Resumen: Objetivo: Caracterizar el comportamiento de COVID-19 en niños chilenos hospitalizados en unidades de paciente crítico pediátrico (UPCP) y evaluar factores de riesgo para COVID-19 severo. Pacientes y Método: Estudio multicéntrico cohorte prospectivo, pacientes 0-18 años con SARS-CoV-2 confirmado hospitalizados en UPCP. Se registraron variables clínicas, laboratorio, imagenológicas y terapéuticas. Se comparó “COVID-19 leve/moderado” versus “COVID-19 severo” utilizando mediana con rango intercuartil (RIC), test U Mann-Whitney, Test Fisher de dos colas y análisis multivariado binario forward para ajuste de variables para “COVID-19 severo”. Significativo p < 0,05. Resultados: 219 pacientes, 55,3% hombres, mediana edad 86 meses (RIC: 13,5-156). Comorbilidades principales: obesidad, enfermedades respiratorias. Mortalidad global: 3,6%. “COVID-19 severo” (26,5%) mostró más leucopenia, linfopenia, más inflamación y alteración de órganos (p < 0,05). También desarrolló más Sepsis/shock, SDRA y disfunción de órganos, requirió más terapia hemodinámica, antiinflamatoria, anticoagulación, antibioterapia, con mayor estadía en UPCP/hospitalaria (p < 0,05) y mortalidad de 13,8%. Factores de riesgo asociados a “COVID-19 severo”: shock al ingreso (aOR 28,44 [IC95%: 10,45-77,4]), obesidad (aOR 3,55 [IC95%: 1,3-9,6]), condensación (aOR 3,1 [IC95%: 1,1-8,7]), atelectasia (aOR: 8.7 [IC95%: 1,17-64,3]), corticoides dosis de estrés (aOR 7,7 [IC95%: 1,9-30,6]), antibioterapia precoz (aOR: 12,02 [IC95%: 1,11-130,02]), inmunodeficiencia adquirida/ congénita (aOR: 19,2 [IC95%: 1,19-321]) y patología oncológica (aOR: 10,7 [IC95%: 2,14-47,8]). Conclusión: En esta cohorte pediátrica chilena, el perfil de paciente que ingresó a UPCP fue de sexo masculino en edad escolar con comorbilidad asociada. Factores de riesgo asociados a COVID-19 severo fueron: presencia de comorbilidades (inmunodeficiencia adquirida/congénita, patología oncológica y obesidad), shock al ingreso y condensaciones en las imágenes radiológicas.

Abstract: Objectives: To characterize the COVID-19 disease profile in Chilean children hospitalized in pediatric intensive care units (PICU) and to evaluate risk factors associated with severe COVID-19. Patients and Method: A multicenter prospective cohort study with patients 0-18 years of age with confirmed SARS-CoV-2 hospitalized in PICU. Clinical, laboratory, imaging, and therapeutic variables were recorded. We compared ”mild/moderate COVID-19” with ’’severe COVID-19” using median with interquartile range (IQR), Mann-Whitney U test, two-tailed Fisher’s test, and forward binary multivariate analysis to adjust variables for “severe COVID-19”. A p < 0.05 was considered significant. Results: From 16 PICUs, 219 patients were recruited, 55.3% were male, with a median age of 86 months (IQR: 13.5-156). The most frequent comorbidities were obesity and respiratory diseases. Overall mortality was 3.6%. “Severe COVID-19” (26.5%) showed more leukopenia, lymphopenia, increased inflammatory parameters, and altered organ function (p < 0.05). It also developed more sepsis/shock, ARDS, and organ dysfunction, requiring more hemodynamic, anti-inflammatory, anticoagulation, and antibiotic therapy, with a longer stay in the PICU/hospital (p < 0.05), and 13.8% of mortality. Risk factors associated with “severe COVID-19” were shock on admission to the PICU [aOR 28.44 (95%CI 10.45-77.4)], obesity [aOR 3.55 (95%CI 1.3-9.6)], consolidation [aOR 3.1 (95%CI 1.1 -8.7)], atelectasis [aOR: 8.7 (95%CI 1.17-64.3)], stress dose of corticosteroids [aOR 7.7 (95%CI 1.9-30.6)], early antibiotic therapy [aOR: 12.02 (95%CI 1.11-130.02)], acquired/congenital immunodeficiency [aOR: 19.2 (95%CI: 1.19-321)], and oncological pathology [aOR 10.7 (95%CI 2.14-47.8)]. Conclusion: In this Chilean pediatric cohort, most patients with COVID-19 admitted to de PICU were male, of school age, with associated comorbidity. Risk factors for developing severe COVID-19 were the presence of comorbidities such as acquired/congenital immunodeficiency, oncological pathology, and obesity, in addition to shock on admission and consolidations on X-rays.

