematological malignancy (P < .001), cancer relapse (P = .011), platelet count (P = .004), and age (P = .023). The multivariate logistic regression model achieves AUROC = 0.66 (95% CI 0.56–0.76). The optimal classification threshold achieves sensitivity = 0.96, specificity = 0.33, PPV = 0.40, and NPV = 0.95. Conclusions This model, based on simple clinical variables, can be used to identify patients at low-risk of septic shock and/or bacteremia. The model’s NPV of 95% satisfies the priority to avoid discharging patients at high-risk for adverse infection outcomes. The model will require further validation on a prospective population.

IntroductionMultisystem inflammatory syndrome in children associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death.MethodsThis multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis (LCA) to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression.ResultsThe study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysms were found in 5.7% and 13.2% of the patients in whom coronary artery diameter was measured, respectively. Any cause in-hospital mortality was 5.4%. Hospitalization after ten days of symptoms was associated with coronary artery abnormalities (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2.0). Age ≥10 years (OR: 5.6, 95% CI: 1.4–2.04), severe underlying condition (OR: 9.3, 95% CI: 2.8–31.0), platelet count 3 (OR: 4.2, 95% CI: 1.2–14.7), international normalized ratio >1.2 (OR: 3.8, 95% CI: 1.05–13.9), and serum ferritin concentration >1,500 mg/dl at admission (OR: 52, 95% CI: 5.9–463) were risk factors for death.DiscussionMortality in patients with MIS-C was higher than reported in other series, probably because of a high rate of cases with serious underlying diseases.

Multisystem inflammatory syndrome in children temporally associated with coronavirus disease 2019 (MIS-C), a novel hyperinflammatory condition secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with severe outcomes such as coronary artery aneurysm and death. This multicenter, retrospective, observational cohort study including eight centers in Mexico, aimed to describe the clinical characteristics and outcomes of patients with MIS-C. Patient data were evaluated using latent class analysis to categorize patients into three phenotypes: toxic shock syndrome-like (TSSL)-MIS-C, Kawasaki disease-like (KDL)-MIS-C, and nonspecific MIS-C (NS-MIS-C). Risk factors for adverse outcomes were estimated using multilevel mixed-effects logistic regression. The study included 239 patients with MIS-C, including 61 (26%), 70 (29%), and 108 (45%) patients in the TSSL-MIS-C, KDL-MIS-C, and NS-MIS-C groups, respectively. Fifty-four percent of the patients were admitted to the intensive care unit, and 42%, 78%, and 41% received intravenous immunoglobulin, systemic glucocorticoids, and anticoagulants, respectively. Coronary artery dilatation and aneurysm were found in 5.7% and 13.2% of the patients, respectively. The rate of mortality due to SARS-CoV-2-related factors was 4.6%. Delay of ≥10 days in hospital admission was associated with coronary artery aneurysm or dilatation (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2–2.0). Age ≥ 10 years (OR 5.6, 95% CI 1.4–2.04), severe underlying condition (OR 9.3, 95% CI 2.8–31.0), platelet count < 150,000/mm3(OR 4.2, 95% CI 1.2–14.7), international normalized ratio > 1.2 at admission (OR 3.8, 95% CI 1.05–13.9), and serum ferritin concentration > 1500 mg/dL (OR 52, 95% CI 5.9–463) were risk factors for death.

