Background: Diagnosis of malignant pleural mesothelioma (MPM) remains a challenge, especially when resources in pathology are limited. The study aimed to evaluate cost-effective tumor markers to predict the probability of MPM in plasma samples in order to accelerate the diagnostic workup of the tissue of potential cases.Methods: We conducted a case-control study stratified by gender, which included 75 incident cases with MPM from three Mexican hospitals and 240 controls frequency-matched by age and year of blood drawing. Plasma samples were obtained to determine mesothelin, calretinin, and thrombomodulin using enzyme-linked immunosorbent assays (ELISAs). We estimated the performance of the markers based on the area under the curve (AUC) and predicted the probability of an MPM diagnosis of a potential case based on the marker concentrations.Results: Mesothelin and calretinin, but not thrombomodulin were significant predictors of a diagnosis of MPM with AUCs of 0.90 (95% CI: 0.85-0.95), 0.88 (95% CI: 0.82-0.94), and 0.51 (95% CI: 0.41-0.61) in males, respectively. For MPM diagnosis in men we estimated a true positive rate of 0.79 and a false positive rate of 0.11 for mesothelin. The corresponding figures for calretinin were 0.81 and 0.18, and for both markers combined 0.84 and 0.11, respectively.Conclusions: We developed prediction models based on plasma concentrations of mesothelin and calretinin to estimate the probability of an MPM diagnosis. Both markers showed a good performance and could be used to accelerate the diagnostic workup of tissue samples in Mexico.

Objective. To describe the tuberculosis morbidity and mortality trends in Mexico, by comparing the data reported by the Ministry of Health (MH) and the World Health Organization (WHO) between 1981 and 1998. Material and Methods. The number of cases notified in the past few years, their rates, and the trends of the disease in Mexico were analyzed. The incidence of smear-positive pulmonary tuberculosis was estimated for 1997 and 1998 with the annual tuberculosis infection risk (ATIR), to estimate the percentage of bacilliferous cases in 1997-1998. Results. WHO reported more tuberculosis cases for Mexico than the MH. However, this difference has decreased throughout the years. The notification of smear-positive cases remained stable during 1993-1998. The estimated percentages of detection were 66% for 1997 and 26% for 1998 (based on ATIR of 0.5%). Tuberculosis mortality decreased gradually (6.7% per year) between 1990 and 1998, whereas the number of new cases increased, suggesting the persistence of disease transmission in the population. Conclusions. Inconsistencies between case notifications from national data and WHO were considerable, but decreased progressively during the study period. According to ATIR estimations, a considerable number of infectious tuberculosis cases are not detected.

RESUMEN. México experimenta grandes retos de salud poblacional y de su sistema de salud. La transición demográfica combina la coexistencia de enfermedades infecciosas y crónico-degenerativas. Las enfermedades respiratorias son algunos de los principales problemas de salud pública y se han agudizado con el surgimiento de las pandemias respiratorias: influenza A H1N1 en 2009 y COVID-19 por el virus SARS-CoV-2 durante el año 2020. En este período, el Instituto Nacional de Enfermedades Respiratorias (INER), el principal centro formador de recursos humanos especializados en México, al igual que otras sedes de la especialidad de neumología, ha experimentado una profunda transformación hacia la integración asistencial de la medicina respiratoria y la medicina crítica. Sin embargo, la gran carencia de recursos humanos especializados en la materia se ha hecho más evidente durante la actual emergencia epidemiológica. Esto viene a confirmar que la propuesta de integración de neumología y medicina crítica en una sola especialidad puede ser una de las respuestas obligadas y efectivas a la altura de algunos de los mayores desafíos de la medicina en nuestro país. Palabras clave: COVID-19, educación médica, recursos humanos de la salud, empleo médico. ABSTRACT. Mexico experiences great challenges in public health and its health system. Demographic transition combines the coexistence of infectious and chronic-degenerative diseases. Respiratory diseases are some of the major public health problems and have been aggravated by the advent of respiratory pandemics: Influenza A H1N1 in 2009 and COVID-19 by SARS-CoV-2 during 2020. In this period, the National Institute of Respiratory Diseases (INER), the main training center for specialized human resources in Mexico, like other centers for the specialty of pulmonary medicine, has undergone a profound transformation towards the healthcare integration of respiratory and critical care medicine. Nevertheless, the great lack of specialized human resources in this area has become more evident during the current epidemiological emergency. It confirms that the proposal to integrate pulmonary and critical care medicine into a single specialty may be one of the compelling and effective responses to match some of the greatest challenges of medicine in our country.