Antonio Sifuentes-Alvarez

Seroepidemiology of Toxoplasma gondii infection in pregnant women in a public hospital in northern Mexico

BackgroundToxoplasma gondii (T. gondii) infection in pregnant women represents a risk for congenital disease. There is scarce information about the epidemiology of T. gondii infection in pregnant women in Mexico. Therefore, we sought to determine the prevalence of T. gondii infection and associated socio-demographic, clinical and behavioural characteristics in a population of pregnant women of Durango City, Mexico.MethodsThree hundred and forty three women seeking prenatal care in a public hospital of Durango City in Mexico were examined for T. gondii infection. All women were tested for anti-T. gondii IgM and IgG antibodies by using IMx Toxo IgM and IMx Toxo IgG 2.0 kits (Abbott Laboratories, Abbott Park, IL, USA), respectively. Socio-demographic, clinical and behavioural characteristics from each participant were also obtained.ResultsTwenty one out of the 343 (6.1%) women had IgG anti-T. gondii antibodies. None of the 343 women had IgM anti-T. gondii antibodies. Multivariate analysis using logic regression showed that T. gondii infection was associated with living in a house with soil floor (adjusted OR = 7.16; 95% CI: 1.39–36.84), residing outside of Durango State (adjusted OR = 4.25; 95% CI: 1.72–10.49), and turkey meat consumption (adjusted OR = 3.85; 95% CI: 1.30–11.44). Other characteristics as cat contact, gardening, and food preferences did not show any association with T. gondii infection.ConclusionThe prevalence of T. gondii infection in pregnant women of Durango City is low as compared with those reported in other regions of Mexico and the majority of other countries. Poor housing conditions as soil floors, residing in other Mexican States, and turkey meat consumption might contribute to acquire T. gondii infection.

Validation of the Edinburgh postpartum depression scale in a population of puerperal women in Mexico

BackgroundThe Edinburgh postnatal depression scale (EPDS) has been validated and used successfully in detecting postnatal depression in several language versions in a number of countries. However, there is not any Mexican version of the EPDS that had been validated. Therefore, we sought to validate a Spanish translated Mexican version of the EPDS in a population of puerperal Mexican women.MethodsOne hundred puerperal women within their three month postpartum period attending routine postnatal consultations in a public hospital in Durango City, Mexico participated in the study. The participants were divided into two groups: one group included 49 women with less than 4 weeks of postpartum, and the other group included 51 women within 4 to 13 weeks of postpartum. All participants submitted a Spanish translated Mexican version of the EPDS and were interviewed by a psychiatrist to assess major and minor depression by using DSM-IV criteria.ResultsOut of the 49 women with less than 4 weeks of postpartum, 4 were found as suffering from major depression and none from minor depression by using the DSM-IV criteria. In this group of women we found that the best EPDS score for screening depression was 11/12. This threshold showed a sensitivity of 75% (95% CI: 63.8–86.2), a specificity of 93% (95% CI: 84.6–100), a positive predictive value of 50%, a negative predictive value of 97.6%, and an area under the curve of 0.84. While in the 51 women within 4 to 13 weeks of postpartum, 7 were found as suffering from major depression and 1 from minor depression by using the DSM-IV criteria. In this group we found that the best EPDS score for screening depression was 7/8. This threshold showed a sensitivity of 75% (95% CI: 66.1–83.9), a specificity of 84% (95% CI: 76.1–91.9), a positive predictive value of 46.2%, a negative predictive value of 94.7% and an area under the curve of 0.80.ConclusionThe Mexican version of the EPDS can be considered for screening depression in puerperal Mexican women whenever cut-off scores of 11/12 and 7/8 in women with less than 4 weeks and within 4 to 13 weeks of postpartum are used, respectively.

Toxoplasma gondii infection and suicide attempts: A case-control study in psychiatric outpatients

Abstract The association of Toxoplasma gondii infection with suicide attempts has been scarcely evaluated. Two hundred eighty-three psychiatric outpatients (156 patients with history of suicide attempt and 127 control patients without history of suicide attempt) were examined with enzyme-linked immunoassays for Toxoplasma immunoglobulin G (IgG) and IgM antibodies. Seroprevalences of Toxoplasma IgG and IgM in the cases and the controls were similar: 7 (4.5%) and 3 (1.9%) vs. 10 (7.9%) and 3 (2.4%) (p = 0.23 and p = 0.55), respectively. In contrast, the Toxoplasma IgG levels higher than 150 IU/ml were more frequently observed in the cases than in the controls (100% vs. 50%, respectively; p = 0.04). The seroprevalence of Toxoplasma infection increased with age and with the number of suicide attempts. Toxoplasma seropositivity was associated with reflex impairment, national trips, and snake meat consumption. Our results suggest that although seroprevalence of Toxoplasma infection is not associated with suicide attempts, a high anti-Toxoplasma antibody level is, therefore warranting further research.