BackgroundThe new coronavirus SARS-CoV-2 pandemic has been relatively less lethal in children; however, poor prognosis and mortality has been associated with factors such as access to health services. Mexico remained on the list of the ten countries with the highest case fatality rate (CFR) in adults. It is of interest to know the behavior of COVID-19 in the pediatric population. The aim of this study was to identify clinical and sociodemographic variables associated with mortality due to COVID-19 in pediatric patients.ObjectiveUsing National open data and information from the Ministry of Health, Mexico, this cohort study aimed to identify clinical and sociodemographic variables associated with COVID-19 mortality in pediatric patients.MethodA cohort study was designed based on National open data from the Ministry of Health, Mexico, for the period April 2020 to January 2022, and included patients under 18 years of age with confirmed SARS-CoV-2 infection. Variables analyzed were age, health services used, and comorbidities (obesity, diabetes, asthma, cardiovascular disease, immunosuppression, high blood pressure, and chronic kidney disease). Follow-up duration was 60 days, and primary outcomes were death, hospitalization, and requirement of intensive care. Statistical analysis included survival analysis, prediction models created using the Cox proportional hazards model, and Kaplan-Meier estimation curves.ResultsThe cohort included 261,099 cases with a mean age of 11.2 ± 4 years, and of these, 11,569 (4.43%) were hospitalized and 1,028 (0.39%) died. Variables associated with risk of mortality were age under 12 months, the presence of comorbidities, health sector where they were treated, and first wave of infection.ConclusionBased on data in the National database, we show that the pediatric fatality rate due to SARS-CoV-2 is similar to that seen in other countries. Access to health services and distribution of mortality were heterogeneous. Vulnerable groups were patients younger than 12 months and those with comorbidities.

Introducción. En la adolescencia aumentan las necesidades nutricionales y se adquieren nuevos hábitos alimentarios, debido a influencias psicológicas y sociales que condicionan la aparición de distorsión de la imagen corporal. El objetivo del estudio fue identificar la relación de la distorsión de la imagen corporal en mujeres adolescentes con su estado de nutrición, síntomas depresivos, hábitos alimentarios, actividad física y sedentarismo.Material y métodos. Estudio transversal en 174 adolescentes en 2018. Se evaluó el estado de nutrición por índice de masa corporal, se auto aplicó un cuestionario para conocer la percepción de imagen corporal, síntomas depresivos, hábitos alimentarios, actividad física y sedentarismo. Se realizó un análisis de regresión logística. La razón de momios se presenta con intervalos de confianza al 95 %. Se consideró estadísticamente significativo p

Child abuse is one of the leading causes of morbidity and mortality worldwide. This study aimed to identify whether the approach to the diagnosis of child abuse was comprehensive in a tertiary care hospital.We conducted a retrospective study of patients with a final diagnosis of child abuse admitted through the emergency department.A total of 73 confirmed cases were analyzed. We observed a predominance of female patients (65.8%). Physical abuse was the most common type of abuse (80.8%). Complete blood count and a nutritional status analysis were recorded in 100% of the patients and coagulation times in 43%; however, no patient had a thorough bone series study.According to the evidence found in medical records, gaps were detected in the approach to patients with suspected child abuse upon arrival at the emergency department. For this reason, all areas where pediatric medical care is provided should have tools that offer agility and ease of diagnosis.El maltrato infantil es una de las principales causas de morbilidad y mortalidad en todo el mundo. El objetivo de este estudio fue identificar si el abordaje del diagnóstico de maltrato infantil se realizó de manera completa en un hospital de tercer nivel de atención.Se llevó a cabo un estudio retrospectivo de pacientes con el diagnóstico final de maltrato infantil que ingresaron a través del servicio de urgencias.Se analizaron 73 expedientes. Se observó un predominio de pacientes del sexo femenino (65.8%). El maltrato físico fue el tipo de maltrato más común (80.8%). Se registraron los datos de hemograma y estado nutricional en el 100% de los pacientes y de tiempos de coagulación en el 43%; sin embargo, no se registró en ningún paciente el dato de una serie ósea completa.Según las evidencias encontradas en los expedientes clínicos, se detectaron lagunas en el abordaje de los pacientes con sospecha de maltrato infantil a su llegada al servicio de Urgencias. Por este motivo, todas las áreas donde se brinda atención médica pediátrica deberían contar con herramientas que ofrezcan agilidad y facilidad para realizar el diagnóstico.

