RESUMEN
BACKGROUND: Although culture remains the standard for TB diagnosis, 15-20% of patients diagnosed and treated for TB are culture-negative. We explored clinical characteristics, risk factors and treatment outcomes for culture-negative TB in a Peruvian cohort.METHODS: We recruited 4,500 index TB patients and 10,160 household contacts in Lima, Peru, and enrolled 692 secondary patients diagnosed with TB during follow-up of household contacts. We analyzed smear and culture status, sociodemographic factors, clinical characteristics and TB treatment outcomes to compare culture-negative and positive patients.RESULTS: Of the 4,880 adult patients, 915 (18.8%) were culture-negative. Culture-negative patients were less likely to report symptoms of TB disease and disease of longer duration. A multivariate analysis showed no statistically significant difference in loss to follow-up, treatment failure or recurrence between the culture-negative and -positive groups but a higher rate of death among culture-negative patients with an adjusted OR of 1.65 (95% CI 1.05-2.60). In a multivariate analysis of determinants of culture negativity, older age, substance use and being a secondary case were associated with culture status.CONCLUSIONS: More recognition and awareness of culture-negative TB is key for early and correct diagnosis to reduce transmission and improve treatment outcomes.
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Tuberculosis Pulmonar , Adulto , Humanos , Tuberculosis Pulmonar/diagnóstico , Factores de Riesgo , Resultado del Tratamiento , Perú/epidemiología , Insuficiencia del TratamientoRESUMEN
BACKGROUND: Antibody (Ab) tests for SARS-CoV-2 virus allows for the estimation of incidence, level of exposure and duration of immunity acquired by a previous infection. In health workers, the hospital setting might convey a greater risk of infection. AIMS: To describe the frequency of immunoglobulin G (IgG) Abs (IgG-Abs) to the SARS-CoV-2 virus among workers at a third-level university hospital in Colombia. METHODS: In this cross-sectional study, we included medical and non-medical personnel with at least one real-time polymerase chain reaction (RT-PCR)/antigen test between March 2020 and March 2021. In April 2021, an IgG-Ab test against SARS-CoV-2 was conducted for all participants and replicated 2 weeks later in a random sample (10%). The frequency of IgG-Abs is presented based on status (positive/negative) and time elapsed since RT-PCR/antigen test (<3 months, 3-6 months, >6 months). RESULTS: We included 1021 workers (80% women, median age 34 years (interquartile range 28-42), 73% medical personnel, 23% with previous positive RT-PCR/antigen). The overall seroprevalence was 35% (95% CI 31.6-37.4, 35% in medical and 33% in non-medical personnel). For those with a previous positive RT-PCR/antigen test, the seroprevalence was 90% (<3 months), 82% (3-6 months) and 48% (>6 months). In participants with a previous negative RT-PCR/antigen test, the seroprevalence was 17% (<3 months), 21% (3-6 months) and 29% (>6 months). CONCLUSIONS: High IgG-Ab positivity was found in hospital personnel, regardless of work activities. The prevalence of detectable Abs differed by previous RT-PCR/antigen status and time elapsed since the diagnostic test.
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COVID-19 , SARS-CoV-2 , Humanos , Femenino , Adulto , Masculino , COVID-19/epidemiología , Colombia/epidemiología , Estudios Seroepidemiológicos , Estudios Transversales , Inmunoglobulina G , Personal de Salud , Personal de Hospital , HospitalesRESUMEN
The approach to and management of critically ill patients is one of the most versatile themes in emergency medicine. Patients with cirrhosis of the liver have characteristics that are inherent to their disease that can condition modification in acute emergency treatment. Pathophysiologic changes that occur in cirrhosis merit the implementation of an analysis as to whether the overall management of a critically ill patient can generally be applied to patients with cirrhosis of the liver or if they should be treated in a special manner. Through a review of the medical literature, the available information was examined, and the evidence found on the special management required by those patients was narratively synthesized, selecting the most representative decompensations within chronic disease that require emergency treatment.