Abstract: Objectives: To characterize the COVID-19 disease profile in Chilean children hospitalized in pediatric intensive care units (PICU) and to evaluate risk factors associated with severe COVID-19. Patients and Method: A multicenter prospective cohort study with patients 0-18 years of age with confirmed SARS-CoV-2 hospitalized in PICU. Clinical, laboratory, imaging, and therapeutic variables were recorded. We compared ”mild/moderate COVID-19” with ’’severe COVID-19” using median with interquartile range (IQR), Mann-Whitney U test, two-tailed Fisher’s test, and forward binary multivariate analysis to adjust variables for “severe COVID-19”. A p < 0.05 was considered significant. Results: From 16 PICUs, 219 patients were recruited, 55.3% were male, with a median age of 86 months (IQR: 13.5-156). The most frequent comorbidities were obesity and respiratory diseases. Overall mortality was 3.6%. “Severe COVID-19” (26.5%) showed more leukopenia, lymphopenia, increased inflammatory parameters, and altered organ function (p < 0.05). It also developed more sepsis/shock, ARDS, and organ dysfunction, requiring more hemodynamic, anti-inflammatory, anticoagulation, and antibiotic therapy, with a longer stay in the PICU/hospital (p < 0.05), and 13.8% of mortality. Risk factors associated with “severe COVID-19” were shock on admission to the PICU [aOR 28.44 (95%CI 10.45-77.4)], obesity [aOR 3.55 (95%CI 1.3-9.6)], consolidation [aOR 3.1 (95%CI 1.1 -8.7)], atelectasis [aOR: 8.7 (95%CI 1.17-64.3)], stress dose of corticosteroids [aOR 7.7 (95%CI 1.9-30.6)], early antibiotic therapy [aOR: 12.02 (95%CI 1.11-130.02)], acquired/congenital immunodeficiency [aOR: 19.2 (95%CI: 1.19-321)], and oncological pathology [aOR 10.7 (95%CI 2.14-47.8)]. Conclusion: In this Chilean pediatric cohort, most patients with COVID-19 admitted to de PICU were male, of school age, with associated comorbidity. Risk factors for developing severe COVID-19 were the presence of comorbidities such as acquired/congenital immunodeficiency, oncological pathology, and obesity, in addition to shock on admission and consolidations on X-rays.

