RMSF is a public health problem in Sonora. Clinically, fatal cases differ from non-fatal cases in renal function and hemorrhagic manifestations, although these findings may occur too late for a timely intervention. First-line providers must be educated to harbor a timely suspicion of RMSF, and should provide empiric treatment with doxycycline when febrile patients first present for care.

Background Rocky Mountain spotted fever (RMSF) is a significant public health problem in Sonora, Mexico, resulting in thousands of cases and hundreds of deaths. Outbreaks of RMSF are perpetuated by heavy brown dog tick infestations in and around homes. During 2009–2015, there were 61 RMSF cases and 23 deaths in a single community of Sonora (Community A). Methods An integrated intervention was carried out from March–November 2016 aimed at reducing tick populations with long-acting acaricidal collars on dogs, environmental acaricides applied to peri-domestic areas and RMSF education. Tick levels were measured by inspection of community dogs to monitor efficacy of the intervention. A similar neighborhood (Community B) was selected for comparison and received standard care (acaricide treatment and education). Results The prevalence of tick-infested dogs in Community A declined from 32.5% to 8.8% (p<0.01). No new cases of RMSF were identified in this area during the subsequent 18 mo. By comparison, the percentage of tick-infested dogs in Community B decreased from 19% to 13.4% (p=0.36) and two cases were reported, including one death. Conclusions Community-based interventions using an integrated approach to control brown dog ticks can diminish the morbidity and mortality attributable to RMSF.

Obesity and its comorbidities have become the most important public health problems for Latin America. In Mexico obesity has increased dramatically to the point where the government has declared it an epidemiological emergency. The most recent national data showed overweight and obesity affects 72.5% of adults, or around 56 million Mexicans. Most Mexican adults with obesity are undiagnosed. According to data derived from a national representative survey, only 20% of adults with BMI >30 kg/m2 were diagnosed with obesity by a health provider. Likewise, only 8% of individuals with obesity had received treatment for obesity. Interventions offered in the Mexican health care delivery system generally consist of traditional consultations with recommendations on diet and exercise, visits are monthly to quarterly, and validated behavior change protocols are not used. Evidence from clinical trials has shown that weight loss with this type of treatment is generally less than 1 kg per year. In contrast, intensive lifestyle interventions – protocols focusing on achieving changes in diet, physical activity, and moderate weight loss using behavioral strategies with weekly or bi-weekly sessions for the first 3 to 6 months, and a maintenance phase with trained interventionists – as implemented in the Diabetes Prevention Program and the Look AHEAD studies achieved weight loss of 7–9% at one year. Additionally, translation studies of these interventions to the community and to real-world clinical practice have achieved weight loss of around 4%. Adaptations of intensive lifestyle interventions have been implemented in the United States, both in clinical practice and in the community, and this type of intervention represents a potential model to combat obesity in Mexico and other Latin American countries. It is essential that primary care providers in Mexico implement clinical practice guidelines based on the best evidence available as discussed here to effectively treat obesity. The authors make recommendations to improve the treatment of obesity in the clinical care delivery system in Mexico using intensive lifestyle interventions.

In this work we use Mimosa tenuiflora (MtE) extracts as reducing agents to synthesize silver nanoparticles (AgMt NPs) which were characterized by DPPH and Total Polyphenols Assays, UV–visible, X-ray diffractometer (XRD), high-resolution transmission electron microscopy (HRTEM), X-ray photoelectron spectroscopy (XPS) and Thermogravimetric analysis (TGA). AgMt NPs possess average sizes of 21 nm and fcc crystalline structure, it was also confirmed that the MtE is present in the AgMt NPs even after the cleaning protocol applied. Subsequently, carbopol hydrogels were made and the MtE and the synthesized AgMt NPs were dispersed in different gels (MtE-G and AgMt NPs-G, respectively) at 100 µg/g concentration. The gels were characterized by UV–Vis, IR, and rheology. Antimicrobial tests were performed using Staphylococcus aureus and Escherichia coli. Burn wound healing was evaluated in a second-degree burn injury on a Wistar rats model for 14 days and additional skin biopsies were examined with histopathological analysis. Gel with commercial silver nanoparticles (Ag NPs) was prepared and employed as a control on the biological assays. Hydrogel system containing silver nanoparticles synthesized with Mimosa tenuiflora (AgMt NPs-G) is a promising therapeutic strategy for burn wound healing, this due to bactericidal and anti-inflammatory effects, which promotes a more effective recovery (in percentage terms) by damaged area.