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Encefalopatía Hepática , Enfermedad Crítica , Urgencias Médicas , Encefalopatía Hepática/terapia , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/terapiaRESUMEN
Los trastornos del desarrollo conforman la "nueva morbilidad" y su identificación oportuna facilita planear los apoyos específicos que pueden favorecer el pronóstico de estos pacientes. El objetivo de este proyecto es brindar información acerca del abordaje de los pacientes con diagnóstico de TEA en el primer nivel de atención, mediante la descripción de diferentes variables a través de la evaluación de sus historias clínicas. Se analizaron 35 historias clínicas y se obtuvieron los siguientes resultados. 85,7% sexo masculino con un promedio de edad de 8,1 años. El 48,57% poseían obra social. 14,29% fueron nacidos pretérmino. 8,57% presentaron síndrome genético/cromosómico asociado al autismo. 22.86% presentaban hermano con mismo diagnóstico. Retraso madurativo o discapacidad intelectual en el 22,8%. Edad de diagnóstico media de 45.05 meses, (DE 17.13). En el 65,71% de las HC no se consignaba si el familiar presentaba alguna preocupación con respecto al desarrollo. En el 40% de las HC figura alteración en la comunicación/ ausencia o retraso del lenguaje, como motivo de preocupación/ derivación. El 91,43% se realizó el diagnostico por el equipo especializado en el Hospital Garrahan. El 85,71% realiza o realizó tratamiento, 71,43% en un centro público. El 88,57% se encontraba escolarizado. 51,43% en escuela especial. El 68,57% tenían certificado de discapacidad. El 28,57% se encontraban en tratamiento psicofarmacológico. El análisis de las HC nos permitió acercarnos a describir nuestra población, con características de diagnóstico y seguimiento que se ajustan en mayor medida a la descripta en la bibliografía, pese a tratarse de una población con un bajo nivel socio económico (AU)
Developmental disorders are the "new morbidity" and their timely identification enhances the planning of specific support measures that may improve the prognosis of these patients. The aim of this project is to provide information on the approach of patients diagnosed with ASD at the first level of care, by describing different variables obtained from medical records (MR). Thirtyfive MR were analyzed and the following results were obtained: 85.7% were male and mean age was 8.1 years. Overall, 48.57% had a health insurance; 14.29% were born preterm; 8,57% had a genetic/chromosomal syndrome associated with autism; 22.86% had a sibling with the same diagnosis. Developmental delay or intellectual disability was observed in 22.8%. Mean age at diagnosis was 45.05 months (SD 17.13). In 65.71% of the MR it was not clear if the caregiver was worried about the development of the child. In 40% of the MR, communication disturbances or absence of language/language delay were mentioned as the reason for worry or referral. In 91.43% the diagnosis was made by the specialized team at Garrahan Hospital. Overall, 85.71% underwent or is undergoing treatment, of whom 71.43% at a public center. Of all the children, 88.57% was attending school, 51.43% of whom at a special school; 68.57% had a disability certificate; 28.57% received psychopharmacological treatment. Analysis of the MR allowed us to describe our population, with diagnostic and follow-up features that mostly agree with the findings reported in the literature, in spite of the low socio-economic level of the families (AU)
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Humanos , Preescolar , Niño , Adolescente , Atención Primaria de Salud/estadística & datos numéricos , Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/terapia , Estudios Transversales , Estudios Retrospectivos , Estudios de SeguimientoRESUMEN
An imbalance in the redox state, increased levels of lipid precursors and overactivation of de novo lipogenesis determine the development of fibrosis during nonalcoholic steatohepatitis (NASH). We evaluated the modulation of NADPH-producing enzymes associated with the antifibrotic, antioxidant and antilipemic effects of nicotinamide (NAM) in a model of NASH induced by excess fructose consumption. Male rats were provided drinking water containing 40% fructose for 16 weeks. During the last 12 weeks of fructose administration, water containing NAM was provided to some of the rats for 5 h/day. The biochemical profiles and the ghrelin, leptin, lipoperoxidation and TNF-α levels in serum and the glucose-6-phosphate dehydrogenase (G6PD), malic enzyme (ME) and NADP+-dependent isocitric dehydrogenase (IDP) levels, the reduced/oxidized glutathione (GSH/GSSG) and reduced/oxidized nicotinamide adenine dinucleotide (phosphate) (NAD(P)H/NAD(P)+) ratios, and the levels of various lipogenic and fibrotic markers in the liver were evaluated. The results showed that hepatic fibrosis induced by fructose consumption was associated with weight gain, hunger-satiety system dysregulation, hyperinsulinemia, dyslipidemia, lipoperoxidation and inflammation. Moreover, increased levels of hepatic G6PD and ME activity and expression, the NAD(P)H/NAD(P)+ ratios, and GSSG concentration and increased expression of lipogenic and fibrotic markers were detected, and these alterations were attenuated by NAM administration. Specifically, NAM diminished the activity and expression of G6PD and ME, and this effect was associated with a decrease in the NADPH/NADP+ ratios, increased GSH levels and decreased lipoperoxidation and inflammation, ameliorating fibrosis and NASH development. NAM reduces liver steatosis and fibrosis by regulating redox homeostasis through a G6PD- and ME-dependent mechanism.