Seroepidemiology of Toxoplasma gondii infection in Tepehuanos in Durango, Mexico.

The epidemiology of Toxoplasma gondii infection is known to depend on a number of behavioral factors, including contact with animals and eating habits. The epidemiology in specific populations (i.e., in indigenous ethnic groups) is not well studied. We therefore investigated the presence of anti-Toxoplasma IgG and IgM antibodies in 156 Tepehuanos, an indigenous ethnic group in Durango State in northern Mexico, using ELISAs. Of the 156 Tepehuanos (mean age 31.03±16.71 years), 35 (22.4%) had anti-Toxoplasma IgG antibodies. IgG levels of 14-99, 100-150, and >150 IU/mL were found in 15 (42.9%), 1 (2.8%), and 19 (54.3%) anti-Toxoplasma IgG-positive Tepehuanos, respectively. Also, 15 (9.6%) subjects had anti-Toxoplasma IgM antibodies. Male Tepehuanos aged 31-50 years showed a significantly higher frequency of exposure to T. gondii than female Tepehuanos of the same age. Seroprevalence of anti-T. gondii IgM antibodies was significantly higher in Tepehuanos without education than those with 7-12 years of education. Tepehuanos suffering from frequent headaches had significantly higher seroprevalences of anti-T. gondii IgG and IgM antibodies than those without this clinical feature. In addition, Tepehuanos suffering from hearing impairment had significantly higher seroprevalence of anti-T. gondii IgM antibodies than those without this clinical feature. Logistic regression analysis did not show an association of T. gondii exposure with any behavioral characteristics, including contact with cats or eating habits. The seroprevalence of T. gondii exposure in Tepehuanos is comparable to that reported in other populations in North America; however, seroprevalence in the largely rural Tepehuanos is higher than that reported in a nearby urban center. Toxoplasma may be impacting the health of Tepehuanos. This is the first report of T. gondii infection in Tepehuanos, and the results should prove useful for the design of preventive measures.

Validation of the edinburgh postpartum depression scale in a population of adult pregnant women in Mexico.

Background The Edinburgh postnatal depression scale (EPDS) is useful for screening depression in puerperal women as well as women during pregnancy. However, such instrument should be validated in a given language before it can be used. There is not validated Mexican version of the EPDS for use in adult pregnant women. Therefore, we sought to validate a Spanish translated Mexican version of the EPDS in a population of adult pregnant women. Methods One hundred fifty-eight adult women (mean age: 28 ± 6.8 years; range: 18 - 45 years) within their 2 - 9 months of pregnancy attending routine prenatal consultations in a public hospital in Durango City, Mexico were studied. All pregnant women submitted a Spanish translated Mexican version of the EPDS. In addition, participants were assessed for major and minor depression by using the DSM-IV criteria. Results Of the 158 pregnant women studied, 11 had major depression and 26 had minor depression by the DSM-IV criteria. The best EPDS score for screening combined major and minor depression in adult pregnant women was 9/10. This threshold showed a sensitivity of 75.7%, a specificity of 74.4%, a positive predictive value of 50.8%, a negative predictive value of 94.7% and an area under the curve of 0.89 (95% confidence interval: 0.71 - 1.06). Conclusion The Mexican version of the EPDS can be considered for screening depression in Mexican adult pregnant women whenever a cut-off score of 9/10 is used.

The use of the edinburgh postpartum depression scale in a population of teenager pregnant women in Mexico: a validation study.

Background :Depression may occur in teenager pregnant women. The use of a validated tool for screening depression is highly recommended. The Edinburgh postnatal depression scale (EPDS) is a screening tool for depression used in women during the postnatal period and pregnancy. However, the EPDS has not been validated in teenager pregnant women. Therefore, we sought to validate a Spanish translated Mexican version of the EPDS in a population of teenager pregnant women. Methods: One hundred and twenty teenager pregnant women attending routine prenatal consultations in a public hospital in Durango City, Mexico participated in the study. All participants submitted a revised Spanish translated Mexican version of the EPDS and were examined by a psychiatrist to evaluate the presence of depression by using DSM-IV criteria. Results: Of the 120 teenager pregnant women studied, 2 had major depression and 25 had minor depression according to the DSM-IV criteria. The optimal EPDS cut-off for screening combined major and minor depression in teenager pregnant women was 8/9. At this threshold, we found a sensitivity of 70.4%, a specificity of 84.9%, a positive predictive value of 47.6%, a negative predictive value of 91.0%, and an area under the curve of 0.81 (95% confidence interval: 0.56-1.07). Conclusion: The EPDS can be used for screening depression in Mexican teenager pregnant women whenever a cut-off score of 8/9 is used.

