RESUMO

BACKGROUND: Illicitly-manufactured fentanyls (fentanyl) have changed the risk environment of people who use drugs (PWUD). In California and many western US states, the opioid overdose rate spiked from 2016 to 2021, driven largely by fentanyl. Mexican border cities act as transit through-points for the illicit drug supply and similar evolving health risks are likely to be present. Nevertheless, due to data gaps in surveillance infrastructure, little is known about fentanyl prevalence in Mexico. METHODS: We employ intensive ethnographic participant-observation among PWUD, as well as key informants including harm reduction professionals, EMTs, and physicians on the front lines in Tijuana, Mexico. We triangulate interview data and direct observations of consumption practices with n=652 immunoassay-based fentanyl tests of drug paraphernalia from mobile harm reduction clinics in various points throughout the city. RESULTS: PWUD informants described a sharp increase in the psychoactive potency and availability of powder heroin-referred to as "china white"-and concomitant increases in frequency of overdose, soft tissue infection, and polysubstance methamphetamine use. Fentanyl positivity was found among 52.8% (95%CI: 48.9-56.6%) of syringes collected at harm reduction spaces, and varied strongly across sites, from 2.7% (0.0-5.7%) to 76.5% (68.2-84.7%), implying strong market heterogeneity. Controlling for location of collection, syringe-based fentanyl positivity increased by 21.7% (10.1-42.3%) during eight months of testing. Key informants confirm numerous increased public health risks from fentanyl and describe the absence of a systematic or evidence-based governmental response; naloxone remains difficult to access and recent austerity measures have cut funding for harm reduction in Mexico. CONCLUSIONS: Fentanyl, linked to powder heroin, is changing the risk environment of PWUD on the US-Mexico border. Improved surveillance is needed to track the evolving street drug supply in Mexico and related health impacts for vulnerable populations. Structural factors limiting access to naloxone, harm reduction, substance use treatment, and healthcare, and minimal overdose surveillance, must be improved to provide an effective systemic response.

Assuntos

Overdose de Drogas , Drogas Ilícitas , Analgésicos Opioides , Overdose de Drogas/epidemiologia , Fentanila , Heroína , Humanos , México/epidemiologia , Naloxona , Pós

RESUMO

Subarachnoid hemorrhage (SAH) is a devastating disease, with a mortality rate of 35%. Among patients who survive the initial bleeding, the leading cause of morbidity and mortality is delayed cerebral ischemia (DCI). Electroencephalography (EEG) can detect cerebral ischemia in the early stages. We report a 66-year-old female patient who consulted for ictal headache and impaired consciousness. On admission, she was confused, dysarthric, and with meningeal signs. Brain angio-CT showed SAH FISHER IV and an aneurysm of the left posterior cerebral artery. After excluding the aneurysm (by coiling), the patient recovered the altered consciousness. Continuous EEG monitoring was initiated. On the sixth day of follow up, she had a transient headache and apathy. The brain MRI showed low cerebral blood flow in the left frontotemporal area, without ischemic lesions. On the seventh day, she presented expression aphasia and right facial-brachial paresis. Angiography confirmed severe vasospasm in M1 and M2 segments bilaterally. Pharmacological angioplasty with nimodipine was performed, with an excellent radiological response, although not clinical. A second MRI was carried out on the eighth day, which showed a left insular infarction and generalized vasospasm. A second therapeutic angiography was performed; the patient persisted with aphasia and left central facial paresis. The quantitative EEG analysis performed retrospectively showed a generalized reduction in the spectral edge frequency 95 (SEF95; meaning slowing in the EEG signal) at the fourth day of follow up, three days earlier than the clinical and imaging diagnosis of DCI was established.

Assuntos

Humanos , Feminino , Idoso , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem , Isquemia Encefálica/etiologia , Isquemia Encefálica/diagnóstico por imagem , Infarto Cerebral , Estudos Retrospectivos , Eletroencefalografia/efeitos adversos , Eletroencefalografia/métodos

