Instituto Mexicano Del Seguro Social Research Articles

Design of a quality management system for a pharmaceutical company

This project was carried out in a company that sells and distributes medicines, it is striving to improve the quality of the service, which is why it is aiming to design the quality management system based on the processes approach and compliance with ISO 9001:2015 regulatory requirements. To fulfill the objective, the following activities were carried out: processes mapping, context analysis, risk identification, stakeholder mapping, establishment of quality policy and objectives, and development of a control plan. The results indicate the following key processes: purchases, inventories and sales, strategic prospecting, supply and support; management of human resources, technology and finance. Most influential stakeholders; in the client category, the Instituto Mexicano del Seguro Social, private hospitals and laboratories; in the provider category, PISA laboratory and independent drug distributors, in addition, the scope of the management system, policy and quality objectives were established, as well as a control plan for the system's risk management. Critical risks include not having developed mechanisms for electronic commerce and the lack of a Quality Management System. The countermeasures consider creating and designing an e-commerce store and implementing the Quality management system.

SA28 Systematic Review of Screening Interventions for Colon and Rectal Cancer, from the Point of View of the Instituto Mexicano Del Seguro Social

Evaluate the sensitivity and specificity of the fecal immunochemical test (FIT) for the diagnosis of adult patients with colorectal cancer (CRC) compared to the guaiac fecal occult blood test (gFOBT), Conventional colonoscopy (CC), and flexible sigmoidoscopy (FS), existing in the Instituto Mexicano del Seguro Social (IMSS). Methodology: We conducted a systematic review to evaluate the sensitivity and specificity of the FIT test compared to the screening options currently available at the IMSS to diagnose of adult patients with CRC.

EE407 Cost-Effectiveness Analysis of Colon and Rectal Cancer Screening Interventions in Beneficiaries of the Instituto Mexicano Del Seguro Social

To develop a complete economic evaluation to identify which screening test for Colon and Rectal Cancer (CCR) is the most cost-effective for the beneficiaries of the Instituto Mexicano del Seguro Social (IMSS). Methodology: A cost-effectiveness analysis was carried out from the perspective of the health system in 2020, through a Markov model with a time horizon of 10 years. The model used five scenarios, and the simulation took into account various assumptions based on the natural history of the CCR. Additionally, a budget impact analysis was carried out to estimate the consumption of resources that the introduction implies.

Inequality, postgraduate salaries and salaries over 30-40 thousand pesos in Mexico

In February 2020, a family of four required between $14,196 pesos and $15,667 pesos per month to obtain a salary that exceeds the welfare or poverty line. This is an income that most Mexican households do not obtain. There is little social mobility in Mexico, where three quarters of the population born in households at the bottom of the social ladder do not manage to rise above the poverty line, even so, I believe that it is advisable to pursue undergraduate and especially graduate studies. By 2020, a person with a graduate degree will receive 6.6 times more than a person with a primary school education, 4.5 times more than a person with a secondary school education, 3.8 times more than a person with a high school education and 2 times more than a person with a bachelor's degree. In terms of gender, women with high school, undergraduate and graduate degrees receive the equivalent of 70% of the salary of men.In December 2021, more than 1.8 million Instituto Mexicano del Seguro Social (IMSS) affiliates receive a salary higher than $30,170 pesos, of which more than 830 thousand receive a salary higher than $47,140 pesos, corresponding to 3.2% and 1.5% of the 56.9 million people that make up the economically active employed population (formal and informal).

Variability in case fatality rate risk due to Covid-19 according to health services provider in Mexico City hospitals.