Depression in Teenager Pregnant Women in a Public Hospital in a Northern Mexican City: Prevalence and Correlates

Background Very little is known about prenatal depression in teenagers in Mexico. We determined the prevalence and correlates of prenatal depression in teenager women attending a public hospital in Durango City, Mexico. Methods We performed a cross-sectional study to assess depression in 181 teenager pregnant women who attended a public hospital for prenatal care. We used a validated Mexican version of the Edinburg postnatal depression scale (EPDS) to screen depression. Women with EPDS scores suggestive of depression were further examined to confirm depression by a psychiatric evaluation using the DSM-IV criteria. Bivariate and multivariate analyses were used to evaluate the prevalence association with socio-demographic, clinical and psychosocial characteristics of the pregnant women. Results Of the 181 teenager pregnant women studied, 61 (33.7%) had EPDS equal to or higher than 8 (range 8 - 23), and 37 of them were confirmed to have prenatal depression by the psychiatric evaluation. The general prevalence of prenatal depression in the teenager pregnant women studied was 20.4%. Of the 37 women with depression, 34 suffered from minor depression and three suffered from major depression. Thus, the prevalence of minor and major depression in the women studied was 18.8% and 1.7%, respectively. Multivariate analysis of the socio-demographic, clinical and psychosocial characteristics of the teenager pregnant women showed that prenatal depression was associated with a previous episode of depression during pregnancy (odds ratio (OR) = 6.12; 95% confidence interval (CI): 1.68 - 22.30; P = 0.006), and borderline associations with big fetal size (OR = 9.9; 95% CI: 0.94 - 104.24; P = 0.05) and family problems (OR = 3.83; 95% CI: 0.99 - 14.84; P = 0.05). Conclusions Results demonstrate that prenatal depression is common in pregnant teenagers in Durango City, Mexico. The history of an episode of depression during pregnancy should alert physicians for further depression episodes during pregnancy in teenagers. Further research to elucidate the association of prenatal depression with size of the fetus and family problems in pregnant teenagers is needed.

Adjustment Disorder in Pregnant Women: Prevalence and Correlates in a Northern Mexican City

Background The epidemiology of adjustment disorder in pregnant women is largely unknown. We sought to determine the prevalence and correlates of adjustment disorder in pregnant women in Durango City, Mexico. Methods Pregnant women (n = 300) attending in a public hospital in Durango City, Mexico were studied. All enrolled pregnant women had a psychiatric interview to evaluate the presence of adjustment disorder using the DSM-IV criteria. A questionnaire was submitted to obtain general epidemiological data of the pregnant women studied. Bivariate and multivariate analyses were used to assess the association of adjustment disorder with the epidemiological data of the women studied. Results Fifteen (5.0%) of the 300 women studied had adjustment disorder according to the DSM-IV criteria. Adjustment disorder was not associated with age, occupation, marital status, or education of pregnant women. In contrast, multivariate analysis of socio-demographic, clinical and psychosocial variables showed that adjustment disorder was associated with the variables lack of support from her couple (odds ratio (OR) = 3.83; 95% confidence interval (CI): 1.00 - 14.63; P = 0.04) and couple living abroad (OR = 10.12; 95% CI: 1.56 - 65.50; P = 0.01). Conclusions This is the first report about the epidemiology of adjustment disorder in pregnant women in Mexico. Results provide evidence of the presence of adjustment disorder and contributing psychosocial factors associated with this disorder in pregnant women in Mexico. Results point towards further clinical and research attention should be given to this neglected disorder in pregnant women.

TNF-α POLYMORPHISMS AND MATERNAL DEPRESSION IN A MEXICAN MESTIZO POPULATION

BACKGROUND Depressive disorders are common during pregnancy. There is compelling evidence that the inflammatory response system is important in the pathophysiology of depression. Higher concentrations of proinflammatory cytokines including tumor necrosis factor-alpha (TNF-α) in depressed subjects have been described. Because several polymorphisms in the TNF-α promoter region are known to affect its gene expression, the aim of this study was determine whether TNF-α - 857C/T, -308G/A, and -238G/A polymorphisms confer susceptibility to depression during pregnancy in a Mexican mestizo population. METHODS This case-control study involved 153 depressed pregnant women and 177 controls. Polymorphisms were genotyped using real-time PCR. Odds ratios (OR) and 95% confidence intervals adjusted by age, body mass index, number of pregnancies, months of pregnancy and number of abortions were used to estimate risk. RESULTS The -857CT genotype was found to increase the risk for depression (OR= 1.73, 95% CI= 1.06-2.82). In contrast, the -238GA genotype reduced the risk (OR= 0.33, 95% CI= 0.14-0.72). The - 308G/A polymorphism was not associated with risk for depression. Finally, the C857-G308-A238 haplotype was associated with a decreased risk of depression (OR= 0.35, 95% CI= 0.15-0.82). CONCLUSION Our results show for the first time an association between TNF-α -857C/T and -238G/A polymorphisms and prenatal depression in Mexican mestizo population.