Resumen: Objetivo: Caracterizar el comportamiento de COVID-19 en niños chilenos hospitalizados en unidades de paciente crítico pediátrico (UPCP) y evaluar factores de riesgo para COVID-19 severo. Pacientes y Método: Estudio multicéntrico cohorte prospectivo, pacientes 0-18 años con SARS-CoV-2 confirmado hospitalizados en UPCP. Se registraron variables clínicas, laboratorio, imagenológicas y terapéuticas. Se comparó “COVID-19 leve/moderado” versus “COVID-19 severo” utilizando mediana con rango intercuartil (RIC), test U Mann-Whitney, Test Fisher de dos colas y análisis multivariado binario forward para ajuste de variables para “COVID-19 severo”. Significativo p < 0,05. Resultados: 219 pacientes, 55,3% hombres, mediana edad 86 meses (RIC: 13,5-156). Comorbilidades principales: obesidad, enfermedades respiratorias. Mortalidad global: 3,6%. “COVID-19 severo” (26,5%) mostró más leucopenia, linfopenia, más inflamación y alteración de órganos (p < 0,05). También desarrolló más Sepsis/shock, SDRA y disfunción de órganos, requirió más terapia hemodinámica, antiinflamatoria, anticoagulación, antibioterapia, con mayor estadía en UPCP/hospitalaria (p < 0,05) y mortalidad de 13,8%. Factores de riesgo asociados a “COVID-19 severo”: shock al ingreso (aOR 28,44 [IC95%: 10,45-77,4]), obesidad (aOR 3,55 [IC95%: 1,3-9,6]), condensación (aOR 3,1 [IC95%: 1,1-8,7]), atelectasia (aOR: 8.7 [IC95%: 1,17-64,3]), corticoides dosis de estrés (aOR 7,7 [IC95%: 1,9-30,6]), antibioterapia precoz (aOR: 12,02 [IC95%: 1,11-130,02]), inmunodeficiencia adquirida/ congénita (aOR: 19,2 [IC95%: 1,19-321]) y patología oncológica (aOR: 10,7 [IC95%: 2,14-47,8]). Conclusión: En esta cohorte pediátrica chilena, el perfil de paciente que ingresó a UPCP fue de sexo masculino en edad escolar con comorbilidad asociada. Factores de riesgo asociados a COVID-19 severo fueron: presencia de comorbilidades (inmunodeficiencia adquirida/congénita, patología oncológica y obesidad), shock al ingreso y condensaciones en las imágenes radiológicas.

Abstract The strategies to reduce overweight and obesity have not had the expected impact. It is necessary to develop greater knowledge regard food estimation and intake frequency. Therefore, the purpose of this study was to examine the psychometric properties of an instrument aimed at the evaluation of meals (EM) and its intake frequency (IFR) in children. A total of 1,090 9-year-old boys and girls from the South region of Jalisco (Mexico) answered the Scale of Estimation and Consumption of Foods in Children, which consists of two sections: EM and IFR. The exploratory factor analysis carried out with 545 participants derived three factors for each section, which were subsequently corroborated based on two confirmatory factor analyses, one per section, performed with the second half of the sample (n = 545). Both models registered some goodness of fit indexes. The final version of the scale, with 23 items, showed appropriate internal consistency in its both sections: EM (α = .86) and IFR (α = .84). The need to extend the analysis of the psychometric properties of the scale in children from other regions of the country is discussed.

Resumen Las estrategias para disminuir el sobrepeso y la obesidad no han tenido el impacto esperado. Se requiere desarrollar mayor conocimiento sobre las variables estimación del alimento y frecuencia de consumo. Por lo tanto, el propósito de este estudio fue examinar las propiedades psicométricas de un instrumento dirigido a evaluar la estimación de alimentos (EAL) y su frecuencia de consumo (FRC) en niños. Participaron 1,090 niños y niñas de 9 años de edad de la región Sur de Jalisco (México), quienes completaron la Escala de Estimación y Consumo de Alimentos en Niños (ECA-N), que consta de dos secciones: EAL y FRC. El análisis factorial exploratorio realizado con 545 de los participantes derivó tres factores para cada sección, mismos que posteriormente fueron corroborados con base a dos análisis factoriales confirmatorios, uno por sección, practicados con la segunda mitad de la muestra (n = 545). Ambos modelos registraron adecuados índices de bondad de ajuste. La versión final de la ECA-N, con 23 ítems, mostró poseer adecuada consistencia interna en sus dos secciones: EAL (α = .86) y FRC (α = .84). Se discute sobre la necesidad de extender el análisis de las propiedades psicométricas de la ECA-N en niños de otras regiones del país.

The purpose of this research was to identify the presence of disordered eating behaviors and attitudes (DEBA) and its relation to body weight and health-related quality of life in children. The sample comprised 398 children from four elementary schools, public and private, 203 women (51%) and 195 men (49%), who completed the Children Eating Attitudes Test (ChEAT-26) and the Pediatric Questionnaire Quality of Life (PedsQL). As a part of the procedure, body weight and size were registered in order to determine the body mass index. The data analysis yielded a prevalence of 14.1% and 13.4% of DEBA respectively to public and private school. Overweight participants showed higher risk of DEBA than peers of normal weight (OR: 2.36; 95% CI: 1.18-4.73). Children with DEBA from public schools showed minimized scores in the physical functioning, scholar functioning and for the total of PedsQL compared to peers from private schools. The scholar functioning was explained by type of school, age and DEBA. It was concluded that a significant number of children, mainly overweight, presented DEBA, and they affect the health-related quality of life.

