ObjectiveTo determine the clinical consequences of pulmonary tuberculosis (TB) among patients with diabetes mellitus (DM).MethodsWe conducted a prospective study of patients with TB in Southern Mexico. From 1995 to 2010, patients with acid-fast bacilli or Mycobacterium tuberculosis in sputum samples underwent epidemiological, clinical and microbiological evaluation. Annual follow-ups were performed to ascertain treatment outcome, recurrence, relapse and reinfection.ResultsThe prevalence of DM among 1262 patients with pulmonary TB was 29.63% (n=374). Patients with DM and pulmonary TB had more severe clinical manifestations (cavities of any size on the chest x-ray, adjusted OR (aOR) 1.80, 95% CI 1.35 to 2.41), delayed sputum conversion (aOR 1.51, 95% CI 1.09 to 2.10), a higher probability of treatment failure (aOR 2.93, 95% CI 1.18 to 7.23), recurrence (adjusted HR (aHR) 1.76, 95% CI 1.11 to 2.79) and relapse (aHR 1.83, 95% CI 1.04 to 3.23). Most of the second episodes among patients with DM were caused by bacteria with the same genotype but, in 5/26 instances (19.23%), reinfection with a different strain occurred.ConclusionsGiven the growing epidemic of DM worldwide, it is necessary to add DM prevention and control strategies to TB control programmes and vice versa and to evaluate their effectiveness. The concurrence of both diseases potentially carries a risk of global spreading, with serious implications for TB control and the achievement of the United Nations Millennium Development Goals.

Asthma morbidity has been increasing for Background -A study was undertaken to reasons not yet well understood.1 Although assess the combined association between evidence for an increasing incidence of asthma urban air pollution and emergency ad-due to air pollution has not been provided, air missions for asthma during the years pollution could exacerbate existing asthma. to sulphur dioxide (SO 2 ), ozone (O 3 ), and Methods -Daily counts were made of nitrogen dioxide (NO 2 ) at levels compatible asthma admissions and visits to the emer-with urban life produced bronchial hypergency room in adults (age range 15-64 responsiveness and inflammation and reduced years) and children (<15 years). Covari-the dose of aeroallergen needed to produce ates were short term fluctuations in tem-a given bronchial response.3-9 Studies on air perature and humidity, viral epidemics, pollution in laboratory face two main limday of the week effects, and seasonal and itations: the non-representative selection of secular trends. Estimates from all the cities subjects and the simplification of human exwere obtained for the entire period and posures. separately by warm or cold seasons using Some recent population studies have related Poisson time-series regression models. daily levels of particles and ozone to the increase Combined associations were estimated of emergency room admissions for asthma, using meta-analysis techniques.though these findings do not extend to all Results -Daily admissions for asthma in the studies.2 10 Epidemiological studies on daily adults increased significantly with in-variations in asthma admissions and air polcreasing ambient levels of nitrogen dioxide lution levels assess the general population at (NO 2 ) (relative risk (RR) per 50 g/m 3 in-real world exposures with adequate internal crease 1.029, 95% CI 1.003 to 1.055) and validity.11 12 The APHEA Project 13 is an internon-significantly with particles measured national European prospective standardised as black smoke (RR 1.021, 95% CI 0.985 to study on the short term health effects of air 1.059). The association between asthma pollution in the general population. This paper admissions and ozone (O 3 ) was hetero-combines the individual city associations of air geneous among cities. In children, daily pollution with asthma admissions in Barcelona, admissions increased significantly with Helsinki, London and Paris, the four European sulphur dioxide (SO 2 ) (RR 1.075, 95% CI cities in APHEA that collected data on asthma. 1.026 to 1.126) and non-significantly with This multi-city study allows an evaluation of a black smoke (RR 1.030, 95% CI 0.979 to wide variability in environmental exposures and 1.084) and NO 2 , though the latter only in enhances the external validity of findings. cold seasons (RR 1.080, 95% CI 1.025 to Individual results have been reported for 1.140). No association was observed for O 3 . Helsinki 14 and Barcelona.

BackgroundSARS-CoV-2 infection represents a global health problem that has affected millions of people. The fine host immune response and its association with the disease course have not yet been fully elucidated. Consequently, we analyze circulating B cell subsets and their possible relationship with COVID-19 features and severity.MethodsUsing a multiparametric flow cytometric approach, we determined B cell subsets frequencies from 52 COVID-19 patients, grouped them by hierarchical cluster analysis, and correlated their values with clinical data.ResultsThe frequency of CD19+ B cells is increased in severe COVID-19 compared to mild cases. Specific subset frequencies such as transitional B cell subsets increase in mild/moderate cases but decrease with the severity of the disease. Memory B compartment decreased in severe and critical cases, and antibody-secreting cells are increased according to the severity of the disease. Other non-typical subsets such as double-negative B cells also showed significant changes according to disease severity. Globally, these differences allow us to identify severity-associated patient clusters with specific altered subsets. Finally, respiratory parameters, biomarkers of inflammation, and clinical scores exhibited correlations with some of these subpopulations.ConclusionsThe severity of COVID-19 is accompanied by changes in the B cell subpopulations, either immature or terminally differentiated. Furthermore, the existing relationship of B cell subset frequencies with clinical and laboratory parameters suggest that these lymphocytes could serve as potential biomarkers and even active participants in the adaptive antiviral response mounted against SARS-CoV-2.

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Background As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has remained in Latin America, Mexico has become the third country with the highest death rate worldwide. Data regarding in-hospital mortality and its risk factors, as well as the impact of hospital overcrowding in Latin America has not been thoroughly explored. Methods and findings In this prospective cohort study, we enrolled consecutive adult patients hospitalized with severe confirmed COVID-19 pneumonia at a SARS-CoV-2 referral center in Mexico City from February 26th, 2020, to June 5th, 2020. A total of 800 patients were admitted with confirmed diagnosis, mean age was 51.9 ± 13.9 years, 61% were males, 85% were either obese or overweight, 30% had hypertension and 26% type 2 diabetes. From those 800, 559 recovered (69.9%) and 241 died (30.1%). Among survivors, 101 (18%) received invasive mechanical ventilation (IMV) and 458 (82%) were managed outside the intensive care unit (ICU); mortality in the ICU was 49%. From the non-survivors, 45.6% (n = 110) did not receive full support due to lack of ICU bed availability. Within this subgroup the main cause of death was acute respiratory distress syndrome (ARDS) in 95% of the cases, whereas among the non-survivors who received full (n = 105) support the main cause of death was septic shock (45%) followed by ARDS (29%). The main risk factors associated with in-hospital death were male sex (RR 2.05, 95% CI 1.34–3.12), obesity (RR 1.62, 95% CI 1.14–2.32)—in particular morbid obesity (RR 3.38, 95%CI 1.63–7.00)—and oxygen saturation < 80% on admission (RR 4.8, 95%CI 3.26–7.31). Conclusions In this study we found similar in-hospital and ICU mortality, as well as risk factors for mortality, compared to previous reports. However, 45% of the patients who did not survive justified admission to ICU but did not receive IMV / ICU care due to the unavailability of ICU beds. Furthermore, mortality rate over time was mainly due to the availability of ICU beds, indirectly suggesting that overcrowding was one of the main factors that contributed to hospital mortality.