Onofre Muñoz-Hernández’s research while affiliated with Hospital Infantil de México Federico Gómez and other places

Background Kohlberg’s theory of moral development asserts that people progress through different stages of moral reasoning as their cognitive abilities and social interactions mature. Individuals at the lowest stage of moral reasoning (preconventional stage) judge moral issues based on self-interest, those with a medium stage (conventional stage) judge them based on compliance with rules and norms, and those at the highest stage (postconventional stage) judge moral issues based on universal principles and shared ideals. Upon attaining adulthood, it can be considered that there is stability in the stage of individuals’ moral development; however, the effect of a global population crisis such as the one experienced in March 2020, when the World Health Organization (WHO) declared the COVID-19 pandemic, is unknown. The purpose of this study was to evaluate the changes in the moral reasoning of pediatric residents before and after one year of the COVID-19 pandemic and compare them with a general population group. Methods This is a naturalistic quasi-experimental study conducted with two groups, one comprised 47 pediatric residents of a tertiary hospital converted into a COVID hospital during the pandemic and another group comprised 47 beneficiaries of a family clinic who were not health workers. The defining issues test (DIT) was applied to the 94 participants during March 2020, before the pandemic initiated in Mexico, and later during March 2021. To assess intragroup changes, the McNemar-Bowker and Wilcoxon tests were used. Results Pediatric residents showed higher baseline stages of moral reasoning: 53% in the postconventional group compared to the general population group (7%). In the preconventional group, 23% were residents and 64% belonged to the general population. In the second measurement, one year after the start of the pandemic, the group of residents had a significant decrease of 13 points in the P index, unlike the general population group in which a decrease of 3 points was observed. This decrease however, did not equalize baseline stages. Pediatric residents remained 10 points higher than the general population group. Moral reasoning stages were associated with age and educational stage. Conclusions After a year of the COVID-19 pandemic, we found a decrease in the stage of moral reasoning development in pediatric residents of a hospital converted for the care of patients with COVID-19, while it remained stable in the general population group. Physicians showed higher stages of moral reasoning at baseline than the general population.

A higher Th17-immune response characterises obesity and obesity-related asthma phenotype. Nevertheless, obesity-related asthma has a more significant Th17-immune response than obesity alone. Retinoid-related orphan receptor C (RORC) is the essential transcription factor for Th17 polarisation. Previous studies have found that adolescents with obesity-related asthma presented upregulation of RORC, IL17A, and TNFA. However, the mechanisms that cause these higher mRNA expression levels in this asthmatic phenotype are poorly understood. Methylation directly regulates gene expression by adding a methyl group to carbon 5 of dinucleotide CpG cytosine. Thus, we evaluated the relationship between RORC, IL17A, and TNFA methylation status and mRNA expression levels to investigate a possible epigenetic regulation. 102 adolescents (11–18 years) were studied in the following four groups: 1) healthy participants (HP), 2) allergic asthmatic participants (AAP), 3) obese participants without asthma (OP), and 4) non-allergic obesity-related asthma participants (OAP). Real-time qPCR assessed the methylation status and gene expression levels in peripheral blood leukocytes. Remarkably, the OAP and AAP groups have lower promoter methylation patterns of RORC, IL17A, and TNFA than the HP group. Notably, the OAP group presents lower RORC promoter methylation status than the OP group. Interestingly, RORC promoter methylation status was moderately negatively associated with gene expression of RORC (rs = −0.39, p < 0.001) and IL17A (rs = −0.37, p < 0.01), respectively. Similarly, the promoter methylation pattern of IL17A was moderately negatively correlated with IL17A gene expression (rs = −0.3, p < 0.01). There is also a moderate inverse relationship between TNFA promoter methylation status and TNFA gene expression (rs = −0.3, p < 0.01). The present study suggests an association between lower RORC, IL17A, and TNFA gene promoter methylation status with obesity-related asthma and allergic asthma. RORC, IL17A, and TNFA gene promoter methylation patterns are moderately inversely correlated with their respective mRNA expression levels. Therefore, DNA methylation may regulate RORC, IL17A, and TNF gene expression in both asthmatic phenotypes.

Análisis con perspectiva bioética de un caso clínico de un paciente de cuatro años de edad, con enfermedad renal cuya familia, testigos de Jehová, se niegan a que el menor reciba un tratamiento de transfusión sanguínea. En la sociedad posmoderna se han introducido ideologías que muchas veces son empleadas para radicalizar algunos comportamientos. En el ejercicio de la medicina contemporánea se ha exaltado una corriente de pensamiento llamada principialismo para discernir los conflictos de la ética y la bioética. El mismo respeto que se exige para con la religión de la familia del paciente, en igualdad de circunstancias y por equidad, se puede pedir para la libertad de conciencia del médico tratante y su equipo de salud.

