Epidemiological aspects of facial trauma in a third level hospital in Mexico

Background: Facial trauma is common in early adulthood and may require complex surgery and even high mortality. Methods: Retrospective, cross-sectional study at the Hospital General de México during the period from January 2018 to December 2021. Patients with a diagnosis of fracture of the facial region, who had a complete clinical record, of any age, were included. Patients who did not comply with the treatment in the hospital unit, with incomplete clinical records, were excluded. Through non-probability sampling, a sample of 156 patients was formed. The descriptive data analysis was carried out by calculating frequencies and percentages for the qualitative variables. For the quantitative variables, measures of central tendency and dispersion were calculated according to the distribution of the variables (mean and standard deviation). for variables with normal distribution and median with interquartile range for variables with non-normal distribution). Results: 156 patients were included, the male sex predominated (89.7%), the age group from 21 to 30 years (35.3%), the injury mechanism of aggression by a third party (54.5%). Facial fractures occurred in the following descending order: orbit (64.7%), zygoma (41.7% n=65), mandibular (23.1% n=36), nasal (22.4% n=35), maxilla (21.8% n=34), NOE (4.5% n=7), Le Fort (3.8% n=6), and palate (3.8% n=6). Within orbital fractures, the most frequently affected region was the orbital floor (42.3%). The patients with orbital fracture were mostly men (88.1% versus 11.9%). The highest frequency of these fractures was between the ages of 21 and 30 (38.6%). Surgical treatment of fractures in general was established in 44.9%, performing open reduction and internal fixation of fractures in 41.0%. Conclusions: The most frequent facial fractures are: orbit, zygoma, and mandibular; they mainly affect the male sex in the second decade of life, they are produced mainly by aggressions to third parties. The management of facial fractures is predominantly surgical, through open reduction and internal fixation

Vulnerability Factors and Pathways Leading to Underage Entry into Sex Work in two Mexican-US Border Cities

The current wave of interest in human trafficking and the commercial sexual exploitation of children has exposed a lack of knowledge about the vulnerabilities leading to underage entry into sex work. This knowledge is necessary for the development of effective prevention programs to identify girls who are most at-risk, especially in Latin America, a region that is believed to be a large source of persons moved across international borders for the purposes of sexual and labor exploitation. The objective of this study was to explore and increase understanding of the vulnerability factors and pathways leading to underage entry into sex work experienced by women currently engaging in sex work in two cities on the northern border of Mexico. From August 2013 to October 2014, 20 female sex workers (FSWs) with a history of entry into sex work prior to age 18 were recruited for in-depth interviews from a larger time-location sample of female sex workers (FSWs) participating in a quantitative survey in Tijuana and Ciudad Juarez. The median age of entry into sex work was 14 (range 10-17); 12/21 participants reported being forced into sex work and, of these, 7 were transported to another city where they began engaging in sex work. Family dysfunction (e.g., domestic violence between parents, parent drug use, neglect, etc.), sexual and physical abuse, and teen pregnancy were among the key themes that emerged as vulnerabilities to underage entry into sex work. Women’s narratives clearly illustrated that the vulnerabilities and pathways leading to underage entry are manifold, complex, and often intersect with each other. Our findings begin to lay the groundwork for understanding the potential vulnerabilities and pathways leading to underage entry into sex, and may have relevance to Latin America in general. This study also provides a foundation for further research to explore what may mitigate these vulnerabilities as well as creating evidence-based interventions to prevent commercial sexual exploitation of minors in the region

Triatoma dimidiata Infestation in Chagas Disease Endemic Regions of Guatemala: Comparison of Random and Targeted Cross-Sectional Surveys

Chagas disease is a vector-borne parasitic zoonosis endemic throughout South and Central America and Mexico. Guatemala is engaged in the Central America Initiative to interrupt Chagas disease transmission. A major strategy is the reduction of Triatoma dimidiata domiciliary infestations through indoor application of residual insecticides. Successful control of T. dimidiata will depend on accurate identification of areas at greatest risk for infestation. Initial efforts focused primarily on targeted surveys of presumed risk factors and suspected infestation to define intervention areas. This policy has not been evaluated and might not maximize the effectiveness of limited resources if high prevalence villages are missed or low prevalence villages are visited unnecessarily. We compare findings from the targeted surveys to concurrent random surveys in two primary foci of Chagas disease transmission in Guatemala to evaluate the performance of the targeted surveys. Our results indicate that random surveys performed better than targeted surveys and should be considered over targeted surveys when reliability of risk factors has not been evaluated, identify useful environmental factors to predict infestation, and indicate that infestation risk varies locally. These findings are useful for decision-makers at national Chagas Disease control programs in Central America, institutions supporting development efforts, and funding agencies

Evaluation of Spatially Targeted Strategies to Control Non-Domiciliated Triatoma dimidiata Vector of Chagas Disease