We present a series of four pregnant women with Rocky Mountain spotted fever (RMSF) that occurred in Sonora, Mexico, during 2015-2016. Confirmatory diagnoses were made by polymerase chain reaction or serological reactivity to antigens of by using an indirect immunofluorescence antibody assay. Each patient presented with fever and petechial rash and was treated successfully with doxycycline. Each of the women and one full-term infant delivered at 36 weeks gestation survived the infection. Three of the patients in their first trimester of pregnancy suffered spontaneous abortions. RMSF should be suspected in any pregnant woman presenting with fever, malaise and rash in regions where is endemic.

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[ahead of print]Freely available online -OPEN ACCESS La Revista Española de Nutrición Humana y Dietética se esfuerza por mantener a un sistema de publicación continua, de modo que los artículos se publican antes de su formato final (antes de que el número al que pertenecen se haya cerrado y/o publicado). De este modo, intentamos poner los artículos a disposición de los lectores/usuarios lo antes posible.The Spanish Journal of Human Nutrition and Dietetics strives to maintain a continuous publication system, so that the articles are published before its final format (before the number to which they belong is closed and/or published). In this way, we try to put the articles available to readers/users as soon as possible. Revista Española de Nutrición Humana y Dietética Spanish Journal of Human Nutrition and Dietetics PROTOCOLO -versión post-printEsta es la versión aceptada, revisada por pares. El artículo puede recibir modificaciones de estilo y de formato. Translational study of obesity management using the Diabetes PreventionProgram "Group Lifestyle Balance" in primary care clinics and public hospitals Balance" for weight loss among adults with overweight and obesity from baseline to 6 months and from baseline to 12 months in primary care clinics and public hospitals from Sonora, México Material and methods: This is a translational, multi-center, non-controlled, 6 and 12-month follow-up clinical study with a pre-test and post-test design. Healthcare providers from two primary care clinics, two hospitals and one university clinic will be trained with the DPP protocol to implement on their overweight and obese adult patients. Body weight, body mass index, waist circumference, systolic and diastolic blood pressure, depression, quality of life and stress scales will be measured in participants receiving the program at baseline, 6 and 12 months. RESUMENIntroducción: La obesidad es el principal factor de riesgo para el desarrollo de enfermedades crónicas en México. Varios ensayos clínicos controlados han mostrado que los programas intensivos de cambio de estilo de vida son eficaces para el manejo de obesidad. Estos programas incluyen sesiones frecuentes (14 o más los primeros 6 meses), centradas en hacer mejoras en la dieta y actividad física utilizando un protocolo de cambio de comportamiento. Sin embargo, la mayoría de clínicas de primer nivel y los hospitales públicos aplican tratamientos tradicionales para el manejo de obesidad que tienen resultados limitados. El propósito del estudio es evaluar la efectividad del Programa de Prevención de Diabetes "Grupo de Equilibrio de Estilo de Vida" sobre la pérdida de peso en adultos con sobrepeso y obesidad del inicio a 6 meses y del inicio a 12 meses del seguimiento en clínicas de primer nivel y hospitales públicos de Sonora, México. Material y métodos:Este es un estudio clínico multicéntrico traslacional, no controlado con diseño pre y post-prueba a 6 y 12 meses. Los proveedores de salud de 2 clínicas de primer nivel, 2 hospitales públicos y una clínica universitaria ser...

Resultados. Se apreció un incremento en la incidencia y mortalidad en los casos hospitalizados por FMMR, con una letalidad de 30%. Tres variables se asociaron con el riesgo de muerte: retraso ≥ 5 días en el inicio del uso de doxiciclina (RM a =2.95, IC95% 1.10-7.95), falla renal aguda (RM a =8.79, IC95% 3.46-22.33) y sepsis severa (RM a =3.71, IC95% 1.44-9.58). Conclusión. La FMMR provoca resultados fatales en niños, que puede evitarse con la administración oportuna de doxiciclina. La falla renal aguda y la sepsis severa son dos predictores de muerte en niños con FMMR. Results. An upward trend was observed in RMSF morbidity and mortality. Fatality rate was 30%. Three predictors were associated with risk of death: delay ≥ 5 days at the start of doxycycline (OR a = 2.95, 95% CI 1.10-7.95), acute renal failure ((OR a = 8.79, 95% CI 3.46-22.33) and severe sepsis (OR a = 3.71, 95% CI 1.44-9.58). Conclusions. RMSF causes high mortality in children, which can be avoided with timely initiation of doxycycline. Acute renal failure and severe sepsis are two independent predictors of death in children with RMSF.