To describe differences in Case Fatality Rate (CFR) for Covid-19 among healthcare subsystems in Mexico City between March and December 2020. This is a retrospective secondary data analysis from the National Epidemiological Surveillance System data of Covid-19 cases. Information about health provider institutions was retrieved from the Catalogue of Health Establishments (CLUES). Logistic regressions were fitted to determine the association between health subsystems and mortality associated to Covid-19. The analyses were divided between hospitalized and ambulatory patients. The probability of dying from Covid-19 was higher among those treated at Instituto Mexicano del Seguro Social (IMSS) (Hospitalized:OR=5.11, Ambulatory:OR=36.57), Instituto de Se-guridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) (Hospitalized:OR=2.10, Ambulatory:OR=9.19), Secretaría de Salud (SS) (Hospitalized:OR=1.94, Ambulatory:OR=5.29) or other public institutions (Hospitalized: OR=1.70, Ambulatory:OR=9.56) than in those treated in private in-stitutions. Differences in healthcare quality and access between health subsystems are profound. It is imperative to increase the capacity and quality of the different health subsystems to improve health outcomes.

Hypozincemia in Mexican patients with diabetic foot ulcer treated out of hospital.

To know the frequency of people with hypozincemia in a group of Mexican patients with Diabetic Foot Ulcers (DFU)m and its relationship with metabolic and clinical profile. Cross-sectional, analytical, and observational study in patients with and without DFU, treated in Family Medicine Units from Instituto Mexicano del Seguro Social (IMSS) in Mérida, Yucatán, México. Frequency of hypozincemia (Zn serum < 70 g/ml) and its relationship with the levels of Glycosylated Hemoglobin (HbA1c), cholesterol and triglycerides was analyzed. 70% of patients with DFU and 25% without DFU had hypozincemia (OR = 5.2, 95% CI 2.139-12.65, p = 0.0004). Patients with hypozincemia were older and the highest prevalence was between 50 and 60 years. The average area of the DFU showed no differences in patients with and without hypozincemia. Patients with DFU reported higher levels of HbA1c, cholesterol, triglycerides, BMI, and blood pressure compared to patients without DFU. Hypozincemia was associated with higher BMI values. The frequency of hypozincemia in diabetic patients with UPD is high and is behaving as a risk factor for presenting UPD, so its identification should be routine.

POSA196 Economic Burden Associated with Advanced Prostate Cancer in Mexico

Describe the healthcare resource utilization (HRU) and direct costs associated with the management of advanced prostate cancer from the comparative perspective of two Mexican public healthcare institutions. HRU was selected according to literature and economic models, with data values and frequencies validated through interviews with medical experts by disease stage: nonmetastatic castration-resistant prostate cancer (nmCRPC), metastatic castration-resistant prostate cancer (mCRPC), and metastatic hormone-sensitive prostate cancer (mHSPC). All unitary costs were obtained from official publications of the “Instituto Mexicano del Seguro Social” (IMSS) [“costos unitarios 2021”] and the “Secretaría de Salud” (SSA) [“tarifarios institucionales”]. The estimated average total costs per patient and per year, converted to US$ using the Banxico exchange rate, were determined considering the proportional distribution of patients by treatment, according to experts’ experiences. Cost analyses by disease stage showed that patients with nmCRPC required the greatest HRU, followed by patients with mHSPC. Costs were higher at IMSS than at SSA institutions, particularly the cost per patient hospitalization day (IMSS, $474 vs. SSA, $13). Annual monitoring costs per patient for mHSPC, nmCRPC, and mCRPC were estimated at $2679, $4242, and $2097 (IMSS); and $1908, $2479, and $1397 (SSA), respectively. Total treatment costs per patient for nmCRPC, mHSPC, and mCRPC were estimated at $2917, $5397, and $17,612 (IMSS); and $2618, $3549, and $12,577 (SSA), respectively. Chemotherapy costs were approximately 24-times higher for IMSS than for SSA and were the primary reason for cost differences between institutions. Total mCRPC costs were 2.5/2.6-times (IMSS/SSA) higher than mHSPC costs and 2.8/2.7-times (IMSS/SSA) higher than nmCRPC costs. Patients with mCRPC generated the largest economic burden, especially relative to the treatments they needed to control the severity of the disease and its symptoms. Patients with nmCRPC required the most HRU and monitoring, however, largely because of intensive medical follow-up.