Among congenital heart diseases, those with univentricular physiology are the most severe with the lowest survival. Fontan surgery (FS) is the procedure of choice, as it bypasses the flow from the caval veins to the pulmonary circulation but requires close monitoring for late complications. The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic caused nations to prioritize the availability of human and material health resources to benefit those infected. This study aimed to evaluate the clinical consequences of hospital reconversion due to the COVID-19 pandemic in a univentricular heart clinic for patients with FS from the bioethical perspective.We conducted an analytical cross-sectional study in a captive cohort of patients with FS treated in a tertiary hospital with conversion to COVID-19 patient care. The consequences of discontinuation of follow-up were recorded. Qualitative variables were expressed as frequencies and percentages, and quantitative variables as medians and interquartile ranges (p25-p75). Comparison between the two groups was performed with the χWe included 51 patients with a median age of 13 years and a follow-up of 5 years. The male: female ratio was 0.88:1.12, and 41% (21) presented failures. More than 90% of the patients presented needs for medications and imaging studies. The two patients cared for in palliative care discontinued their care.Continuity of care must be guaranteed for all patients who require it, so health policies are needed to ensure compliance with vulnerable groups.Entre las cardiopatías congénitas, las de fisiología univentricular son el espectro más grave y con menor supervivencia. La cirugía de Fontan es el procedimiento de elección, ya que deriva el flujo de las venas cava a la circulación pulmonar, pero requiere un seguimiento estrecho de las complicaciones tardías. La pandemia por el SARS-CoV-2 (coronavirus 2 causante del síndrome respiratorio agudo grave) condicionó que las naciones priorizaran la disposición de los recursos humanos y materiales en salud en beneficio de los infectados. El objetivo de este estudio fue evaluar las consecuencias clínicas de la reconversión hospitalaria por la pandemia de COVID-19 en una clínica de corazón univentricular de los pacientes con cirugía de Fontan desde el punto de vista bioético.Se llevó a cabo un estudio transversal analítico en una cohorte cautiva de pacientes con cirugía de Fontan atendidos en un hospital de tercer nivel con reconversión para atención de pacientes por COVID-19. Se registraron las consecuencias derivadas de la interrupción del seguimiento. Las variables cualitativas se expresaron en frecuencias y porcentajes, y las cuantitativas en medianas y rangos intercuartílicos (p25-p75). La comparación entre ambos grupos se realizó con la prueba de χSe incluyeron 51 pacientes, con una mediana de edad de 13 años y seguimiento de 5 años. La relación de sexo masculino: femenino fue de 0.88:1.12, y el 41% (21) presentaron fallas. Más del 90% de los pacientes presentaron necesidades en el suministro de medicamentos y estudios de imagen. Los dos pacientes atendidos en cuidados paliativos suspendieron su atención.La continuidad asistencial debe estar garantizada para todos los enfermos que la requieran, por lo que se necesitan políticas de salud para que esta continuidad se cumpla en los grupos vulnerables.

BackgroundPediatric inflammatory multisystem syndrome (PIMS) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children that resembles Kawasaki syndrome and places them at high risk of cardiorespiratory instability and/or cardiac damage. This study aims to describe the clinical presentation and outcomes of patients with PIMS in Mexico City.MethodsThis was an observational study of children hospitalized for PIMS based on the Centers for Disease Control and Prevention case definition criteria, in a single tertiary care pediatric center in Mexico City between May 1, 2020, and September 30, 2021. Demographic characteristics, epidemiological data, medical history, laboratory tests, cardiologic evaluations, treatment, and clinical outcomes were analyzed.ResultsSeventy-five cases fulfilled the case definition criteria for PIMS [median age: 10.9 years, Interquartile range (IQR): 5.6–15.6]. Fifteen (20%) patients had a severe underlying disease, 48 (64%) were admitted to the intensive care unit, 33 (44%) required invasive mechanical ventilation and 39 (52%) received vasopressor support. The patients were clustered through latent class analysis based on identified symptoms: Cluster 1 had rash or gastrointestinal symptoms (n = 60) and cluster 2 were those with predominantly respiratory manifestations (n = 15). Two patients (2.7%) died, and both had severe underlying conditions. Five patients (6.7%), all from cluster 1, developed coronary aneurysms.ConclusionThere were a high proportion of patients with severe respiratory involvement and positive RT-PCR SARS-CoV-2 and very few cases of coronary aneurysms in our study which suggests that a high proportion of the children had severe acute COVID-19. The clinical manifestations and outcomes are comparable to previously reported international studies.