Chagas disease is one of the most important parasitic diseases in Latin America. Since the 1980's, many national and international initiatives have contributed to eliminate vectors developing inside human domiciles. Today's challenge is to control vectors that are non-adapted to the human domicile, but still able to transmit the parasite through regular short stay in the houses. Here, we assess the potential of different control strategies applied in specific spatial patterns using a mathematical model that reproduces the dynamic of dispersion of such ‘non-domiciliated’ vectors within a village of the Yucatan Peninsula, Mexico. We show that no single strategy applied in the periphery of the village, where the insects are more abundant, provides satisfying protection to the whole village. However, combining the use of insect screens in houses at the periphery of the village (to simultaneously fight insects dispersing from the garden and the forest), and the cleaning of the peri-domicile areas of the centre of the village (where sylvatic insects are absent), would provide a cost-effective control. This type of spatially mixed strategy offers a promising way to reduce the cost associated with the repeated interventions required to control non-domiciliated vectors that permanently attempt to infest houses

Eco-bio-social determinants for house infestation by non-domiciliated Triatoma dimidiata in the Yucatan peninsula, Mexico

Background Chagas disease is a vector-borne disease of major importance in the Americas. Disease prevention is mostly limited to vector control. Integrated interventions targeting ecological, biological and social determinants of vector-borne diseases are increasingly used for improved control. Methodology/principal findings We investigated key factors associated with transient house infestation by T. dimidiata in rural villages in Yucatan, Mexico, using a mixed modeling approach based on initial null-hypothesis testing followed by multimodel inference and averaging on data from 308 houses from three villages. We found that the presence of dogs, chickens and potential refuges, such as rock piles, in the peridomicile as well as the proximity of houses to vegetation at the periphery of the village and to public light sources are major risk factors for infestation. These factors explain most of the intra-village variations in infestation. Conclusions/significance These results underline a process of infestation distinct from that of domiciliated triatomines and may be used for risk stratification of houses for both vector surveillance and control. Combined integrated vector interventions, informed by an Ecohealth perspective, should aim at targeting several of these factors to effectively reduce infestation and provide sustainable vector control

Factors Affecting Infestation by Triatoma infestans in a Rural Area of the Humid Chaco in Argentina: A Multi-Model Inference Approach

Vector-borne transmission of Chagas disease remains a major public health problem in parts of Latin America. Triatoma infestans is the main vector in the countries located in the South American Cone, particularly in the Gran Chaco ecoregion where residual insecticide control has achieved only a moderate, irregular impact. To contribute to improved control strategies, we analyzed the factors associated with the presence and abundance of T. infestans in 327 inhabited houses in a well-defined rural area with no recent vector control interventions in the humid Argentine Chaco. Bugs were found mainly in domiciles, kitchens, storerooms, and chicken coops and nests, particularly where adequate refuge and animal hosts (humans, dogs, cats or poultry) were available. Domiciles constructed from mud were the most often infested, but brick-and-cement domiciles, even in good conditions, were also found infested. Availability of refuge and hosts for T. infestans are key targets for vector control. Ten-fold variations in domestic infestation observed across neighboring villages, and differences in the relevant factors for T. infestans presence with respect to other areas of the Gran Chaco region suggest that host management, building techniques and insecticide use need to be tailored to the local environment, socio-economic characteristics, and climatic conditions

Phylogeography and Genetic Variation of Triatoma dimidiata, the Main Chagas Disease Vector in Central America, and Its Position within the Genus Triatoma

Chagas disease is a serious parasitic disease of Latin America. Human contamination in poor rural or periurban areas is mainly attributed to haematophagous triatomine insects. Triatoma includes important vector species, as T. dimidiata in Central and Meso-America. DNA sequences, phylogenetic methods and genetic variation analyses are combined in a large interpopulational approach to investigate T. dimidiata and its closest relatives within Triatoma. The phylogeography of Triatoma indicates two colonization lineages northward and southward of the Panama isthmus during ancient periods, with T. dimidiata presenting a large genetic variability related to evolutionary divergences from a Mexican-Guatemalan origin. One clade remained confined to Yucatan, Chiapas, Guatemala and Honduras, with extant descendants deserving species status: T. sp. aff. dimidiata. The second clade gave rise to four subspecies: T. d. dimidiata in Guatemala and Mexico (Chiapas) up to Honduras, Nicaragua, Providencia island, and introduced into Ecuador; T. d. capitata in Panama and Colombia; T. d. maculipennis in Mexico and Guatemala; and T. d. hegneri in Cozumel island. This taxa distinction may facilitate the understanding of the diversity of vectors formerly included under T. dimidiata, their different transmission capacities and the disease epidemiology. Triatoma dimidiata will offer more problems for control than T. infestans in Uruguay, Chile and Brazil, although populations in Ecuador are appropriate targets for insecticide-spraying