Changes in Weight-Related Outcomes Among Adolescents Following Consumer Price Increases of Taxed Sugar-Sweetened Beverages

Following the implementation of a tax on sugar-sweetened beverages (SSBs) in Mexico in 2014, SSB prices increased by about 10% on average, but differently across cities. It remains unclear how observed SSB price changes are associated with adolescent weight-related outcomes. To compare weight-related outcomes among adolescents living in cities with differential SSB price changes before and after the SSB tax was implemented in Mexico. Associations between differential SSB price changes and changes in weight-related outcomes were examined overall and by sex among 12 654 adolescents aged 10 to 18 years born between 1999 and 2002 living in 39 cities in Mexico. Multivariate regressions with individual fixed effects were applied on longitudinal individual-level yearly clinical data (height and weight) from 2012 to 2017 collected by the Instituto Mexicano del Seguro Social (IMSS) and merged with city-level SSB price data from 2011 to 2016 collected by the National Institute of Statistics and Geography (INEGI). Data were analyzed from July 2018 to July 2021. Yearly city-level changes in SSB prices between 2011 and 2016. Age- and sex-specific body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) percentile and indicator for overweight or obesity if BMI was at or above the 85th percentile. Before 2014, 46% of 12 654 adolescents (6850 girls and 5804 boys) included in this study had obesity or overweight. The mean (SD) age was 11.38 (1.08) years. Among girls, a 10% SSB price increase was associated with a 1.3 percentage point absolute decrease (95% CI, -2.19 to -0.36; P = .008) or a 3% relative decrease in overweight or obesity prevalence within 2 years of a price change. For girls with BMI at or above the 75th percentile pretax, this price increase was associated with a 0.59 lower BMI percentile (95% CI, -1.08 to -0.10; P = .02) or a 0.67% relative decrease. Improved outcomes for girls were observed in cities where price increases were greater than 10% after the tax. No such associations were observed for boys. In this study, increased SSB prices were associated with decreased overweight or obesity prevalence among girls but not among boys. Improvements in outcomes were small, and mostly observed for girls with heavier weight and in cities where price increases after the tax were greater than 10%.

Haploidentical Peripheral Blood Stem Cell Transplantation (Haplo-PBSCT) with Cyclophosphamide Pos Transplant (CyPost) in High-Risk Hematologic Malignancies. Results of 5 Years in Transplant Center in Northeast of Mexico

Introduction: Haploidentical peripheral blood stem cell transplantation ( Haplo-PBSCT) is a curative option in patient with hematology malignancy. In Mexico is very difficult to find an identical HLA donor , for this reason Haplo PBSCT it is an option in our public Health institution.Materials and methods: we aimed a retrospective study since (2017 -2021) in our Hospital Unidad Médica de alta Especialidad 25, Instituto Mexicano del Seguro Social (IMSS UMAE 25) Monterrey, Mexico. We include patients over 15 years of age who were undergo Haplo PBSCT with hematolgy malignancies . We performed Analysis of Overall and Relapse-free survival with kaplan meier curves and incidence of acute and chronic graft versus host disease (GVHD) and percentage of Transplant-Related Mortality (TRM).Results: we analized a 38 patients, the median age was 35 years (range 15-64). Of the total , 25 were male (65%) and 13 famale (34%). The rest of baseline data is described in table 1.The median time of neutrophil engrafment was days 17 ( 11-26 ) and platelets was 19.5 days ( 12-38 ). The Incidence of Primary Graft failure was 18 % ( seven patients). Patients with graft had 99-100% chimerism at day 100. The Incidence of aGVHD was 26 % and the cGVHD was 16%. DLI was used in four patients to treat passenger lymphocyte syndrome (2 patients) and ( 2 patients) with severe graft rejection.The principal cause of death was sepsis in eleven patients (29%). Two patients with acute leukemia (AML and ALL) died after development of post transplant lymphoproliferative disease. The TRM was 28.2%. There were no relapse-related deaths during follow-up after Haplo-PBSCT.The median of survival was 4.5 months ( range 1-44) with Overall Survival (OS) of 42 % at 3 years ( figure 1).Conclusion: Our analysis shows results that were comparable with those published in first world international transplant centers . Relapse remains the major cause of transplant failure, in our population the antigenic disparity between donor and recipient can strengthen the immune response versus disease. Haplo-PBSCT is a feasible transplantation method in patients with hematological malignancies in developing countries with limited resources. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Differences in the neutrophil/lymphocyte ratio and the platelet/lymphocyte ratio in pregnant women with and without COVID-19.