Background: Non-therapeutic hysterectomy has been performed to this day in Mexican women with intellectual disabilities (IDs), but the rationale for performing the procedure has been rarely submitted to clinical ethics committees. The objectives of the present research were to determine the frequency of hysterectomy and the clinical and epidemiologic characteristics that associated to the indication of hysterectomy in girls and young females with IDs and to analyse the emerging ethical issues related to the procedure.Materials and Methods: A medical chart review was conducted to identify female patients aged ≤ 25 years who had IDs based on anatomical pathologies and hospital records and underwent hysterectomy between January 2014 and December 2019 in nine high-concentration hospitals in Mexico City. Data were collected using a questionnaire developed ex professo and validated through a pilot study and analysed using the Statistical Package for the Social Sciences (SPSS) 21.0 software.Results: Information of 234 female patients with or without ID who were ≤ 25 years of age was reported by the departments of anatomical pathology and paediatrics. Of the patients, 184 (79%) were excluded because the information reported was found to be erroneous or incomplete during the medical records review. Most of the 50 emales included in the study had moderate ID (n = 23, 46%) followed by those with severe ID (n = 17, 34%). The mean age at hysterectomy was 15 ± 2.9 years. Prophylactic-total abdominal hysterectomy was the most frequently performed (n = 42, 84%). A concurrence was observed between the parental and medical reasons justifying hysterectomy. The most frequent reasons were fertility control (parents vs. physicians: 46 vs. 42%), management of menstrual hygiene (28 vs. 30%) and risk of sexual abuse (6 vs. 6%).Conclusion: This study showed that performing non-therapeutic hysterectomy is subject to the clinical judgement of physicians according to their perception of the patient's quality of life. Therefore, the ethical quality of the decision to perform the procedure in girls and young females resides in the ethical value of its consequences.

Background New-onset diabetes after transplantation refers to the development of diabetes after solid organ transplantation without a history of diabetes and is related to poor graft function and lower survival rate. In the kidney transplant population, NODAT occurs in 24% of adults and 9% of children. The real incidence and risk factors in the pediatric population is unknown, which we aimed to determine in this study. Methods A retrospective study was conducted in patients who underwent kidney transplantation in the Pediatric Nephrology Service of the "Federico Gomez" Children's Hospital of Mexico. Results The study included 127 children divided into groups 1 and 2 (without [n = 110 patients, 86.5%] and with NODAT [n = 17 patients, 13.4%], respectively), with median ages of 14 years (interquartile range [IQR], 9-16 years) and 15 years (IQR, 13-16 years; p = .3), respectively. Cox proportional hazards analysis revealed an association between changes from baseline to 24-h postoperative blood glucose level as a risk factor of the development of NODAT. This implies that each unit increase in blood glucose level in the first hours after transplantation also increases the risk of developing diabetes (95% confidence interval, 1.011-1.021; p = Conclusions Post-kidney transplant patients require immediate follow-up, and attention should be paid to changes in blood glucose level in the first 24 h after transplantation, as any alteration may be an early sign of development of NODAT, especially in patients with a family history of diabetes mellitus.