RESUMO

Subarachnoid hemorrhage (SAH) is a devastating disease, with a mortality rate of 35%. Among patients who survive the initial bleeding, the leading cause of morbidity and mortality is delayed cerebral ischemia (DCI). Electroencephalography (EEG) can detect cerebral ischemia in the early stages. We report a 66-year-old female patient who consulted for ictal headache and impaired consciousness. On admission, she was confused, dysarthric, and with meningeal signs. Brain angio-CT showed SAH FISHER IV and an aneurysm of the left posterior cerebral artery. After excluding the aneurysm (by coiling), the patient recovered the altered consciousness. Continuous EEG monitoring was initiated. On the sixth day of follow up, she had a transient headache and apathy. The brain MRI showed low cerebral blood flow in the left frontotemporal area, without ischemic lesions. On the seventh day, she presented expression aphasia and right facial-brachial paresis. Angiography confirmed severe vasospasm in M1 and M2 segments bilaterally. Pharmacological angioplasty with nimodipine was performed, with an excellent radiological response, although not clinical. A second MRI was carried out on the eighth day, which showed a left insular infarction and generalized vasospasm. A second therapeutic angiography was performed; the patient persisted with aphasia and left central facial paresis. The quantitative EEG analysis performed retrospectively showed a generalized reduction in the spectral edge frequency 95 (SEF95; meaning slowing in the EEG signal) at the fourth day of follow up, three days earlier than the clinical and imaging diagnosis of DCI was established.

Assuntos

Isquemia Encefálica , Hemorragia Subaracnóidea , Idoso , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Infarto Cerebral , Eletroencefalografia/efeitos adversos , Eletroencefalografia/métodos , Feminino , Humanos , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico por imagem

RESUMO

BACKGROUND AND AIMS: Results from a recent study among 750 heroin users in three Mexico's northern border cities revealed an increase in white powder availability (also known as China white) and preference for this product among heroin users, as well as a general perception of increased overdose cases among this population. Here, we questioned whether those findings reflect an increased presence of heroin laced with fentanyl, which is associated with greater risks of overdose but that, until now, has not been described in Mexico. DESIGN: We tested fentanyl using highly sensitive test strips in syringe plungers, metal cookers and drug wrappings associated with heroin use. SETTING: Three injection sites in Tijuana, Baja California, México. PARTICIPANTS: Eighty-nine heroin users who interchanged paraphernalia for new syringes. MEASUREMENTS: We tested 59 residues of 'pure' white powder. The rest were white powder with black tar (n = 5) or white powder with crystal meth (n = 9), black tar with crystal meth (n = 1), black tar only (n = 13) and crystal meth only (n = 2). FINDINGS: Users believed that they consumed either white powder heroin, white powder heroin with crystal meth, white powder with black tar heroin or black tar heroin only. Analyses revealed that 93% (n = 55) of the 'pure' white powder samples had fentanyl. All (n = 9) the white powder samples mixed with crystal meth and 40% (n = 2) of the white powder with black tar were also laced with fentanyl. CONCLUSIONS: In a sample of 89 heroin users in Mexico, most white powder heroin users were unknowingly exposed to fentanyl, with fentanyl detected in 93% of white powder samples.

Assuntos

Contaminação de Medicamentos , Fentanila/isolamento & purificação , Heroína/química , Humanos , México , Fitas Reagentes , Abuso de Substâncias por Via Intravenosa

RESUMO

OBJECTIVE: From 2011 to 2013, the Global Fund (GF) supported needle and syringe programmes in Mexico to prevent transmission of HIV among people who inject drugs. It remains unclear how GF withdrawal affected the costs, quality and coverage of needle and syringe programme provision. DESIGN: Costing study and longitudinal cohort study. SETTING: Tijuana, Mexico. PARTICIPANTS: Personnel from a local needle and syringe programme (n=6) and people who inject drugs (n=734) participating in a longitudinal study. PRIMARY OUTCOME MEASURES: Provision of needle and syringe programme services and cost (per contact and per syringe distributed, in 2017 $USD) during GF support (2012) and after withdrawal (2015/16). An additional outcome included needle and syringe programme utilisation from a concurrent cohort of people who inject drugs during and after GF withdrawal. RESULTS: During the GF period, the needle and syringe programme distributed 55 920 syringes to 932 contacts (60 syringes/contact) across 14 geographical locations. After GF withdrew, the needle and syringe programme distributed 10 700 syringes to 2140 contacts (five syringes/contact) across three geographical locations. During the GF period, the cost per harm reduction contact was approximately 10-fold higher compared with after GF ($44.72 vs $3.81); however, the cost per syringe distributed was nearly equal ($0.75 vs $0.76) due to differences in syringes per contact and reductions in ancillary kit components. The mean log odds of accessing a needle and syringe programme in the post-GF period was significantly lower than during the GF period (p=0.02). CONCLUSIONS: Withdrawal of GF support for needle and syringe programme provision in Mexico was associated with a substantial drop in provision of sterile syringes, geographical coverage and recent clean syringe utilisation among people who inject drugs. Better planning is required to ensure harm reduction programme sustainability is at scale after donor withdrawal.