ObjectiveTo determine the differences in the neutrophil/lymphocyte ratio (NLR) and the platelet/lymphocyte ratio (PLR) in pregnant women with and without COVID‐19.MethodsObservational, cross‐sectional, retrospective, comparative, open, controlled study done from January to April 2021 at the UMAE Hospital de Gineco Obstetricia “Luis Castelazo Ayala” Instituto Mexicano del Seguro Social. Mexico City, Mexico: Patients were divided into those with a negative test for COVID‐19 and those with a positive test, with the latter then being divided according to disease severity into mild, moderate, and severe groups. In all the NLR and PLR were calculated. Symptoms, vital signs, and oxygen saturation were documented. Statistical analysis: Central tendency and dispersion measures, Kruskal‐Wallis test, Mann‐Whitney U test, and chi‐squared test were used. Sensitivity, specificity, positive predictive value, negative predictive value, and odds ratio (OR) were calculated.ResultsSeventy‐seven patients were included, 24 without COVID‐19 and 53 with COVID‐19. There were 33, 10, and 10 patients in the mild, moderate, and severe disease groups, respectively. There was no difference in NLR between the groups and the PLR was significantly higher in the severe disease group. With a 5.1 NLR cutoff point, between normal and those with severe disease, the sensitivity was 70% and specificity 63%, whilst with a 221 PLR cutoff point, the sensitivity was 90% and the specificity 83% (OR 45, 95% CI 4.40–461.7).ConclusionPLR more than NLR was useful to detect pregnant patients with COVID‐19 with severe disease.

Not the same, but is it the same? Cycling of biologic agents in rheumatoid arthritis. Experience in the Instituto Mexicano del Seguro Social

IntroductionAvailable data for biocomparable drugs are not enough to make clear decisions with respect to the potential consequences of a change for non-medical reasons in efficacy, security and inmunogenicity in patients. In the near future, options on biological treatments, biocomparable drugs, non biocomparable drugs and new chemical synthesis options will grow. Therefore, it is important to know how patients behave in persistence of treatment after a change for non- medical reasons, which already happens on a regular basis in social security institutions in Mexico. This information will help us to better understand the standard of treatment for patients with chronic immunomediated conditions. ObjectiveThe primary objective was to measure the impact of change for non-medical reasons in patients with rheumatoid arthritis (RA) treated with an innovative biological on persistence of treatment after changing to a biocomparable drug or a non-biocomparable drug, compared with those patients staying with the innovative biological. Study designThis is an observational study (non-interventionist) of paired cohorts, where an historic cohort obtained by review of clinical records of stable patients in which no modifications to treatment were made for at least six months is compared with two cohorts of patients whose treatments were switched to another treatment with the same therapeutic mechanism for-non-medical reasons (cycling). ResultsWe included 264 RA patients (ACR/EULAR, 2010); 132 were switched for non-medical reasons, and 132 were not switched. Two-hundred and thirty (87.1%) were female. Average age was 53.9 years, ranging from 16 to 84 years. Two-hundred and sixty-three patients were Latino (99.6%); one was Caucasian. Persistence of treatment 12 months after the change was 84.8% (85.8% in Enbrel/Infinitam, 78.9% for Remicade/Remsima). No statistical difference was found with respect to RA clinical activity measured by DAS28 12 months after the switch (P > .05). In the 134 switched patients, 20 discontinued the new treatment due to lack of efficacy of the new drug and were changed to a different drug with a different biologic target. Although no differences were found in the cohorts of switched patients with respect to DAS 28 after 12 months of use, we did find differences in the frequency of adverse events. Forty-two patients had an adverse event in the drug switch cohorts: 33 in the Enbrel-Infinitam group and 9 in the Remicade-Remsima group. ConclusionsThe persistence of treatment after switching from an innovative drug to a biocomparable or a non- biocomparable in RA patients did not show statistically significative differences in our cohorts, but we did find a higher number of adverse events when comparing those who were changed with those who continued on an innovative drug. Twenty patients in the switch groups had to receive a new drug with a different biological target due to lack of efficacy of the switched drug.