Background. When we talk about morality, a question arises as to whether it is a natural characteristic of humans—that is, whether it is what people should pursue as individuals or whether it is a social construct. Kohlberg established six progressive stages of moral judgment that form three levels of moral development, showing the development of people’s thinking on moral issues that is characterized by the aforementioned criteria. Methods. This study’s objective was to compare the level of moral reasoning among graduate students in medicine with a group of young graduates from other degrees and a group of non-professional adults.The moral reasoning questionnaire (Defining Issues Test, DIT) designed by James Rest based on Kohlberg’s theory (Rest 1979) was applied. In total, 304 questionnaires were completed. Results. Depending on the population studied, differences have been found in the profile of moral development. The profile of family clinic users showed a very high predominance of subjects in category 1 at 70%, but only 4.5% in category 3, while in the group of pediatric specialty students, 37.5% were found in category 1 and 34% in category 3. They were the group with the highest percentage in this category. This vast difference could be because the differences in the age and socio-education levels of the beneficiaries are much wider than that of the residents. However, differences are also found if the profiles of residents are compared with those of master’s students because the latter comprised 56% in category 1 and 19% in category 3. We also found differences in the profiles of moral development based on the highest education level. Conclusions. Based on the results of this study, the population could be classified into three levels of moral development, the first level being the predominant one and the third the least common, as we expected prior to the study. The reason why some individuals reach the highest level while others do not remains a question to be addressed. The results show us that there is a difference in some populations depending on education level and even the type of degree pursued.

El desarrollo de enterocolitis necrosante, con la consecuente perforación intestinal, es frecuente en los recién nacidos pretérmino. El tratamiento estándar de la perforación intestinal es quirúrgico. Sin embargo, se sugiere que la inserción de un drenaje en el abdomen puede ser efectivo para tratar esta afección. Se resumen los resultados de una revisión sistemática Cochrane que compara la efectividad del drenaje peritoneal con la de la laparotomía en neonatos con enterocolitis necrosante perforada.Necrotizing enterocolitis is common in preterm newborns, with consequent intestinal perforation. The standard treatment for intestinal perforation is surgery. However, it is suggested that inserting a drain into the abdomen may be effective in treating this condition. This document summarizes the results of a Cochrane systematic review comparing the effectiveness of peritoneal drainage with laparotomy in neonates with perforated necrotizing enterocolitis.

The pandemic caused by SARS CoV-2 (COVID-19) has affected millions of people since 2020. There are clinical differences and in mortality between the adult and paediatric population. Recently, the immune response through the development of antibodies has gained relevance due to the risk of reinfection and vaccines' development.Objective: Was to compare the association of clinical history and the clinical presentation of the disease with the development of IgG antibodies against SARS-CoV-2 in paediatric and adult patients with a history of positive reverse transcriptase-polymerase chain reaction (RT-PCR) results.Methods: Cross-sectional observational study carried out in a Paediatric Hospital in Mexico City included patients under 18 years of age and health personnel with positive RT-PCR for COVID-19 comparing antibody expression. The development of specific IgG antibodies was measured, the presence of comorbidities, duration, and severity of symptoms was determined.Results: Sixty-one subjects (20 < 18 years and 41 > 18 years) were analysed. The median sample collection was 3 weeks. There were no differences in the expression of specific antibodies; no differences were shown according to the symptoms' severity. A positive correlation (r = 0.77) was demonstrated between the duration of symptoms and antibody levels.Conclusions: In conclusion, there is a clear association between the duration of the symptoms associated with SARS-CoV-2 infection and the IgG units generated in paediatric and adult patients convalescing from COVID-19.

El desarrollo de enterocolitis necrosante, con la consecuente perforacion intestinal, es frecuente en los recien nacidos pretermino. El tratamiento estandar de la perforacion intestinal es quirurgico. Sin embargo, se sugiere que la insercion de un drenaje en el abdomen puede ser efectivo para tratar esta afeccion. Se resumen los resultados de una revision sistematica Cochrane que compara la efectividad del drenaje peritoneal con la de la laparotomia en neonatos con enterocolitis necrosante perforada. Necrotizing enterocolitis is common in preterm newborns, with consequent intestinal perforation. The standard treatment for intestinal perforation is surgery. However, it is suggested that inserting a drain into the abdomen may be effective in treating this condition. This document summarizes the results of a Cochrane systematic review comparing the effectiveness of peritoneal drainage with laparotomy in neonates with perforated necrotizing enterocolitis.