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Hígado Graso/metabolismo , Hígado Graso/prevención & control , Niacinamida/farmacología , Animales , Antioxidantes/metabolismo , Fructosa/efectos adversos , Fructosa/metabolismo , Glucosa/metabolismo , Glutatión/metabolismo , Homeostasis , Metabolismo de los Lípidos/fisiología , Lípidos/biosíntesis , Lipogénesis/fisiología , Hígado/metabolismo , Hígado/patología , Cirrosis Hepática/patología , Masculino , NAD/metabolismo , NADP/metabolismo , Niacinamida/metabolismo , Enfermedad del Hígado Graso no Alcohólico/patología , Oxidación-Reducción/efectos de los fármacos , Ratas , Ratas Sprague-DawleyRESUMEN
Bacterial biofilms on medical devices (MDs) can cause deadly infections due to their resistance to antibiotics. Technology to prevent this kind of complication is urgently needed because they impact not only patients' lives but also hospital budgets. In this article, the creation and testing of an easy-to-produce antibiofilm (more precisely antibiofouling) coating are described for the first time. This coating can be applied to catheters, prostheses, and other plastic pieces, even after they have been manufactured. Rapid and ecofriendly synthesis of nanostructured gold coating was done in situ in just 15 minutes. Complete characterization and microbiological analysis of its antibiofouling capacity are presented. The coating prevents biofilm formation of pathogenic clinical isolates and ATCC strains on MDs, possibly due to its complex nanostructured gold surface. If the next generation of MDs is coated with this kind of antibiofouling technology, biofilm-related infections could be dramatically reduced. Graphical Abstract [Figure: see text].
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Biopelículas , Oro/química , Control de Infecciones , Catéteres Urinarios , Diseño de Equipo , Humanos , NanopartículasRESUMEN
BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.
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Asma/diagnóstico , Asma/prevención & control , Niño , Preescolar , Femenino , Humanos , Masculino , MéxicoRESUMEN
BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) regimens often contain pyrazinamide (PZA) even if susceptibility to the drug has not been confirmed. This gap is due to the limited availability and reliability of PZA susceptibility testing. OBJECTIVES: To estimate the prevalence of PZA resistance using the Wayne assay among TB patients in Lima, Peru, to describe characteristics associated with PZA resistance and to compare the performance of Wayne with that of BACTEC™ MGIT™ 960. METHODS: PZA susceptibility using the Wayne assay was tested in patients diagnosed with culture-positive pulmonary TB from September 2009 to August 2012. Factors associated with PZA resistance were evaluated. We compared the performance of the Wayne assay to that of MGIT 960 in a convenience sample. RESULTS: The prevalence of PZA resistance was 6.6% (95%CI 5.8-7.5) among 3277 patients, and 47.7% (95%CI 42.7-52.6) among a subset of 405 MDR-TB patients. In multivariable analysis, MDR-TB (OR 86.0, 95%CI 54.0-136.9) and Latin American-Mediterranean lineage (OR 3.40, 95%CI 2.33-4.96) were associated with PZA resistance. The Wayne assay was in agreement with MGIT 960 in 83.9% of samples (κ 0.66, 95%CI 0.56-0.76). CONCLUSION: PZA resistance was detected using the Wayne assay in nearly half of MDR-TB patients in Lima. This test can inform the selection and composition of regimens, especially those dependent on additional resistance.