Teacher profile of teachers who attend the Educational Research and Teacher Training Center.

In the configuration of the teacher profile, the way in which the teacher represents his professional function and the way and intensity in which he feels challenged by others plays a decisive role. To know the predominant type of profile in teachers who attend courses at the Educational Research and Teacher Training Center from the National Medical Center Siglo XXI (NMC SXXI). Cross-sectional study in professors who attended the aforementioned center, where the Questionnaire for the Assessment of Teaching Methodology was applied to know if the teaching profile was focused on teaching or learning. 43 professors were included, with an average age of 40.84 ± 6.7 years. 65% came from general hospitals (GH). The majority disagreed with teacher-centered education, while learner-centered education had a high agreement; however, when comparing medians, no significant difference was found. Although there was a clear significant difference in the learner-centered profile in terms of those under 40-years-old, both genders as well as teaching background, especially within the Instituto Mexicano del Seguro Social (IMSS) (p = 0.000) and more specifically in the NMC SXXI Specialties Hospital (p = 0.001) and at the GH (p = 0.000). There is a dominant trend in the learner-centered teaching profile; however, it was higher for teachers with teacher preparation within IMSS than outside this institute, as well as for professors from the Specialties Hospital and GH.

Morbimortalidad en pacientes sometidas a ligadura de arterias hipogástricas con riesgo de hemorragia obstétrica

BackgroundObstetric haemorrhage is the leading cause of maternal death in underdeveloped countries, accounting for a third of deaths. There are alternative surgical techniques to stop bleeding, such as ligation of the hypogastric arteries. ObjectiveTo determine maternal morbidity and mortality in patients sometimes linked to hypogastric arteries at risk of obstetric haemorrhage from June to December 2012 in Hospital General Regional n.o 36, Instituto Mexicano del Seguro Social, Puebla (HGR # 36, IMSS, Puebla). Material and methodsDescriptive, observational, cross-sectional, retrospective, homodemic study. Patients at risk of obstetric haemorrhage undergoing “hypogastric artery ligation” from June to December 2012 were included in the HGR # 36, IMSS, Puebla, of any maternal and gestational age. Sample type and size was finite, not probabilistic. Statistical method: descriptive and Odds. ResultsThirty-eight patients underwent a ligation of the hypogastric arteries. Average age: 26.9 years. Placental accretion (44.74%) was the most frequent indication Odds=.78, subsequent uterine hypotonia (7.89%) Odds=.07 and placenta previa (7.89%) Odds=.07. 22 (57.8%) patients with obstetric haemorrhage were considered, 15 (68.18%) had a history of prior caesarean section Odds=2.12. The probability ratio of completing a hysterectomy for obstetric haemorrhage=4.2. One (2.63%) patient with ureteral complication after ligation was documented Odds=.027. Maternal and perinatal mortality in 0 patient. ConclusionThe complication after ligation of the hypogastric arteries presented in 1 patient with ureteral ligation. There were no vascular complications. Maternal mortality was 0%. Perinatal mortality was 0%.

