Abstract Background: In Mexico, 29% of mortality resulting from SARS-CoV-2 was associated with one or more comorbidities. Diabetes mellitus was one of the most frequently increasing in-hospital mortality. Objective: This study was aimed at determining the impact of nosocomial infections in diabetic patients diagnosed with COVID-19. Materials and methods: An analysis of 930 patients with SARS-CoV-2 was performed, grouping data from April 2020 to December 2021. Survival, hospital stay, causative agents, antimicrobial resistance, and comorbidities were the variables of interest. Results: About 30% of patients had diabetes mellitus, which presented a greater number of concomitant comorbidities such as arterial hypertension in 50%, and chronic kidney disease in 13%. The survival function was higher in patients without diabetes mellitus. Conclusions: The association between nosocomial infections and diabetes mellitus increased hospital length of stay and mortality, which is why multidisciplinary teams are important to carry out prevention programs and establish hospital sanitation measures.

Objective: this study evaluated burnout symptoms among physicians and nurses before, during and after COVID-19 care. Method: a cross-sectional comparative study in the Pulmonary Care unit of a tertiary-level public hospital. The Maslach Burnout Inventory was used. Results: 280 surveys were distributed across three periods: before (n=80), during (n=105) and after (n=95) COVID-19 care; 172 surveys were returned. The response rates were 57.5%, 64.8% and 61.1%, respectively. The prevalence of severe burnout was 30.4%, 63.2% and 34.5% before, during and after COVID-19 care (p<0.001). Emotional exhaustion (p<0.001) and depersonalization (p=0.002) symptoms were more prevalent among nurses than among physicians. Severe burnout was more prevalent in women, nurses and night shift staff. Conclusion: the high prevalence of burnout doubled in the first peak of hospital admissions and returned to pre-pandemic levels one month after COVID-19 care ended. Burnout varied by gender, shift and occupation, with nurses among the most vulnerable groups. Focus on early assessment and mitigation strategies are required to support nurses not only during crisis but permanently.

Objetivo: este estudio evaluó síntomas de Burnout entre médicos y enfermeros antes, durante y después de la atención provista a pacientes con la enfermedad COVID-19. Método: estudio comparativo y transversal realizado en la unidad de Atención Respiratoria de un hospital público de nivel terciario. Se empleó el Inventario de Burnout Maslach. Resultados: se distribuyeron 280 encuestas entre los tres períodos: antes (n=80), durante (n=105) y después (n=95) de la atención a pacientes con COVID-19; se obtuvieron 172 encuestas respondidas. Las tasas de respuesta fueron 57,5%, 64,8% y 61,1%, respectivamente. Los valores de prevalencia de Burnout grave fueron 30,4%, 63,2% y 34,5% antes, durante y después de la atención a pacientes por la enfermedad del coronavirus 2019 (p<0,001). Los síntomas de agotamiento emocional (p<0,001) y despersonalización (p=0,002) fueron más prevalentes entre los enfermeros que entre los médicos. El Síndrome de Burnout grave fue más prevalente en las mujeres, los enfermeros y el personal del turno noche. Conclusión: la elevada prevalencia de Burnout se duplicó en el primer pico de internaciones y regresó a niveles previos a la pandemia un mes después de finalizada la atención a pacientes por la enfermedad del coronavirus 2019. El Síndrome de Burnout varió por sexo, turno de trabajo y ocupación, y los enfermeros representaron los grupos más vulnerables. Es necesario enfocarse en estrategias de evaluación y mitigación tempranas para asistir a los enfermeros, no solo durante la crisis sino permanentemente.

Objetivo: este estudo avaliou os sintomas de burnout entre médicos e enfermeiros antes, durante e após o cuidado dos pacientes contaminados com o COVID-19. Método: estudo transversal comparativo realizado na unidade de Atenção Pulmonar de um hospital público de nível terciário. Foi utilizado o Inventário de Burnout de Maslach. Resultados: 280 formulários de pesquisa foram distribuídos em três períodos: antes (n=80), durante (n=105) e após (n=95) os cuidados dos pacientes contaminados com COVID-19; 172 formulários foram respondidos. As taxas de resposta foram de 57,5%, 64,8% e 61,1%, respectivamente. A prevalência de burnout grave foi de 30,4%, 63,2% e 34,5% antes, durante e após o atendimento dos pacientes (p<0,001). Os sintomas de exaustão emocional (p<0,001) e despersonalização (p=0,002) foram mais prevalentes entre os enfermeiros do que entre os médicos. O burnout grave foi mais prevalente em mulheres, enfermeiros e funcionários do turno da noite. Conclusão: a alta prevalência de burnout dobrou no primeiro pico de internações hospitalares e voltou aos níveis pré-pandemia um mês após o término dos cuidados dos pacientes contaminados com COVID-19. O burnout variou de acordo com o sexo, turno e profissão, encontrando-se os enfermeiros entre os grupos mais vulneráveis. O foco na avaliação precoce e nas estratégias de mitigação é necessário para apoiar os enfermeiros não apenas durante a crise, mas de forma permanente.