Resumen: El propósito de esta investigación fue identificar la presencia de conductas y actitudes alimentarias anómalas (CAAA) y su asociación con el peso corporal y la calidad de vida relacionada con la salud en una muestra infantil. Participaron 398 niños de una escuela pública y tres privadas, 203 mujeres (51%) y 195 varones (49%), quienes contestaron el Test Infantil de Actitudes Alimentarias (ChEAT-26) y el Cuestionario de Calidad de Vida Pediátrica (PedsQL); también se registró su peso y talla para el cálculo del índice de masa corporal. Se encontró que la prevalencia de CAAA fue de 14,1% para la escuela pública y 13,4% para la escuela privada. Los participantes con sobrepeso presentaron mayor riesgo de CAAA (OR: 2,36; 95% IC: 1,18-4,73) en comparación con los participantes de peso normal. Las niñas y niños con CAAA que asistían a escuelas públicas presentaron puntuaciones significativamente menores en funcionamiento físico, funcionamiento escolar y el total del PedsQL que sus contrapartes de escuelas privadas. El tipo de escuela, la edad y las CAAA explicaron el funcionamiento escolar. Se concluyó que una cantidad importante de niños, principalmente con sobrepeso, presentaron CAAA y estas influyen en la calidad de vida relacionada con la salud.

Abstract: The aim of this research was to characterize the scientific production of the Revista Mexicana de Trastornos Alimentarios /Mexican Journal of Eating Disorders during the 2010-2014 period. A retrospective and descriptive analysis of published articles in the period 2010-2014 was performed. The type of production, authorship pattern, country, average number of references per article, and type of documents cited were analyzed. The results showed that 70 articles were published in five volumes of the Revista Mexicana de Trastornos Alimentarios /Mexican Journal of Eating Disorders. The highest percentage was original studies (64.28%). The mean number of author per article was four, and five women were the highest productive ones. Mexican researchers have been made the most percentage of contributions (60%) and most of them belong to the Universidad Nacional Autónoma de México . Furthermore, the collaboration among researchers of two or three different countries was identified. On average of 46 references were cited per article, mostly of them were scientific journal articles. It is concluded that Revista Mexicana de Trastornos Alimentarios /Mexican Journal of Eating Disorders showed similar indexes to those obtained by health journals and psychology journals.

Resumen: El objetivo de esta investigación fue caracterizar la producción científica de la Revista Mexicana de Trastornos Alimentarios/Mexican Journal of Eating Disorders del periodo 2010-2014. Se llevó a cabo un análisis descriptivo retrospectivo de los artículos publicados en el periodo 2010-2014. Se analizó el tipo de artículo, el patrón de autoría, país, promedio de referencias incluidas en los artículos y tipo de referencia incluida. Los resultados mostraron que se publicaron 70 artículos en los cinco volúmenes de la Revista Mexicana de Trastornos Alimentarios/Mexican Journal of Eating Disorders . El mayor porcentaje de artículos correspondió a trabajos originales (64.28%). El promedio de autores por artículo fue de cuatro y se identificaron cinco autoras con la mayor producción. Investigadores mexicanos han realizado el mayor porcentaje de contribuciones (60%) y la mayoría pertenece a la Universidad Nacional Autónoma de México. Asimismo, se identificó la colaboración entre investigadores de dos o tres países. En promedio se incluyeron 46 referencias por artículo, principalmente artículos de revistas científicas. Se concluye que la Revista Mexicana de Trastornos Alimentarios/Mexican Journal of Eating Disorders presentó índices similares a los obtenidos en revistas del área de la salud y de psicología.