Background: Non-allergic asthma caused by obesity is a complication of the low-grade chronic inflammation inherent in obesity. Consequently, the serum concentrations of adipokines such as retinol-binding protein 4 (RBP4) and plasminogen activator inhibitor-1 (PAI-1) increase. No gold standard molecule for the prediction of non-allergic asthma among obese patients has been identified. Objective: To evaluate RBP4 and PAI-1 as prognostic biomarkers of non-allergic asthma caused by obesity. Methods: A cross-sectional study between four groups of adolescents: (1) healthy (n = 35), (2) allergic asthma without obesity (n = 28), (3) obesity without asthma (n = 33), and (4) non-allergic asthma with obesity (n = 18). Results: RBP4 was higher in the non-allergic asthma with obesity group than in the obesity without asthma group (39.2 ng/mL [95% confidence interval (CI): 23.8-76.0] vs. 23.5 ng/mL [95% CI: 3.2-33.5], p < 0.01), and PAI-1 was higher in the non-allergic asthma with obesity group than in the obesity without asthma group (21.9 ng/mL [95% CI: 15.7-26.5] vs. 15.9 ng/mL [95% CI: 9.4-18.2], p < 0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that the serum RBP4 cut-off value was >42.78 ng/mL, with an area under the ROC curve (AUC) of 0.741 (95% CI: 0.599-0.853, p = 0.001), considered acceptable. The PAI-1 cut-off value was >12.0 ng/mL, with an AUC of 0.699 (95% CI: 0.554-0.819, p = 0.008), considered fair. Conclusions: RBP4 may be useful to predict non-allergic asthma among obese adolescents in clinical practice.

Background Obesity is associated with a non-T2 asthma phenotype which is clinically more severe and difficult to control. Unfortunately, physicians have no gold standard biomarker to predict non-allergic asthma among obese patients. Objective To evaluate the ability of TNFA, IL17A and RORC mRNA expression to predict non-allergic asthma among obese adolescents. Methods This investigation was a cross-sectional study involving 4 adolescent groups: 1) healthy adolescents (n = 23), 2) adolescents with allergic asthma without obesity (n = 29), 3) adolescents with obesity without asthma (n = 28), and 4) adolescents with non-allergic asthma with obesity (n = 22). Results Receiver operating characteristic (ROC) curve analysis, the areas under the ROC curve (AUCs) for RORC, IL17A, and TNFA mRNA expression were 0.955 (95% CI: 0.86–0.99, p < 0.0001), 0.856 (95% CI: 0.73–0.94, p < 0.0001), and 0.756 (95% CI: 0.62–0.87, p = 0.0009), respectively. Conclusion RORC, IL17A and TNFA mRNA expression levels may be potential biomarkers of non-allergic asthma among obese adolescents in clinical practice.

Measles is an exanthematous disease caused by a virus of the Morbillivirus genus. On February 23, 2020, the exanthema began in the first confirmed case of measles this year. At the same time, on February 28, 2020, the first case of the new coronavirus disease (COVID-19) was confirmed. Up to June 6, 2020, 176 measles cases have been confirmed: 137 in Mexico City, 37 in the state of Mexico, and two in the state of Campeche. In Mexico City, municipalities with more cases were Gustavo A. Madero, Miguel Hidalgo, and Iztapalapa; in the State of Mexico were Ecatepec, Tlalnepantla, and Netzahualcoyotl; in Campeche, there are only two cases reported. On the other hand, 7,065,133 cases of COVID-19 have been registered worldwide with a global case fatality rate of 5.7%. In Mexico, there have been 113,619 confirmed cases and 13,511 deaths, while in Mexico City, there have been 30,223 cases and 3062 deaths. Iztapalapa and Gustavo A. Madero are the locations with more cases reported. Hence, a campaign of social distancing started as part of the strategies to control the spread of the infection. The potential threat is that as social confinement measures are relaxed and mobility is initiated, both viruses could continue to spread. It is expected that due to the time that has passed since the last reported measles case, control of this disease will be achieved.

Coronavirus disease 2019 (COVID-19) was declared a pandemic and international health emergency by the World Health Organization. Patients with obesity with COVID-19 are 7 times more likely to need invasive mechanical ventilation than are patients without obesity (OR 7.36; 95% CI: 1.63–33.14, p = 0.021). Acute respiratory distress syndrome (ARDS) is one of the main causes of death related to COVID-19 and is triggered by a cytokine storm that damages the respiratory epithelium. Interleukins that cause the low-grade chronic inflammatory state of obesity, such as interleukin (IL)-1β, IL-6, monocyte chemoattractant peptide (MCP)-1, and, in particular, IL-17A and tumour necrosis factor alpha (TNF-α), also play very important roles in lung damage in ARDS. Therefore, obesity is associated with an immune state favourable to a cytokine storm. Our hypothesis is that serum concentrations of TNF-α and IL-17A are more elevated in patients with obesity and COVID-19, and consequently, they have a greater probability of developing ARDS and death. The immunobiology of IL-17A and TNF-α opens a new fascinating line of research for COVID-19.