Elsa Rodríguez-Angulo

Clinical manifestations of the rotavirus infection and his relation with the electropherotypes and serotypes detected during 1998 and 1999 in Merida, Yucatan, Mexico

BACKGROUND Group A rotavirus (RV) is associated with acute infectious diarrhea (AID) in children and adults. The clinical manifestations of RV infection are classified as slight, moderate and severe and could be the results of differing rotaviral serotypes. Attempts have been made to correlate the severity of the infection with specific RV groups, subgroups (SG) serotypes and electropherotypes, but the results have been inconclusive. OBJECTIVE To correlate the severity of the RV infection with the strains of RV isolated from the patients. STUDY DESIGN 142 feces were collected from patients with AID caused by RV. The samples were subjected to polyacrylamide gel electrophoresis (PAGE) to determine the electrophoretic pattern and immunoenzymatic assays with monoclonal antibodies specific for serotype, SG and group. The Program EPIINFO 6.0 was used to analyze the correlation. RESULTS The 142 RV strains isolated were from group A and long electrophoretic pattern. Respect to the symptoms were classified, 43 (30%) as slight; the RV isolates corresponding to these patients were 35 of serotype G1P1A SG II; 4 G1P1A SG I and II; 1 G1P1A SG Non I Non I; 1 G3 SG II; 1 G3 SG Non I and Non II and 1 G3 SG I and II. 89 (53%) of patients showed moderate clinical symptoms. 58 isolates of RV were G1P1A SG II; 11 G1P1A SG Non I Non II; 9 G1P1A SG I and II; 1 G1P1B SG II; 1 G4P1A SG II; 1G1 and G4 SG I and II; 6 G3 SG Non I Non II; 2 G3 SG II. The severe RV infection occurred in only 10 (7%). 8 were serotype G1P1A SG II and 2 were G1P1A SG I and II. CONCLUSION This study demonstrated that the severity of AID has no significant statistical relationship to the specific RV strains isolated from the patients.

Problems with Epidemiological Surveillance and Under-Reporting of Maternal Deaths in Yucatan, Mexico: An Analysis of Six Studies

Surveillance for maternal death cases remains a significant challenge for many countries worldwide. The importance of determining the actual magnitude of the global maternal mortality problem is reflected in the study and application of methodologies that attempt to approximate the actual number of deaths using several sources of information. Traditionally, death certificates have been the best source of data, but unfortunately the diagnoses recorded in them are not always accurate, with the unfortunate result in the under-reporting of maternal deaths. In Mexico, surveillance for cases of maternal deaths is conducted by examining the main cause of death recorded in death certificates. In some situations, the evaluation of the cause(s) of a mother death needs to be clarified, and the relatives are then interviewed. In Yucatan, six studies have been conducted to analyze the under-reporting of maternal deaths. The percentage of state under-reporting for the period between 1997 and 2001 was 19%. The rates of under-reporting varied between 10.5% and 28.6%, and it decreased to 3% in the eastern area between 2002 and 2010. The main causes of maternal death under-reporting were errors regarding the interpretation of the death diagnosis and the completion of the death certificate, as well as omissions when codifying, even though the pregnancy, delivery, or puerperium conditions had been recorded. Therefore, we recommend the establishment of an effective and highly functional maternal death surveillance system, including medical education and training of medical professionals to recognize the causes of maternal death and to prepare death certificates and training of the individuals responsible for coding obstetrical complications to include the correct interpretation of the causes.