Tétanos en un preescolar de 5 años con abandono familiar: Reporte de caso

Background: Tetanus is an infectious disease caused by Clostridium tetani, with severe symptoms and a high mortality rate. In Yucatan, the incidence rate is low (0.09 per 100,000 population), reporting only two cases in 2017, so it is now a disease of low diagnostic suspicion in the region. Case presentation: A 5-year-old male preschool, from a rural community of Yucatán and with incomplete immunization scheme, who was attended by generalized muscle spasms as well as recent foreign body wounds and battered child syndrome. In the Intensive Care Unit, the diagnosis of tetanus was integrated, for which he received etiological and symptomatic management, achieving improvement at his discharge. Discussion: Yucatan is a state with high child abuse rate of. In the presence of this social problem, it is important to rule out an incomplete immunization scheme, which with the coexistence of typical clinical findings and recent foreign body wound, tetanus should be suspectedIntroducción: El tétanos es una enfermedad infecciosa causada por Clostridium tetani, con un cuadro clínico grave y una elevada mortalidad. En Yucatán, la tasa de incidencia es baja (0.09 por 100,000 habitantes), reportándose únicamente dos casos en 2017, por lo que actualmente es una enfermedad de baja sospecha diagnóstica en la región. Caso clínico: Preescolar masculino de 5 años, originario de una comunidad rural de Yucatán y con esquema de inmunización incompleto, quien fue atendido por espasmos musculares generalizados, así como heridas recientes por cuerpo extraño y síndrome del niño maltratado. En la Unidad de Terapia Intensiva, se integró el diagnóstico de tétanos, por lo que recibió manejo etiológico y sintomático, logrando mejoría a su egreso. Discusión: Yucatán es una de las entidades federativas con mayor índice de maltrato infantil. Ante la presencia de dicha problemática social, es importante descartar un esquema de inmunización incompleto, mismos que con la coexistencia de hallazgos clínicos típicos y herida reciente por cuerpo extraño, se debe sospechar tétano

Rickettsia rickettsii and Rickettsia typhi in hospitalized children diagnosed with Pediatric Multisystemic Inflammatory Syndrome in Merida, Yucatan

Multisystem Inflammatory Syndrome in Children (MIS-C) presents with fever, fatigue, elevated inflammatory markers (acute phase reactants), and a history of exposure to SARS-CoV-2 or positive antibodies to SARS-CoV-2. As the COVID-19 pandemic unfolded, the risk of MIS-C in the pediatric population increased. However, exposure to other viruses and the presence of SARS-CoV-2 positive antibodies in children hospitalized for various pathogen-associated illnesses will also remain common and may complicate differential diagnoses with diseases endemic to the region such as rickettsial diseases. The objective was to highlight the desirability of medical personnel systematically incorporating rickettsiosis as a differential diagnosis for MIS-C when studying a child with fever, non-specific symptoms, and elevated inflammatory markers. In conclusion MIS-C should be considered in children with elevated inflammatory markers when there is a history of COVID-19 and they also meet criteria that have already been established by international agencies, such as CDC and WH

Análisis de la mortalidad materna de los años 2013 a 2015 en el estado de Yucatán