There are very few data on analytical biomarker levels in children with congenital heart disease (CHD) before and after cardiopulmonary bypass surgery. We conducted a preliminary study in the Pediatric Hospital of Medical Center IMSS Mexico, to evaluate plasma levels of endothelin-1 (ET-1) and circulating endothelial progenitor cells (CPEC) before and after correction surgery. 56 patients were included: 41 with CHD that required CPB and 15 controls with surgery other than CPB, which were stratified by age (infants, preschool-age-children, and school-age-children). Samples of peripheral blood were taken 24h before and 48h after surgery, cytokine levels (TNF/IL-1β/IL-6/IL-8/IL-10 and IL-12p70) and brachial-artery-flow-mediated dilation (BAFMD) were explored too. Demographic and clinical data were collected. BAFMD was evaluated by-Doppler-ultrasound, the percentage (%) and absolute number (N) of CPEC [CEC and EPC], ET-1 and cytokines concentrations were measured by flow-cytometry, radioimmunoassay and a Bead-Array-cytometric-system, respectively. The% and N of CEC[CD34 + / CD146 + / VEGFR2 + / CD133−] increased in infants versus their control group; and EPC[CD34 + / CD146 + / VEGFR2 + / CD133 +] were higher in the control group of infants versus patients. ET-1 levels were higher in patients than in controls (p = 0.002). N-CEC showed differences between 24 and 48 hours; BAFMD in CPB-preschool at 24H and 48H showed a significant difference. Higher levels of IL-6 and IL-8 were detected in CPB-school-age at 48H. This pilot study observed a significant increase in the levels of CEC and ET-1. To validate these data, subsequent studies should increase the sample size.

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.

Background Depression is highly prevalent worldwide, and may have fatal consequences. Violence is associated to psychopathology and has exponentially increased in some areas of Mexico. Healthcare professionals are vulnerable to increased anxiety, depression, suicide and lately, to violence by organized crime. The aim of the study was to determine the prevalence of anxiety/depression/suicidal ideation and the weight of social violence as a risk factor. Methods Cross sectional study in three generations of undergraduate medical students at entry to internship year in our institution. All students voluntarily agreed to participate. All of them answered Beck and HAM-A. Two generations also responded Plutchik suicidal risk inventory. Sex, type of university and degree of violence in their geographic areas were also recorded. Prevalence rates were calculated for each outcome. χ2 tests and odds ratio (OR) for bivariate analysis, and Mantel-Hanezel to adjust according to level of violence. Results All of the eligible students responded the anxiety and inventories (n = 8,858), and 6,451 also responded the suicide risk test. Overall, 37.2% displayed severe anxiety, 14.9% moderate/severe depression and 8.5% suicidal ideation. Female sex and private university increased the risk for anxiety and depression. High violence, severe anxiety or depression increased the risk for suicidal ideation. Adjusted by violence zone, female sex, being single and the coexistence of depression were associated with a higher risk for suicidal ideation. Conclusions Anxiety, depression and suicidal ideation are highly prevalent among premedical interns in Mexico. Living in highly violent areas significantly increases the risk for anxiety/depression/suicidal ideation.

How primary carers, physicians, health education professionals, and others see or understand the subject of menstruation in women with intellectual disability (ID) is rooted in the socio-cultural context and in the socio-economic structures in which all of them live. The aim of this study was to explore how parents of young females with ID and special education professionals perceive and experience menstrual hygiene management, which coping strategies are applied; and what triggers the performance of a hysterectomy. A qualitative focus group study design was conducted with 69 parents and 11 special education professionals, in 14 schools and one Down syndrome clinic, in Mexico City. Data were analysed using the method of thematic analysis. The main concern of parents was how to cope with the underlying disease. They perceived menstrual bleeding positively. Their psychological distress had to do with the reproductive health of their daughters, with their wish to avoid pregnancy, and with their fear of death and leaving their daughters alone and helpless without them. None of them favoured hysterectomy. Medical indication of hysterectomy was identified as the trigger for its performance. There is an urgent need of policy development/review on best practices for hysterectomy in the females in question.