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Antituberculosos/administración & dosificación , Pirazinamida/administración & dosificación , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Pulmonar/tratamiento farmacológico , Adolescente , Adulto , Anciano , Estudios de Cohortes , Farmacorresistencia Bacteriana , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Análisis Multivariante , Perú , Prevalencia , Estudios Prospectivos , Reproducibilidad de los Resultados , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/microbiología , Adulto JovenRESUMEN
SETTING: In 2012, Peru's National TB Program (NTP) reported approximately 2400 incident cases of tuberculosis (TB) disease in children aged <15 years. Peru's TB burden is concentrated in the Lima metropolitan area, particularly in poor districts such as El Agustino and La Victoria, where this study was conducted. OBJECTIVE: To identify barriers to the treatment of childhood tuberculous infection and TB disease in Lima from the perspective of front-line providers and patients' families. DESIGN: We conducted 10 semi-structured focus groups with 53 purposefully sampled primary care providers, community health workers, and parents/guardians of pediatric TB patients. We also completed nine in-depth interviews with National TB Program administrators and pulmonologists specializing in TB. Two authors performed inductive thematic analysis and identified emerging themes. RESULTS: Four main treatment barriers emerged from the data: 1) dosing errors, 2) time- and labor-intensive preparation and administration of medications, 3) provider concern that isoniazid preventive therapy (IPT) generates isoniazid resistance, and 4) poor adherence to IPT. CONCLUSION: Our findings highlight the urgent need for child-friendly formulations, provider and parent/guardian education about IPT, and strategies to promote adherence to IPT, including support and supervision by health workers and/or regimens with fewer doses.
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Antituberculosos/administración & dosificación , Isoniazida/administración & dosificación , Cumplimiento de la Medicación , Tuberculosis/tratamiento farmacológico , Adolescente , Niño , Preescolar , Agentes Comunitarios de Salud , Farmacorresistencia Bacteriana , Femenino , Grupos Focales , Humanos , Masculino , Errores de Medicación , Programas Nacionales de Salud , Padres , Perú , Atención Primaria de SaludRESUMEN
SETTING: In 2012, Peru's National Tuberculosis Program (NTP) reported that children aged 0-14 years accounted for 7.9% of the country's tuberculosis (TB) incidence. This figure is likely an underestimate due to suboptimal diagnosis of childhood TB. OBJECTIVE: To identify barriers to childhood TB diagnosis in Lima, Peru. DESIGN: Using semi-structured guides, moderators conducted in-depth interviews with four NTP administrators and five pulmonologists specializing in TB and 10 focus groups with 53 primary care providers, community health workers (CHWs), and parents and/or guardians of pediatric TB patients. Two authors independently performed inductive thematic analysis and identified emerging themes. RESULTS: Participants identified five barriers to childhood TB diagnosis: ignorance and stigma among the community, insufficient contact investigation, limited access to diagnostic tests, inadequately trained health center staff, and provider shortages. CONCLUSION: Recent efforts to increase childhood TB detection have centered on the development of new technologies. However, our findings demonstrate that many diagnostic barriers are rooted in socio-economic and health system problems. Potential solutions include implementing multimedia campaigns and community education to reduce ignorance and stigma, prioritizing contact investigation for high-risk households, and training primary care providers and CHWs to recognize and evaluate childhood TB.
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Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Tuberculosis/diagnóstico , Adolescente , Niño , Preescolar , Femenino , Grupos Focales , Personal de Salud/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Entrevistas como Asunto , Masculino , Padres , Perú/epidemiología , Tuberculosis/epidemiologíaRESUMEN
Shiga toxin-producing Escherichia coli (STEC) are important food-borne pathogens, with the main virulence factor of this bacterium being its capacity to secrete Shiga toxins (Stxs). Therefore, the use of certain antibiotics for the treatment of this infection, which induces the liberation of Stxs, is controversial. Reactive oxygen and nitrogen species are also involved in the pathogenesis of different diseases. The purpose of this study was to analyze the effects of antibiotics on biofilms of STEC and the relationships between cellular stress and the release of Stx. To this end, biofilms of reference and clinical strains were treated with antibiotics (ciprofloxacin, fosfomycin and rifaximin) and the production of oxidants, the antioxidant defense system and toxin release were evaluated. Ciprofloxacin altered the prooxidant-antioxidant balance, with a decrease of oxidant metabolites and an increase of superoxide dismutase and catalase activity, being associated with high-levels of Stx production. Furthermore, inhibition of oxidative stress by exogenous antioxidants was correlated with a reduction in the liberation of Stx, indicating the participation of this phenomenon in the release of this toxin. In contrast, fosfomycin and rifaximin produced less alteration with a minimal production of Stx. Our data show that treatment of biofilm-STEC with these antibiotics induces oxidative stress-mediated release of Stx.