Maternal Mortality is considered a significant indicator of the quality of the health services in any country. It is known that approximately 95% of these deaths in Latin America and the Caribbean are preventable. Objectives. Our objective is to determine whether or not the Maternal Mortality Ratio (MMR) in Yucatan is higher than the national mean during the years 2013 to 2015. Materials and methods. Transversal-observational study in pregnant women who died from direct causes related to pregnancy during the years 2013 to 2015 in Yucatan. Data from the National Institute of Statistics and Geography (INEGI) were used. Results. In 2013 the MMR in Yucatan was 38,11% higher than the national mean, in 2014 the MMR of this state was 34,68% higher in comparison to the national mean and in 2015 the MMR was 21,14% higher than the national mean. The main causes of dead in the state of Yucatan are in agreement with the national causes which are hypertensive disorders and hemorrhagic disorders. Conclusions. The MMR during the years 2013 to 2015 in the state of Yucatan was higher than the national average. It is important to implement preventive measures to reduce this disparity in terms of maternal mortality in the state of Yucatán.La mortalidad materna se considera un indicador significativo de la calidad de los servicios de salud, así se conoce que aproximadamente un 95% de estas muertes en América Latina y el Caribe son prevenibles. Objetivos. Determinar si la razón de muerte materna (RMM) en Yucatán es mayor a la media nacional durante los años 2013 a 2015. Material y Métodos. Estudio transversal observacional en el que se analizaron los datos contenidos en los certificados de defunción de mujeres que fallecieron por causas directas relacionadas con el embarazo durante los años 2013 a 2015 en el estado de Yucatán. Los resultados obtenidos fueron comparados con los datos del Instituto Nacional de Estadística y Geografía (INEGI) mediante chi cuadrada. Resultados. La RMM en Yucatán fue de 38,11%, 34,68% y 21,14%, para los años 2013, 2014 y 2015 respectivamente; en todos los casos mayores que la nacional. Las principales causas de muerte en el estado concuerdan con lo expuesto en la bibliografía, siendo éstas los desórdenes hipertensivos y las hemorragias. Conclusión. La RMM durante los años 2013 a 2015 en el estado de Yucatán fue mayor a la media nacional. Es importante implementar medidas preventivas que permitan reducir esta disparidad en términos de mortalidad materna en el estado de Yucatán

Choque séptico secundario a fiebre por chikungunya no congénita en un lactante menor: caso clínico

ResumenIntroducciónA partir de julio de 2015, en el estado de Yucatán, México, se presentó un brote de chikungunya.ObjetivoAnalizar el curso clínico de un caso de chikungunya de trasmisión vectorial y proporcionar evidencia práctica que sirva para orientar impresiones diagnósticas y pronósticas futuras en áreas endémicas y períodos de brote.Reporte de casoLactante de un mes de edad, sin antecedentes de importancia, quien presentó cuadro febril acompañado de eritema maculopapular, inicialmente tratado con antiinflamatorios no esteroideos. Evolucionó con hipoactividad, trombocitopenia severa y neutropenia sin linfopenia, dificultad respiratoria, disfunción hepática, convulsiones y posteriormente shock séptico con desenlace fatal. La IgM para chikungunya fue positiva en la paciente, mientras que en su madre fue negativa. En el hemocultivo creció Pseudomonas aeruginosa, por posible contaminación, sin descartarse una sepsis de origen mixto.ConclusionesChikungunya es una enfermedad cuyas manifestaciones en los neonatos y lactantes pueden ser graves e incluso fatales. Es importante sospecharla en este grupo etario debido al riesgo de contacto vectorial, en presencia de fiebre sin foco aparente y manifestaciones cutáneas maculares o maculopapulares. Los antipiréticos se deben emplear con precaución, considerando la posibilidad de agravar el cuadro clínico subyacente, con potencial daño hepático y hematológico.AbstractIntroductionA chikungunya outbreak took place in the State of Yucatan starting in the second half of 2015ObjectiveTo analyse the clinical course of a case of chikungunya in a previously healthy infant, providing practical evidence to guide future diagnoses and treatment during outbreak seasons in endemic areasCase reportClinical manifestation started with a sudden onset of fever and a diffuse macular-papillary erythema, originally treated in the community with non-steroidal anti-inflammatory drugs. Two days later, the fever relapsed with hypoactivity, severe thrombocytopenia and neutropenia (without lymphopenia), respiratory distress, liver dysfunction, sepsis, followed by septic shock with a fatal outcome. IgM test was positive to chikungunya, while her mother tested negative. Pseudomonas aeruginosa was isolated from the blood culture possible due to contamination, without ruling out the possibility of a mixed origin sepsis.ConclusionsChikungunya is a disease in which the manifestations in neonates and young infants can be severe, and even fatal. It is important to suspect it in this age group at risk of vector contact, in the presence of fever without apparent source of infection and cutaneous manifestations. It is important to use the antipyretics cautiously, considering the possibility of aggravating the underlying infection, and the potential hepatic and haematological damage

Effects of replacing barley straw and corn silage by olive cake in the diet on microbial populations in RUSITEC fermenters