Assuntos

Programas de Troca de Agulhas/economia , Programas de Troca de Agulhas/estatística & dados numéricos , Agulhas/provisão & distribuição , Abuso de Substâncias por Via Intravenosa/epidemiologia , Seringas/provisão & distribuição , Custos e Análise de Custo , Infecções por HIV/prevenção & controle , Hepatite C/prevenção & controle , Humanos , Estudos Longitudinais , México/epidemiologia , Agulhas/economia , Seringas/economia

RESUMO

Background: The aim of this study was to determine the level of knowledge and practices about toxoplasmosis in a sample of clinical laboratory professionals in Mexico. Methods: 192 clinical laboratory professionals were surveyed. They were asked about (1) Toxoplasma gondii; (2) clinical manifestations, diagnosis, treatment, and epidemiology of toxoplasmosis; and (3) their practices with respect to toxoplasmosis. Results: The range of animals infected by T. gondii was known by 44.8% of participants. Clinical aspects of toxoplasmosis were known by up to 44.3% of subjects. Correct answers about the interpretation of serological markers of T. gondii infection were provided by up to 32.8% of participants. A minority (32.2%) of participants knew about a high number of false positive results of anti-T. gondii IgM antibody tests. Most participants (90.1%) did not know what the anti-T. gondii IgG avidity test was. Up to 55.7% of participants provided incorrect answers about the interpretation of serology tests for the treatment of pregnant women. Common routes of T. gondii infection were known by <15% of participants. Most (84.4%) participants had not performed tests for detection T. gondii infection. Conclusions: Results indicate incomplete knowledge of T. gondii infection and toxoplasmosis and a limited practice of laboratory tests among the professionals surveyed.

Assuntos

Serviços de Laboratório Clínico , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Laboratório , Toxoplasmose , Adulto , Animais , Anticorpos Antiprotozoários/sangue , Biomarcadores , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Testes Imunológicos , Masculino , México , Pessoa de Meia-Idade , Gravidez , Inquéritos e Questionários , Toxoplasma/imunologia , Toxoplasmose/diagnóstico , Toxoplasmose/tratamento farmacológico , Toxoplasmose/epidemiologia , Toxoplasmose/transmissão

RESUMO

BACKGROUND: Very little is known about concordance of Toxoplasma gondii (T. gondii) infection markers among couples. Through a cross-sectional study, we sought to determine the correlation of T. gondii infection in a sample of 119 heterosexual couples in Durango State, Mexico. METHODS: Participants were examined for the presence of anti-T. gondii IgG and IgM antibodies using enzyme-linked immunoassays. IgG and IgM seropositive couples were further analyzed for the presence of T. gondii DNA by using polymerase chain reaction (PCR). RESULTS: Anti-T. gondii IgG antibodies were found in 71 (59.7%) men and in 63 (52.9%) women (odds ratio (OR) = 1.31; 95% confidence interval (CI): 0.78 - 2.19; P = 0.29). Of the 71 seropositive men, 40 (56.3%) had a seropositive couple; in contrast, of the 63 seropositive women, 40 (63.5%) had a seropositive couple (OR = 0.74; 95% CI: 0.37 - 1.48; P = 0.39). In total, 65 (54.6%) couples had concordant results (both IgG positive or both IgG negative), and 54 (45.4%) had discordant results (a seropositive man with a seronegative woman, or a seropositive woman with a seronegative man) (kappa index = 0.08; 95% CI: -0.09 - 0.26). With respect to high (> 150 IU/mL) levels of anti-T. gondii IgG antibodies, 79 (66.4%) of the 119 couples had concordant results and 40 (33.6%) had discordant results (kappa index = -0.15; 95% CI: -0.03 - 0.33). Forty couples were positive for anti-T. gondii IgM antibodies. Of them, 21 (52.5%) had concordant results, and 19 (47.5%) had discordant results (kappa index = -0.01; 95% CI: -0.39 - 0.28). Concerning PCR, eight (50%) of 16 couples were positive for T. gondii DNA. Of them, 11 (68.8%) had concordant results, and five (31.2%) had discordant results (kappa index = 0.31; 95% CI: -0.17 - 0.79). CONCLUSIONS: Results suggest a poor concordance of serological and molecular markers of T. gondii infection among heterosexual couples. Further studies to confirm our results should be conducted.