Introduction: Secondary hyperparathyroidism (SHPT) is a multisystemic syndrome that affects calcium and bone homeostasis in patients with chronic kidney disease (CKD). Despite medical treatment, 1–2% of patients require parathyroidectomy annually. The use of an intraoperative parathormone protocol (IOPTH) to predict cure is still in debate, due to the lack of standardized protocols, the use of different assays, and uneven PTH clearance. This study aimed to determine the diagnostic accuracy of an IOPTH in patients with SHPT for predicting successful surgery after parathyroidectomy.Methods: About 30 patients were enrolled. A prospective observational study (cohort) was performed in patients who were submitted to parathyroidectomy by an endocrine surgeon for SHPT. All were submitted to a bilateral neck exploration with a subtotal parathyroidectomy. Three IOPTH determinations were withdrawn: at anesthetic induction (PTH0), 15 min (PTH15), and 30 min (PTH30) after completion of gland resection. Another sample was taken 24 h after the procedure (PTH24), values Results: A total of 26 patients were included, 19 patients were in the successful group. IOPTH showed a significant difference between groups in their absolute PTH15 and PTH30 values. A significant difference was also found in their PTH drop at 30 min (81 vs. 91%, p = 0.08). For predicting a successful surgery, having a PTH drop >90% at 30 min was the most significant factor [Odds Ratio (OR) 3.0 (1.5–4) IC 95%].Conclusions: This study points toward a stricter and staggered IOPTH protocol to predict a successful surgery. Our results suggest taking a PTH15 expecting a PTH drop of >90%. If this is not achieved, reexploration and a PTH30 sample are suggested to accurately predict success.

Introduction: Peripheral pulmonary arterial stenosis is poorly recognized in the adult population that it can cause pulmonary hypertension, but it is likely that it is misdiagnosed as idiopathic pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension. Case description: 16-year-old female, in functional class II, grade II systolic murmur pulmonary focus, saturation 96%. Chest tomography: left peribronchovascular consolidation. Catheterization: diffuse peripheral pulmonary stenosis, perfusion defect in the left lobe vasculature, probable thrombosis vs atresia, PMAP 78mmHg. Preserved biventricular systodiastolic function. Perfusion lung scan: pulmonary thromboembolism. Methodology: The Boolean method was used to search for MESH terms "segmental arteries" "pulmonary" [and] "stenosis" in the database with repositories of indexed arbitrary scientific evidence (PubMed) and not indexed (ScholarGoogle). Discussion Patients with this disease usually have systemic pressures of the right ventricle secondary to obstruction in the lobar, segmental, and subsegmental branches. Small segmental artery stenting, particularly in patients with congenital diffuse peripheral pulmonary stenosis, has been less successful. Conclusions: In recent years, peripheral pulmonary artery surgery has been associated with low mortality and a reduction in the RV / Ao pressure ratio of almost 50%. The current treatment of these patients remains somewhat controversial and poorly documented since there are places where they cannot be approached surgically.

Acute stress disorder (ASD) is one of the most frequent mental illnesses occurring during sanitary emergencies. This study aimed to estimate the frequency of ASD in health care workers of a tertiary level pediatric hospital during the coronavirus disease (COVID-19) pandemic.We conducted a cross-sectional study in which health care workers completed a virtual questionnaire, including sociodemographic information and the ASD scale.We analyzed 206 questionnaires. The population was divided into three groups: attending physicians, medical residents, and nursing personnel. The frequency of health care workers who showed at least nine symptoms of ASD was 88.8%. No significant differences were found between the studied groups.ASD is a frequent condition in health care workers in the context of the COVID-19 pandemic. We need to investigate further and assess risk and protective factors for developing this and other psychopathologies in this population.El trastorno por estrés agudo es una de las enfermedades mentales más frecuentemente manifestadas en emergencias sanitarias. El objetivo de este estudio fue conocer la frecuencia con la que se presentó el trastorno por estrés agudo en el personal de salud de un hospital pediátrico de tercer nivel durante la epidemia de COVID-19.Se realizó un estudio transversal en el que trabajadores de la salud contestaron un cuestionario virtual que incluyó datos sociodemográficos y la Escala de Trastorno por Estrés Agudo.Se analizaron 206 encuestas. La población se dividió en tres grupos: médicos adscritos, residentes y personal de enfermería. El 88.8% de los trabajadores de la salud reportaron más de nueve síntomas de trastorno por estrés agudo. No se encontraron diferencias significativas entre los grupos de estudio.Los síntomas del trastorno por estrés agudo son frecuentes en los trabajadores de la salud en el contexto de la COVID-19. Es necesario investigar acerca de los factores de riesgo y protectores asociados al desarrollo de esta y otras psicopatologías en dicha población.