Abstract Objective: To identify and describe the risk factors that increase susceptibility in older adults to infection by SARS-CoV-2 (Covid-19). Material and methods: Descriptive, cross-sectional study in adults over 60 years, patients with a positive result (RT-PCR) were analysed to detect SARS-CoV-2. The study was carried out from May 17 to July 21, 2020. A multiple logistic regression model was used to analyse the risk factors of the study population. Results: 102 older adults were included with a mean age of 82.5 ± 8.8 years, 55 (54%) were positive and 47 (46%) were negative. When analysing the risk factors related to higher mortality coupled with Covid-19 infection, the statistically significant variable was frailty, with an OR of 11.6 in frail adults compared to robust individuals (p-value = 0.024.) Conclusion: In the vulnerable population, risk factors must be identified and treated, but above all, such factors must be prevented in advance; early detection, isolation, effective treatment must be carried out as well as follow-up of contacts and prevention of the spread of the new virus to reduce mortality in vulnerable groups.

Abstract Objective: Intensive care units (ICUs) collapsed under the global wave of coronavirus disease 2019 (COVID-19). Thus, we designed a clinical decision-making model that can help predict at hospital admission what patients with COVID-19 are at higher risk of requiring critical care. Methods: This was a cross-sectional study in 119 patients that met hospitalization criteria for COVID-19 including less than 30 breaths per minute, peripheral oxygen saturation < 93%, and/or ≥ 50% lung involvement on imaging. Depending on the need for critical care, patients were retrospectively assigned to ICU and non-ICU groups. Demographic, clinical, and laboratory parameters were collected at admission and analyzed by classification and regression tree (CRT). Results: Forty-five patients were admitted to ICU and 80% of them were men older than 57.13 ± 12.80 years on average. The leading comorbidity in ICU patients was hypertension. The CRT revealed that direct bilirubin (DB) > 0.315 mg/dl together with the neutrophil-to-monocyte ratio (NMR) > 15.90 predicted up to correctly in 92% of the patients the requirement of intensive care management, with sensitivity of 93.2%. Preexisting comorbidities did not influence on the tree growing. Conclusions: At hospital admission, DB and NMR can help identify nine in 10 patients with COVID-19 at higher risk of ICU admission.

Resumen: Introducción: Existen indicadores de calidad tanto generales como específicos en medicina crítica. Los indicadores para procesos propios de unidades de cuidados intensivos respiratorios (UCIRs) son necesarios. Material y métodos: Un grupo de trabajo de las UCIRs de los servicios de tórax de los principales hospitales de tercer y cuarto nivel de atención sanitaria en México, siguiendo la metodología de los grupos de trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias y la Fundación Avedis-Donabedian, identificó aspectos relevantes del proceso del cuidado con relación a volumen, riesgo y complejidad, recabando información de 10 años de actividad asistencial para ser correlacionados y finalmente diseñar indicadores. Resultados: Con información de 2,776 pacientes atendidos del 1o de noviembre de 2009 al 1o de noviembre de 2019, se delimitó el campo de actuación con aspectos importantes como broncoscopia, neumonía, paciente inmunocomprometido, hemoptisis masiva, embolización de arterias bronquiales, cirugía de resección segmentaria/lobar o pulmonar, pleurocentesis y ultrasonido fueron identificados y correlacionados en consenso por el grupo de expertos, llevando al diseño de cuatro indicadores. Conclusiones: Este es el primer reporte de desarrollo de indicadores de calidad para UCIRs de servicios de tórax que servirán para la mejora de la calidad en este tipo de unidades.

Abstract: Introduction: There are both general and specific quality indicators in critical care medicine. Indicators for respiratory intensive care units (RICUs) processes are needed. Material and methods: Following the methodology of the working groups of the Spanish Society of Intensive, Critical Care and Coronary Units and the Avedis-Donabedian Foundation, a working group of the RICUs belonging to departments of chest medicine of the main hospitals of third and fourth level of care in Mexico identified relevant aspects of the care process in relation to volume, risk and complexity, collecting information from ten years of clinical activity to be correlated and finally to design indicators. Results: Delimitation of the field of action was made accounting with information on 2,776 patients treated from November 1, 2009 to November 1, 2019. Important aspects such as bronchoscopy, pneumonia, immunocompromised patient, massive hemoptysis, bronchial artery embolization, segmental/lobar or pulmonary resection surgery, thoracentesis and ultrasound were identified and correlated in consensus by the group of experts leading to the design of four indicators. Conclusions: This is the first report on the development of quality indicators for RICUs belonging to departments of chest medicine that will serve to improve quality in this type of units.