Construcción y validación de un cuestionario para evaluar la percepción sobre la tutoría metodológica en los cursos de Especialización Médica

El tutor metodológico es concebido como una persona con experiencia investigativa, aportación de ideas constructivas, conocimientos e inclinado a colaborar con otras personas. Debe facilitar la realización de investigaciones relevantes, de alto nivel académico y compromiso social, sin perder de vista las relaciones interpersonales en los diversos escenarios y contextos. Contar con un instrumento que permita evaluar la percepción de la tutoría metodológica puede beneficiar no solo a los tutores en la evaluación objetiva de su trabajo, sino a los coordinadores de educación para identificar áreas de oportunidad para el fortalecimiento de este proceso. El propósito de esta investigación es determinar la validez y confiabilidad del cuestionario para evaluar la percepción sobre la tutoría metodológica en los cursos de Especialización Médica. Método: Se realizó un estudio cuantitativo con diseño transversal analítico en el Centro de Investigación Educativa y Formación Docente del Instituto Mexicano del Seguro Social, Delegación Guanajuato. Para la validez de contenido participaron cinco expertos. Para la prueba piloto se seleccionó una muestra no probabilística de 94 médicos residentes que cursaban el último año de la especialidad médica y que contaban con su proyecto de investigación concluido y registrado. La validez de contenido se determinó de forma cualitativa por ronda de expertos y cuantitativa, mediante el índice de Lowshe. La validez de constructo se realizó mediante el análisis factorial exploratorio (AFE) y la confiabilidad con el coeficiente de Alpha de Cronbach. La investigación está apegada a los principios éticos establecidos en la Ley General de Salud y su Reglamento, así como en la Declaración de Helsinki en su última revisión. Se registró en el Comité Local de Investigación 1008 del IMSS. Resultados: Se determinó la validez de contenido por juicio de expertos, al considerar que el cuestionario es claro, suficiente, coherente y relevante. Asimismo, se obtuvo un Índice de Lowshe de 0.99. El coeficiente de alfa de Cronbach fue de 0.97 global (0.92 para competencias personales y socioemocionales y 0.96 en competencias para socializar y facilitar el proceso investigativo). El AFE permitió identificar una estructura de dos factores (con una medida de adecuación de tamaño de muestra KMO de 0.885, una prueba de esfericidad de Bartlet significativa [p= 0.001] y una correlación entre las variables &gt;0.6. El cuestionario está conformado por 21 ítems, con dos factores: Competencias personales y socioemocionales del tutor y competencias metodológicas para socializar y facilitar proceso investigativo, con 6 y 15 ítems respectivamente. Las competencias para la tutoría se agruparon en dos dimensiones que explicaron el 76.78% de las varianzas. Conclusión: La psicometría del cuestionario es adecuada, por lo que cuenta con validez de contenido y de constructo, y con consistencia interna, por lo que permite evaluar la percepción de tutoría metodológica.

The challenges of breast cancer care in Mexico during health-care reforms and COVID-19.

The challenges of breast cancer care in Mexico during health-care reforms and COVID-19.

Acute Chlamydophila pneumoniae infection and its association with cardiovascular diseases.

Chronic infection with Chlamydophila pneumoniae (C pneumoniae) has been associated with cardiovascular disease (CVD). This study evaluates the association of acute C pneumoniae infection and CVD in adult patients. We conducted a cross-sectional study that included 397 patients with a diagnosis of CVD, and 127 without CVD, at the Hospital General de Zona del Instituto Mexicano del Seguro Social (IMSS) in the state of Morelos, Mexico; the diagnosis was established by the Department of Cardiology. Patients with CVD were divided into 4 groups: I) Cardiac arrhythmia, II) Ischemic heart disease, III) Hypertensive heart disease and, IV) Valvular heart disease. Exposure to C pneumoniae was measured by antibody determination (IgG, IgM e IgA) with the microimmunofluorescence (MIF) technique. Statistical analysis included the determination of prevalence, and multiple logistic regression analysis. Results showed that the prevalence of acute C pneumoniae infection in the study population was 21%, and was highest in the groups with CVD versus patients without CVD, and an association was established (OR, 13.93; 95% CI, 3.8-66.1). Likewise, when comparing the Ig titer geometric means, we found that an acute C pneumoniae infection increased the risk of presenting a cardiac arrhythmia and ischemic heart disease by a factor of 18, and increased 12-fold the risk of having hypertensive or valvular heart disease. The prevalence of acute infection + chronic infection was greater in the group with ischemic heart disease (18.4%). Our study reflects the great significance of seroprevalence of acute infection with C pneumoniae among patients with CVD. Further, the seroprevalence of acute infection + chronic infection was greater in patients with ischemic heart disease, suggesting that this combination may be associated with the mechanisms leading to atherosclerosis mediating coronary episodes. It appears that this is the first report on the subject.