BACKGROUND: The new evere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is characterized by its high capacity to transmit. Health-care personnel is highly susceptible to becoming infected. This study aimed to determine the characteristics and known risk factors for contagion and severe outcomes of SARS-CoV-2 disease in health-care personnel of a pediatric coronavirus disease (COVID) center in Mexico City. METHODS: In the last week of March 2020 (at the beginning of phase 2 of the Ministry of Health's national campaign in Mexico), a study was conducted on healthcare workers of a pediatric COVID hospital in Mexico City. Using a virtual interview, we evaluated comorbidities, mobility, areas and functions where they carry out the activities, protection measures, contact history, and vaccination. According to their activities, healthcare workers were classified into the following areas: medical, nursing, other health-care personnel (researchers, nutritionists, rehabilitation, imaging, and laboratory), administrative, and other services. We compared the variables between the groups of healthcare workers with the X2 test. RESULTS: We included 812 participants. The mean age was 41 ± 11 years, and 33% were overweight or obese, 18% were over 60 years old, and 19% had high blood pressure. Medical and nursing personnel presented a higher proportion in the use of standard protection measures. CONCLUSIONS: Among healthcare workers, there are risk conditions for the development of complications in case of SARS-CoV-2 infection. Most medical and nursing personnel use standard protective measures.

Background: Coronavirus disease (COVID)-19 has currently affected 8,015,502 million people worldwide with global mortality around 5% Information in pediatric cancer patients is still limited, but it is emerging day by day The objective of this scoping review was to analyze the available data associated with COVID-19 infection and mortality in pediatric cancer patients and to provide useful information to plan and design strategies in this group Methods: A search was conducted, and eight articles were obtained for qualitative analysis;110 patients were included, all from cross-sectional studies At the time of publication, all the analyzed documents reported no deaths associated with COVID-19 Results: According to the information, COVID-19 infection appears to be less severe in the pediatric population in comparison with adults and does not appear to be a cause of mortality in patients with childhood cancer Conclusions: Given the nature of preliminary reports and a short follow-up in cancer patients, it is necessary to have medium- and long-term follow-up studies to determine the effects of infection and modifications to the treatments of these patients Resumen Introduccion: La enfermedad conocida como COVID-19 ha afectado ya a 8,015,502 millones de personas en el mundo, con una mortalidad global de aproximadamente el 5% La informacion en pacientes pediatricos con cancer es aun limitada y esta surgiendo dia a dia El objetivo de esta revision sistematica fue conocer los datos disponibles sobre la COVID-19 y la mortalidad en los pacientes pediatricos con cancer, y aportar informacion util para planear y disenar estrategias en este grupo Metodos: Se llevo a cabo una busqueda y se seleccionaron ocho articulos para realizar un analisis cuantitativo;se incluyeron 110 pacientes, todos provenientes de estudios transversales Al momento de las publicaciones, no se documentaron fallecimientos asociados a la COVID-19 en los documentos analizados Resultados: De acuerdo con la informacion de esta revision sistematica, la COVID-19 parece ser menos grave que en los adultos y no parece ser causa de mortalidad en pacientes pediatricos con cancer Conclusiones: Dada la naturaleza de los reportes preliminares y el corto seguimiento en los pacientes con cancer, es necesario contar con estudios de seguimiento a mediano y largo plazo para conocer los efectos de la infeccion y de las modificaciones del tratamiento en estos pacientes