Background: There is an increasing recognition of organisms in the order Actinomycetales including Nocardia sp. causing lung infections that mimic pulmonary tuberculosis or fungal pneumonias. Methods: We retrospectively evaluated a cohort of patients in the southeastern United States in whom a presumptive diagnosis of pulmonary tuberculosis was initially entertained but who eventually were found to have infection caused by Rhodococcus sp. or Tsukamurella sp. Results: Among a cohort of 52 individuals diagnosed as case suspects for pulmonary tuberculosis, we identified six patients who were infected with either Rhodococcus sp. or Tsukamurella sp. Of these six patients, two had co-infection with Mycobacterium tuberculosis. Conclusions: Infection with aerobic actinomycetes may mimic pulmonary tuberculosis or may cause concomitant disease in patients with pulmonary tuberculosis.

There are two types of leprosy reactions: reversal reactions or type 1 and erythema nodosum leprosum or type 2. Deformity and disability associated with leprosy are frequently the result of uncontrolled or untreated reactions. Although there is current availability of glucocorticoids as the mainstay of therapy, much needs to be learned about the etiology, risk factors, and pathogenesis of leprosy reactions. There is some evidence that leprosy reactions may represent, particularly, erythema nodosum leprosum autoinflammatory disease due to the aberrant activation of the innate immune system. The role for herpesviruses influencing autophagy in macrophages needs to be evaluated in the pathogenesis of leprosy reactions.

American trypanosomiasis or Chagas disease continues to endanger the lives of many million people in Latin America, and through travel and population migration there is a risk of congenital cases in nonendemic settings. Substantial improvements in the transmission of the disease have been achieved through vector control and blood-bank screening. However, vector-borne transmission remains the main mode of acquisition of infection in many settings coupled with congenital transmission and food-borne and accidental exposure through transplantation or laboratory exposure. The main sites of affection include the heart and gastrointestinal tract. Antiparasitic treatment of indeterminate forms is successful in many cases by delaying the risk of progression of cardiomyopathy, but treatment of chronic chagasic cardiomyopathy remains mainly supportive. The BENEFIT trial that will be completed by late 2011 or early 2012 will provide evidence for or against treating chronic symptomatic forms. Control or eliminating Chagas disease transmission coupled with decreasing the associated burden of disease in Latin America will promote better health and social and economic development among the most impoverished populations in the region.

The neglected tropical diseases (NTDs) consist of a group of chronic, debilitating, and poverty-promoting parasitic, bacterial, and viral and fungal infections that are widespread among people in poor rural or peri-urban communities living in tropical or subtropical areas. However, due to population mobility, diseases such as Chagas disease can be diagnosed anywhere on the globe. The NTDs are disabling, disfiguring and deadly diseases impacting more than one billion people worldwide. They also impair physical and cognitive development, cause adverse pregnancy outcomes, and limit adult productivity in the workforce. The global burden of disease associated with the NTDs is comparable to other infectious diseases such as that of malaria or tuberculosis. Controlling or eliminating NTDs represents an affordable opportunity to improve the health of poor communities, which may ultimately promote social development.

Leprosy or Hansen's disease is a chronic mycobacterial infectious disease caused by Mycobacterium leprae and affects mainly peripheral nerves and skin as well as upper respiratory mucosae. This infection is a conjoined bacteriological and immunological disease. Target cells of infection are macrophages, histiocytes in the skin, and the nonmyelinating and myelinating Schwann cells in the peripheral nerves leading to axonal dysfunction and demyelination leading to functional impairment and deformity. Leprosy reactions represent the most important determinant of nerve impairment if untreated and unrecognized. Control of leprosy transmission remains a challenge despite substantial improvements through the use of multidrug therapy in many settings. Most importantly, although many patients have been microbiologically cured through the efforts of the World Health Organization, many are left with significant disability that has recently been estimated to be ~20% of those treated (~15 million individuals) in the last decades. Further efforts are needed to elucidate the epidemiology and risk factors for disability among those with multibacillary forms.