By-products are an important waste in agro-food industry in many countries, and they can represent an environmental problem, as they are difficult to eliminate. Their use in ruminant feeding could alleviate this problem and contribute to a more sustainable livestock production. Olive cake is a by-product of olive oil extraction that contains bioactive compounds with antimicrobial and antioxidant activities that could also affect the ruminal microbiota, but this aspect has not yet been investigated. Four Rusitec fermenters were used in a cross-over design in two 14-day incubation runs to study the effects of replacing part of the forage by olive cake in a dairy sheep diet on microbial populations. Three rumen-cannulated Merino sheep were used as ruminal content donors for inoculation of the system. Experimental diets were a conventional diet for dairy sheep (50:50 forage:concentrate) with corn silage and barley straw as forage, and a diet in which corn silage and barley straw were partially replaced by olive cake (16.7%). Samples of liquid and solid digesta were collected from the fermenters at the end of each incubation run. DNA was extracted and the abundance of bacteria and protozoa, as well as the relative abundance of fungi and archaea, were assessed by qPCR. Bacterial diversity was analysed using Automated Ribosomal Intergenic Spacer Analysis (ARISA). Data were processed using R with the vegan package and the PROC MIXED from SAS. The number of peaks detected in the ARISA electropherograms and the Shannon’s index were not affected (P>0.05) by the inclusion of olive cake in the diet, but they were higher (P=0.006 and P=0.005, respectively) in liquid than in solid digesta. Principal coordinates analysis based on Bray-Curtis distance showed that samples were not clearly grouped by diet, due to the variability of samples from the same diet and the strong effect of the digesta phase. Bacterial and protozoal abundance in the liquid digesta and the relative abundance of fungi and archaea in both digesta phases were not affected (P>0.05) by the inclusion of olive cake in the diet. In the solid digesta, diet affected (P=0.013) the bacterial abundance and tended to affect (P=0.06) the protozoal abundance, both being higher for the diet containing olive cake than for the conventional diet. In conclusion, the addition of olive cake in substitution of corn silage and barley straw in the diet promoted greater bacterial and protozoal growth in the solid digesta of Rusitec fermenters

Effects of replacing barley straw and corn silage by olive cake in the diet on microbial populations in RUSITEC fermenters

By-products are an important waste in agro-food industry in many countries, and they can represent an environmental problem, as they are difficult to eliminate. Their use in ruminant feeding could alleviate this problem and contribute to a more sustainable livestock production. Olive cake is a by-product of olive oil extraction that contains bioactive compounds with antimicrobial and antioxidant activities that could also affect the ruminal microbiota, but this aspect has not yet been investigated. Four Rusitec fermenters were used in a cross-over design in two 14-day incubation runs to study the effects of replacing part of the forage by olive cake in a dairy sheep diet on microbial populations. Three rumen-cannulated Merino sheep were used as ruminal content donors for inoculation of the system. Experimental diets were a conventional diet for dairy sheep (50:50 forage:concentrate) with corn silage and barley straw as forage, and a diet in which corn silage and barley straw were partially replaced by olive cake (16.7%). Samples of liquid and solid digesta were collected from the fermenters at the end of each incubation run. DNA was extracted and the abundance of bacteria and protozoa, as well as the relative abundance of fungi and archaea, were assessed by qPCR. Bacterial diversity was analysed using Automated Ribosomal Intergenic Spacer Analysis (ARISA). Data were processed using R with the vegan package and the PROC MIXED from SAS. The number of peaks detected in the ARISA electropherograms and the Shannon’s index were not affected (P>0.05) by the inclusion of olive cake in the diet, but they were higher (P=0.006 and P=0.005, respectively) in liquid than in solid digesta. Principal coordinates analysis based on Bray-Curtis distance showed that samples were not clearly grouped by diet, due to the variability of samples from the same diet and the strong effect of the digesta phase. Bacterial and protozoal abundance in the liquid digesta and the relative abundance of fungi and archaea in both digesta phases were not affected (P>0.05) by the inclusion of olive cake in the diet. In the solid digesta, diet affected (P=0.013) the bacterial abundance and tended to affect (P=0.06) the protozoal abundance, both being higher for the diet containing olive cake than for the conventional diet. In conclusion, the addition of olive cake in substitution of corn silage and barley straw in the diet promoted greater bacterial and protozoal growth in the solid digesta of Rusitec fermenters