Resumo: Introdução: Existen indicadores de qualidade tanto gerais como específicos em medicina crítica. São necessários os indicadores para procesos própios das unidades de terapias intensivas respiratórias (UTIRs). Material e métodos: Um grupo de trabalho das UTIRs dos serviço de tórax dos principais hospitais de tercero e quarto níveis de atenção sanitária no México, seguindo a metodologia dos grupos de trabalho da Sociedade Espanhola de Terapia Intensiva, Crítica e Unidades Coronárias e a Fundação Avedis-Donabedian, identificou aspectos relevantes do processo de cuidado com relação ao volume, risco e complexidade, reunindo informações de 10 anos de atividade assistencial para ser correlacionada e, finalmente, desenhar indicadores. Resultados: Com informações de 2,776 pacientes atendidos de 1o de novembro de 2009 a 1o de novembro de 2019, o campo de atuação foi definido com aspectos importantes como broncoscopia, pneumonia, paciente imunocomprometido, hemoptise maciça, embolização de artérias brônquicas, cirurgia de ressecção segmentar/lobar ou pulmonar, pleurocentese e ultrassom foram identificados e correlacionados em consenso pelo grupo de especialistas, resultando no desenho de quatro indicadores. Conclusão: Este é o primeiro relatório de desenvolvimento de indicadores de qualidade para UTIRs do serviço de tórax que servirão para melhorar a qualidade neste tipo de unidade.

Background: Pulmonary tuberculosis (PTB) is a world public health problem. Its association with human immunodeficiency virus (HIV) occurs as a consequence of immunosuppression that facilitates coinfection. Materials and methods: A descriptive observational study of consecutive cases from January 6 to September 30, 2016, was made in a tertiary care reference center in Mexico, where HIV-positive patients suspicious of having PTB were negative for bacilli in the acid-fast stain of sputum. Bronchial lavage (BL) was performed and cultures for Mycobacterium tuberculosis (Mtb) were made to confirm PTB. Some cases were tested with Xpert® MTB/RIF® methodology with a polymerase chain reaction to detect Mtb and its sensitivity to rifampicin. Results: BL was performed on 82 HIV-positive acid-fast negative patients from whom samples were obtained to search for Mtb through culture. Expectoration smear samples of 26 patients resulted in 21 negatives for Mtb. The remaining five patients turned Ziehl-Neelsen positive as well as positive for Mtb through culture. In the 56 cases of non-expectoration and dry cough, 37 patients were negative for Mtb, seven were positive by culture, and 12 were positive by Xpert. A total of 24 (29.2%) cases were positive for Mtb. Conclusions: BL facilitates the early diagnosis of PTB in smear-negative HIV-positive patients. Xpert MTB/RIF positive results allowed treatment initiation within 2 h.

Abstract It is known that, in ancient Mexico, diseases of the respiratory system were a major cause of death in the population. Severe epidemics in the XVI century ravaged and killed nine out of ten indigenous persons. Pre-Hispanic physicians served as medical sorcerers and dealt with the physical and spiritual diseases that afflicted the population. Important medical knowledge pertaining to each culture has been identified; this knowledge explained the diseases depending on the religious beliefs of each culture, and it tried to solve the health problems that afflicted the population at that time.

Resumen En el México antiguo se tiene conocimiento de enfermedades propias del sistema respiratorio que fueron una causa importante de mortalidad en la población. Severas epidemias en el siglo XVI asolaron y produjeron la muerte a nueve de cada 10 indígenas. Los médicos prehispánicos se desempeñaban como médicos-hechiceros y atendían las enfermedades físicas y espirituales que aquejaban a la población. Se ha identificado un conocimiento médico importante propio de cada cultura, que explicaba las enfermedades dependiendo de las creencias religiosas e intentaba resolver los problemas de salud que aquejaban en esa época.