Absceso de Psoas. Resolución percutánea

Description of the case of a patient who goes to the emergency service of one General Hospital Zone of the Instituto Mexicano del Seguro Social, I.M.S.S. with a left abdominal-inguinal pain and fever of one month of evolution. The study of the case, gets tomographic evidence of a left psoas abscess of large dimensions is obtained with laboratory tests compatible with systemic inflammatory response. Percutaneous drainage was performed in the emergency service to continue his hospital stay later, with gradual improvement until his discharge. Few cases are reported of this pathology and much less of those that can be resolved in this way so little invasive.

389. Neutrophil-lymphocyte index, platelet-lymphocyte index and systemic inflammation-immunity index in patients with Covid-19 pneumonia in Veracruz, Mexico

BackgroundDifferent indices have been devised that attempt to correlate the severity of the symptoms and predict mortality mainly in septic states and inflammation, with important results that validate their usefulness. In the present pandemic, to date, no indices have been used in severe cases of Covid- 19 that can predict the outcome.Result of the measurement of demographic and clinical variables Comparative analysis of the variables studied stratified by hospital outcome MethodsIt includes a cohort of patients with pneumonia confirmed by Sars Cov 2 PCR-RT, treated at the Veracruz Norte branch of the Instituto Mexicano del Seguro Social from April to May 2020, analyzing the neutrophil-lymphocyte, platelet-lymphocyte and immunity-systemic inflammation indices.Correlation analysis of severity hematological variables with hospital outcome ResultsWe included 100 patients, 54 (54%) women and 46 (46%) men, with a mean age of 49.4 ± 19.3 years. The mean of leukocytes was 10,103.0 ± 4,289.0 cel / mm3, neutrophils 8,509.3 ± 4,216.0 cel / mm3 and lymphocytes of 1,112.7 ± 585.4 cel / mm3; Regarding the hematological indices used to measure severity, we found that the mean of the INL was 10.7 ± 10.9, that of the IPL was 290.1 ± 229.2 and that of the IIIS was 2.6 ± 3.4 x 109. Regarding the type of pneumonia, 54 (54%) had mild pneumonia and 46 (46%) had severe pneumonia. Regarding hospital outcomes, 75 (75%) of the patients were discharged due to clinical improvement and 25 (25%) of the patients died during the hospital stay. The mean age was significantly higher in the group of patients who died during the hospital stay (45.9 ± 18.6 VS 60.0 ± 17.5 years, p = 0.001), the proportion of women who died was higher and tended to be statistically significant. The mean INL was 20.4 ± 16.9 in patients who died VS 7.5 ± 4.9 in patients who improved (p = 0.001). The mean IPL was 417.1 ± 379.7 in patients who died VS 247.7 ± 127.4 in patients who had improvement; p = 0.038. Finally, the mean IIIS was significantly higher in patients who died VS patients who had clinical improvement (4.8 ± 6.1 VS 1.9 ± 1.2; p = 0.030, respectively). In the correlation analysis, high and significant r were found in the three indices.ConclusionNeutrophil-lymphocyte, platelet-lymphocyte and systemic immunity-inflammation indices in patients with Covid-19 pneumonia can be used as predictors of severity and predict hospital outcome.Disclosures All Authors: No reported disclosures

Zika and dengue but not chikungunya are associated with Guillain-Barré syndrome in Mexico: A case-control study.

