Instituto Nacional de Pediatria

To evaluate clinical outcomes, treatment response and predictors of seizure freedom after vagus nerve stimulation in patients with drug-resistant epilepsy in a Mexican cohort. We conducted a retrospective multicenter cohort across 13 epilepsy centers in Mexico (2003-2024) including patients aged ≥4 years with drug-resistant epilepsy or epileptic encephalopathy. Treatment response was defined as at least 50% seizure reduction and Engel outcomes. Logistic regression identified predictors of seizure freedom. Model performance was assessed with receiver operating characteristic analysis, area under the curve, Hosmer-Lemeshow test, and a confusion matrix. Ninety-three patients (51 children, 42 adults) were included. At 1 year, median monthly seizure frequency decreased by 82.5% (40-7; p < .001). The incidence of status epilepticus declined by 92.8%, acute prolonged seizures by 80.9%, the burden of antiseizure medications by 25%, and epilepsy-related hospitalizations by 100% (all p < .001). Overall, 68.8% achieved ≥50% reduction and 11.8% became seizure-free. On univariate analysis, comorbidities, multiple seizure types, higher baseline seizure frequency, greater number of antiseizure medications, and magnet use were inversely related to seizure freedom, while normal brain MRI showed a direct relationship. On multivariable analysis, only baseline seizure frequency ≥30/month independently predicted seizure freedom (p = .047), corresponding to 97.7% lower odds. A predictive model incorporating comorbidities and number of antiseizure medications improved discrimination (p < .001) with 86.6% sensitivity and 81.8% specificity. Vagus nerve stimulation was associated with substantial seizure frequency reduction, lower morbidity, and less healthcare utilization, with a favorable safety profile. Baseline seizure burden emerged as the key predictor of seizure freedom and may guide patient selection, supporting earlier vagus nerve stimulation consideration in drug-resistant epilepsy.

BackgroundMexico is undergoing rapid population ageing, but its pace and intensity vary markedly across regions. This process unfolds amid deep social and economic inequalities, particularly in rural and marginalized areas where limited access to healthcare and social protection increases the risk of chronic disease, disability, and dependence.ObjectiveTo examine how demographic ageing, socioeconomic, and health conditions relate to disability prevalence among older adults at the municipal level, emphasizing the structural and territorial factors that constrain healthy ageing.MethodsUsing data from the 2020 Population and Housing Census and 2015–2019 mortality records, a municipal composite ageing index was developed to capture both the magnitude and structure of ageing. Spatial analytical techniques—Moran’s I, Local Indicators of Spatial Association (LISA), and Geographically Weighted Regression (GWR)—were applied to identify spatial dependence and local variation.ResultsBivariate Moran’s I indicated limited global autocorrelation between ageing and disability, but LISA revealed pronounced local clusters. Ageing was more advanced in northern and central Mexico, whereas disability concentrated in the south and southeast. Lower educational attainment, reduced social protection coverage, and greater socioeconomic disadvantage were linked to highter disability prevalence.ConclusionsThe findings show that ageing and disability are spatially patterned outcomes shaped by long-standing territorial inequalities. Recognizing these spatial dynamics is key to designing regionally differentiated, place-based public health and social policy responses that promote equitable ageing in Mexico.

gut microbiota dysbiosis is closely associated with the development of allergic diseases. Short-chain fatty acids (SCFAs), as microbial metabolites, regulate immune responses and may represent a therapeutic target. Cow's milk protein allergy (CMPA) is one of the most common food allergies in infancy, making SCFAs a potential biomarker and modulator in this context. to synthesize current evidence on fecal SCFA concentrations in infants diagnosed with CMPA. a systematic search was conducted in MEDLINE/PubMed and LILACS for studies published from July 2011 to October 2025, following PRISMA 2020 guidelines. Inclusion criteria required studies to report fecal SCFA concentrations in infants with CMPA and include a control group. Exclusion criteria were animal models, reviews, studies without relevant measurements, or publications not in English or Spanish. Methodological quality was assessed using the Quality Assessment Tool for Observational and Cross-sectional Cohort Studies, and reporting quality was verified through the STROBE checklist. six studies fulfilled the criteria. Findings were heterogeneous: two studies reported higher SCFA levels in CMPA infants compared with controls, while three studies showed lower levels. One study did not provide specific values. Several investigations observed associations between SCFA concentrations and distinct bacterial taxa, suggesting interplay between microbial composition and metabolite production. evidence remains inconsistent regarding SCFA alterations in infants with CMPA. Further standardized, robustly designed studies are required to determine whether fecal SCFAs can serve as reliable indicators or mediators in CMPA pathophysiology.

Infectious diseases represent a major threat to the survival of endangered sea turtles. The immune response in these animals is configured early in development and is heavily influenced by the incubation environment. While maternal traits are known to influence offspring immune function in some reptiles, their role in shaping immune responses in sea turtle hatchlings remains poorly understood. The hemolytic capacity, a key component of the innate immune system, shows stability across incubation environments, suggesting that it might be shaped by maternal factors rather than by environmental variation. Herein, the relationship between the hemolytic capacity of hatchlings challenged with lipopolysaccharide (LPS) and maternal characteristics, including hemolytic response and body size, was studied. Blood samples and morphologic measurements were collected from nesting females over 2 years. Each clutch was entirely relocated to individual shaded nests for incubation. Upon emergence, one hatchling per nest was injected intraperitoneally with phosphate-buffered saline (PBS) and another hatchling with LPS. 4 h later, hatchlings were euthanized and blood samples were collected. The results showed that hatchling's hemolytic capacity was positively associated with maternal hemolysis and body mass, but negatively linked to maternal straight carapace length. Lipopolysaccharide challenge did not significantly modify the hemolytic capacity of hatchlings. Although based on a limited sample size due to the species' protected status and technical constraints of ecoimmunological research in wild animals, these findings suggest a possible influence of maternal attributes on offspring immune function. They also suggest that hemolytic capacity is a robust early-life immune defense in hatchlings.