National immunization rates indicate high vaccine coverage in Mesoamerica, but there is growing evidence that the most vulnerable groups are not being reached by immunization programs. Therefore, there is likely low effective vaccine coverage in the region, leading to persistent and growing health inequity. The planning phase of this project was from June to December 2009. The project will be conducted in the target populations which includes children under five, pregnant women, and women of child-bearing age from the most vulnerable populations within countries of the Mesoamerican region, as indicated geographically by a low human development index (HDI) and/or high prevalence of poverty at the municipal level and through the use of participatory methods to define poverty and vulnerability in local contexts. We defined three lines of action for vaccine-preventable disease interventions: 1) pilot projects to fill gaps in knowledge; 2) strengthening immunization policy; and 3) implementation of evidence-based practices. Health system strengthening through health equity is the central regional objective of the immunization workgroup. We hope to have a transformational impact on health systems so as to improve effective coverage, including vaccine and other integrated primary healthcare services.

Las cifras nacionales de inmunización indican altas coberturas de vacunación en Mesoamérica, sin embargo, hay evidencia creciente de que los grupos más vulnerables no son alcanzados por los programas de vacunación. La planeación de este proyecto se llevó a cabo entre junio y diciembre de 2009. La ejecución del proyecto se llevará a cabo en la población objetivo seleccionada a partir de junio de 2011. Está integrada por niños menores de cinco años y mujeres en edad fértil de las poblaciones más vulnerables en los países de Mesoamérica, identificadas geográficamente por un bajo índice de desarrollo humano o por la alta prevalencia de pobreza en el ámbito municipal, o a través del uso de métodos participativos para definir pobreza y vulnerabilidad en contextos locales. El Grupo de Trabajo ha definido tres líneas de acción para las intervenciones de enfermedades prevenibles por vacunación, para lograr una mejor cobertura efectiva en poblaciones vulnerables: 1) estudios piloto de coberturas para vacíos de conocimiento, 2) fortalecimiento de las políticas de vacunación, 3) ejecución de prácticas basadas en evidencia. El fortalecimiento de los sistemas de salud bajo la óptica de equidad en salud es el objetivo regional central del Grupo de Trabajo en inmunizaciones enfocado en un aumento de la cobertura efectiva.

Latin America has undergone gradual transformations in public health influenced by historical events locally or at a global level. These epidemiologic transitions have also occurred through the implementation of interventions by public institutions such as the Pan-American Health Organization, by philanthropic foundations, non-governmental organizations, and bilateral or multilateral international donor organizations. These public health initiatives have produced substantial improvements in the heath status of many populations in Latin America. Overall, human development and health have advanced over the past century. However, these public health benefits have not been shared equally among all areas of Latin America. The Mesoamerican Region -the area encompassing from Southern Mexico to Panama- continues to experience profound social inequities focalized to indigenous communities and groups of African-descent living in urban, periurban, or rural areas. The Mesoamerican Health Initiative is a private-public partnership that attempts to close the gap of health inequalities affecting the most vulnerable populations in this region of Latin America.

Históricamente, la salud pública en Latinoamérica ha atravesado por diferentes etapas influidas por eventos regionales o globales, por instituciones públicas como la Organización Panamericana de la Salud, o por iniciativas de fundaciones filantrópicas u organizaciones internacionales bilaterales o multinacionales. Estas diferentes iniciativas han resultado en mejoras significativas en la salud pública en las diferentes regiones de América Latina. En general, ha habido un aumento en los índices de desarrollo humano y en la salud; sin embargo, estos éxitos no son compartidos por todos en América Latina. En la región Mesoamericana, que abarca desde el sur de México hasta Panamá, ha existido una transición epidemiológica inversa a pesar de esfuerzos regionales y nacionales. El determinante fundamental es la inequidad social prevalente en Mesoamérica y su focalización en poblaciones indígenas y en aquellas de origen afroamericano que viven en zonas urbanas, periurbanas y rurales. La Iniciativa Mesoamericana de Salud Pública (IMSP) es una asociación público-privada que pretende cambiar el rumbo de la salud pública de las poblaciones más desprotegidas y, de esta forma, promover acciones que contribuyan a mejorar las desigualdades de salud y cumplir con los objetivos del milenio en la región.