Background Zika, dengue and chikungunya viruses (ZIKV, CHIKV and DENV) are temporally associated with neurological diseases, such as Guillain-Barré syndrome (GBS). Because these three arboviruses coexist in Mexico, the frequency and severity of GBS could theoretically increase. This study aims to determine the association between these arboviruses and GBS in a Mexican population and to establish the clinical characteristics of the patients, including the severity of the infection. A case-control study was conducted (2016/07/01-2018/06/30) in Instituto Mexicano del Seguro Social (Mexican Social Security Institute) hospitals, using serum and urine samples that were collected to determine exposure to ZIKV, DENV, CHIKV by RT-qPCR and serology (IgM). For the categorical variables analysis, Pearson's χ2 or Fisher exact tests were used, and the Mann-Whitney U test for continuous variables. To determine the association of GBS and viral infection diagnosis through laboratory and symptomatology before admission, we calculated the odds ratio (OR) and 95% confidence intervals (95%CI) using a 2x2 contingency table. A p-value ≤ 0.05 was considered as significant. Ninety-seven GBS cases and 184 controls were included. The association of GBS with ZIKV acute infection (OR, 8.04; 95% CI, 0.89-73.01, p = 0.047), as well as laboratory evidence of ZIKV infection (OR, 16.45; 95% CI, 2.03-133.56; p = 0.001) or Flavivirus (ZIKV and DENV) infection (OR, 6.35; 95% CI, 1.99-20.28; p = 0.001) was observed. Cases of GBS associated with ZIKV demonstrated a greater impairment of functional status and a higher percentage of mechanical ventilation. According to laboratory results, an association between ZIKV or ZIKV and DENV infection in patients with GBS was found. Cases of GBS associated with ZIKV exhibited a more severe clinical picture. Cases with co-infection were not found.

Neuroprotective effect of immunomodulatory peptides in rats with traumatic spinal cord injury.

Several therapies have shown obvious effects on structural conservation contributing to motor functional recovery after spinal cord injury (SCI). Nevertheless, neither strategy has achieved a convincing effect. We purposed a combined therapy of immunomodulatory peptides that individually have shown significant effects on motor functional recovery in rats with SCI. The objective of this study was to investigate the effects of the combined therapy of monocyte locomotion inhibitor factor (MLIF), A91 peptide, and glutathione monoethyl ester (GSH-MEE) on chronic-stage spinal cord injury. Female Sprague-Dawley rats underwent a laminectomy of the T9 vertebra and a moderate contusion. Six groups were included: sham, PBS, MLIF + A91, MLIF + GSH-MEE, A91 + GSH-MEE, and MLIF + A91 + GSH-MEE. Two months after injury, motor functional recovery was evaluated using the open field test. Parenchyma and white matter preservation was evaluated using hematoxylin & eosin staining and Luxol Fast Blue staining, respectively. The number of motoneurons in the ventral horn and the number of axonal fibers were determined using hematoxylin & eosin staining and immunohistochemistry, respectively. Collagen deposition was evaluated using Masson's trichrome staining. The combined therapy of MLIF, A91, and GSH-MEE greatly contributed to motor functional recovery and preservation of the medullary parenchyma, white matter, motoneurons, and axonal fibres, and reduced the deposition of collagen in the lesioned area. The combined therapy of MLIF, A91, and GSH-MEE preserved spinal cord tissue integrity and promoted motor functional recovery of rats after SCI. This study was approved by the National Commission for Scientific Research on Bioethics and Biosafety of the Instituto Mexicano del Seguro Social under registration number R-2015-785-116 (approval date November 30, 2015) and R-2017-3603-33 (approval date June 5, 2017).