Abstract Introduction: In Mexico, there is an alarming increase in the number of cases of Mycobacterium bovis infection on pulmonary and extrapulmonary presentations. The lack of timely identification triggers complications and increases mortality. Objective: To know the frequency of M. bovis infections in clinical samples of patients with tuberculosis in the mycobacteria laboratory of a reference hospital in Mexico City. Method: Prospective, descriptive study. Strains isolated from biological material were studied in Löwestein-Jensen and MGITI960 cultures. M. bovis was identified by amplifying the RD9 fragment with end-point polymerase chain reaction (PCR). Results: Eight-hundred and fifty tuberculosis-diagnosed patients were included; in 441 cases, Mycobacterium tuberculosis was confirmed by positive culture (250 pulmonary, 65 ganglionic, 39 renal, 34 meningeal, 25 miliary, 14 pleural, 8 peritoneal, 4 bone and 2 pericardial cases). Forty-eight strains (10.8%) were typified as M. bovis by amplification of the RD9 fragment with end-point PCR. Conclusions: M. bovis is not currently thought of a causative agent of tuberculosis, which could be the cause of pharmacological treatment failure. In this study, the main extrapulmonary form was observed to be cervical lymphadenopathy.

Resumen Introducción: En México existe un incremento alarmante de casos de infección pulmonar y extrapulmonar por Mycobacterium bovis. La falta de identificación oportuna deriva en complicaciones y eleva la mortalidad. Objetivo: Conocer la frecuencia de infecciones por Mycobacterium bovis en muestras clínicas de pacientes con tuberculosis, identificadas en el laboratorio de micobacterias en un hospital de concentración de la Ciudad de México. Método: Estudio prospectivo, descriptivo. Se estudiaron cepas aisladas de material biológico en cultivos Löwestein-Jensen y MGITI960. La identificación de Mycobacterium bovis se realizó mediante la amplificación del fragmento RD9 por PCR punto final. Resultados: Se incluyeron 850 pacientes con diagnóstico de tuberculosis, en 441 casos se confirmó Mycobacterium tuberculosis por cultivo positivo (250 casos pulmonares, 65 ganglionares, 39 renales, 34 meníngeos, 25 miliares, 14 pleurales, ocho peritoneales, cuatro óseos y dos pericárdicos). Se tipificaron 48 cepas (10.8 %) como Mycobacterium bovis por amplificación del fragmento RD9 por PCR punto final. Conclusiones: Actualmente no se piensa en Mycobacterium bovis como agente causal de tuberculosis, lo que pudiera ser la causa del fracaso del tratamiento farmacológico. En este estudio se observó que la principal forma extrapulmonar es la linfadenopatía cervical.

Tuberculosis can be a silent disease that can progress into chronic and irreversible forms leading to incapacitaron and death; not rarely the diagnosis in made at the autopsy table. Lung tuberculosis is diagnosed by readily avaible methods; extrapulmonary tuberculosis diagnosis may require biopsy material. The usual laboratory diagnosis includes Ziehl-Neelsen smears for acid fast bacilli fluorescence techniques and Lowestein-Jensen cultures; for body fluids, new procedures include polymerase chain reaction and adenosine deaminase. The Mycobacterium growth identification tube culture allows a quicker identification of mycobacteria and earlier medical treatment, preventing the progression of TB and potential appearance of complications that represent a heavy monetary burden for the responsible institutions. This study presents the advantages and cost-effectiveness of several diagnostic procedures for TB, pondering the sensitivity, specificity, positive and negative predictive values of each one.

La tuberculosis puede ser una enfermedad insidiosa que, cuando su diagnóstico es tardío, puede evolucionar hacia formas crónicas o a la muerte; a veces, el estudio post mortem es el que da el diagnóstico de la enfermedad. La tuberculosis pulmonar se diagnostica con los métodos ya existentes, a diferencia de la tuberculosis extrapulmonar, en la que es más difícil el diagnóstico y en la que se requiere, en algunas ocasiones, de biopsias o material de aspiración. Para el diagnóstico de tuberculosis los métodos más usados han sido el examen microscópico para detectar bacilos ácido alcohol resistentes por tinción de Ziehl-Neelsen, la técnica de fluorescencia y el cultivo en medio de Löwestein-Jensen. En la actualidad existen nuevos métodos como la reacción en cadena de la polimerasa y la adenosin desaminasa, aplicable a líquidos corporales. El cultivo Mycobacterium Growth Identification Tube por fluorescencia permite identificar a la micobacteria de la manera más rápida e iniciar el tratamiento médico, evitar la progresión de la enfermedad, prevenir complicaciones y secuelas que tienen un costo muy elevado para las instituciones de salud. En el presente estudio se presentan las ventajas y el costo-efectividad de los diversos métodos de diagnóstico, evaluando la sensibilidad y especificidad, el valor predictivo positivo y negativo de cada uno de ellos.