RESUMO

BACKGROUND: Very little is known about the seroepidemiology of infection with the parasite Toxoplasma gondii (T. gondii) in miners. We determine the association of T. gondii infection and the occupation of miner, and the association of seropositivity for T. gondii with the socio-demographic, clinical, work and behavioral characteristics of the miners. METHODS: Through a case-control study, 125 miners working in Durango State, Mexico and 250 age- and gender-matched non-miner subjects were examined for the presence of anti-T. gondii IgG and IgM antibodies using enzyme-linked immunoassays. In addition, the presence of T. gondii DNA in miners was determined using polymerase chain reaction. Bivariate and multivariate analyses were used to determine the association of socio-demographic, work, clinical and behavioral characteristics of miners with T. gondii infection. RESULTS: Anti-T. gondii IgG antibodies were detected in 75 (60.0%) of 125 miners and in 55 (22.0%) of 250 controls (odds ratio (OR) = 5.31; 95% confidence interval (CI): 3.33 - 8.47; P < 0.001). Among IgG seropositive subjects, the frequency of anti-T. gondii IgM antibodies was significantly higher in miners (39/75, 52%) than in controls (8/55, 14.5%) (P < 0.001). All T. gondii seropositive miners referred themselves as healthy. Multivariate analysis of socio-demographic, housing, and behavioral characteristics of miners showed that T. gondii seropositivity was positively associated with being born in Durango State (OR = 3.44; 95% CI: 1.09 - 10.7; P = 0.03), consumption of boar meat (OR = 5.53; 95% CI: 1.49 - 20.3; P = 0.01), living in an overcrowded home (OR = 5.83; 95% CI: 1.49 - 22.8; P = 0.01), and was negatively associated with cleaning cat excrement (OR = 0.33; 95% CI: 0.11 - 0.90; P = 0.03) and consuming goat meat (OR = 0.16; 95% CI: 0.03 - 0.76; P = 0.02). CONCLUSIONS: Surprisingly, our results indicate that miners represent a risk group for T. gondii infection. This is the first age- and gender-matched case-control study on the association of T. gondii infection and the occupation of miner. Further studies to identify the exact cause of high seropositivity in miners in rural Durango are needed.

RESUMO

We assessed the association of Toxoplasma gondii infection and depression in a sample of psychiatric patients and control subjects without depression. We performed an age- and gender-matched case-control study of 89 patients suffering from depression attended in a public psychiatric hospital in Durango City, Mexico and 356 control subjects without depression from the general population of the same city. Participants were tested for the presence of anti-Toxoplasma IgG and IgM antibodies using enzyme-linked immunoassays. Anti-T. gondii IgG antibodies were found in 11 (12.4%) of the 89 cases and in 22 (6.2%) of the 356 controls (OR = 2.14; 95% CI: 1.00-4.59; P = 0.04). Anti-T. gondii IgM antibodies were found in four (19%) of 21 anti-T. gondii IgG seropositive controls but not in 11 anti-T. gondii IgG seropositive cases (P = 0.27). Patients aged 30 years old and younger had a significantly higher seroprevalence of T. gondii infection than controls of the same age group (P = 0.001). Results of the present study suggest a potential association between T. gondii infection and depression. Furthers studies to confirm our results and to determine the epidemiology of T. gondii in young depressed patients should be conducted.

RESUMO

BACKGROUND: The parasite Toxoplasma gondii (T. gondii) may invade the brain and might induce behavioral changes. We sought to determine the association of T. gondii infection and mixed anxiety and depressive disorder. METHODS: Through an age- and gender-matched case-control seroprevalence study, we examined 65 patients suffering from mixed anxiety and depressive disorder (WHO ICD-10 code: F41.2) attending in a public hospital of mental health and 260 control subjects without this disorder from the general population. Sera of participants were analyzed for anti-Toxoplasma IgG and IgM antibodies using enzyme-linked immunoassays. RESULTS: Fifteen (23.1%) of the 65 patients and 18 (6.9%) of the 260 controls had anti-T. gondii IgG antibodies (odds ratio (OR): 4.03; 95% confidence interval (CI): 1.90 - 8.53; P < 0.001). The frequency of high (> 150 IU/mL) anti-T. gondii IgG levels was similar in cases and controls (OR: 0.25; 95% CI: 0.05 - 1.06; P = 0.05). Seroprevalence was similar in male cases and controls (P = 1.0); however, seroprevalence was significantly higher in female cases than in female controls (OR: 7.08; 95% CI: 2.83 - 17.67; P < 0.00001). Patients aged 31 - 50 years old had a significantly higher seroprevalence of T. gondii infection than controls of the same age group (OR: 21.04; 95% CI: 5.22 - 84.80; P < 0.00001). Anti-T. gondii IgM antibodies were found in four (26.7%) of the 15 anti-T. gondii IgG seropositive cases and in 10 (55.6%) of the 18 anti-T. gondii IgG seropositive controls (P = 0.15). CONCLUSIONS: Results support for the first time an association between seropositivity to T. gondii and mixed anxiety and depressive disorder. Further research to confirm this association and to determine the seroepidemiology of T. gondii infection in patients with this disorder is needed.