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Antibacterianos/farmacología , Toxina Shiga I/metabolismo , Toxina Shiga II/metabolismo , Escherichia coli Shiga-Toxigénica/efectos de los fármacos , Animales , Antioxidantes/farmacología , Ácido Ascórbico/farmacología , Biopelículas , Catalasa/metabolismo , Supervivencia Celular/efectos de los fármacos , Chlorocebus aethiops , Ciprofloxacina/farmacología , Fosfomicina/farmacología , Glutatión/farmacología , Pruebas de Sensibilidad Microbiana , Óxido Nítrico/metabolismo , Estrés Oxidativo/efectos de los fármacos , Especies Reactivas de Oxígeno/metabolismo , Rifamicinas/farmacología , Rifaximina , Escherichia coli Shiga-Toxigénica/genética , Escherichia coli Shiga-Toxigénica/metabolismo , Escherichia coli Shiga-Toxigénica/fisiología , Superóxido Dismutasa/metabolismo , Células Vero , Factores de Virulencia/genéticaRESUMEN
SETTING: Observational cohort study in Lima, Peru. OBJECTIVE: To determine the association between exposure to a smoking tuberculosis (TB) case and latent tuberculous infection (LTBI). METHOD: Between September 2009 and August 2012, we identified 2132 patients with drug-susceptible TB and their 2054 child household contacts. Data were collected on active and secondhand smoking status and other risk factors for infection specific to the index case, the household and the exposed contacts. Contacts underwent a tuberculin skin test (TST) to determine their tuberculous infection status at baseline, 6-month and 12-month follow-up. We estimated the association between exposure to a smoking index case and LTBI using a modified Poisson regression model. RESULTS: The 21 children (age â©¿15 years) exposed to smoking index TB patients were more likely to be TST-positive at baseline (RR 2.64, 95%CI 1.78-3.91), by 6 months (RR 1.91, 95%CI 1.40-2.60) and by 12 months (RR 1.48, 95%CI 1.07-2.06), than those who were not exposed. TST positivity among children at these time points did not vary with secondhand smoke exposure. CONCLUSIONS: TB patients who smoke may be more likely to transmit infection to their contacts. Interventions designed to reduce smoking among TB patients may minimise further spread of the disease.
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Tuberculosis Latente/epidemiología , Fumar/epidemiología , Contaminación por Humo de Tabaco , Tuberculosis/transmisión , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Trazado de Contacto , Femenino , Estudios de Seguimiento , Humanos , Lactante , Tuberculosis Latente/diagnóstico , Masculino , Persona de Mediana Edad , Perú/epidemiología , Distribución de Poisson , Factores de Riesgo , Factores de Tiempo , Prueba de Tuberculina , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVE: Periodontitis may alter the systemic condition in patients with diabetes and hence interfere with glycemic control. The objective of this study was to determine the quantifiable changes in glycated hemoglobin (HbA1C) after periodontal non-surgical therapy plus azithromycin in a mixed population of patients with poorly controlled diabetes. MATERIALS AND METHODS: One hundred and five patients were randomized to receive non-surgical therapy plus azythromycin (AZ-Sca =33), non-surgical therapy plus placebo (PB-Sca = 37) and supragingival prophylaxis plus azithromycin (AZ-Pro = 35). Glycated hemoglobin, glycemia and periodontal parameters were measured at baseline, 3, 6 and 9 mo after treatment. RESULTS: Periodontal parameters were improved in the AZ-Sca and PB-Sca groups as compared to the AZ-Pro group. A greater reduction in probing depth was observed in the AZ-Sca as compared to the PB-Sca group. Improvement in clinical attachment level was similar between AZ-Sca and PB-Sca groups. A reduction from 8.0% to 7.2% (∆0.8%; p < 0.05) in HbA1C was observed in the AZ-Sca at 9 mo as compared to the PB-Sca group in which the reduction was from 7.9% to 7.6% (∆0.3%). There was no decrease in HbA1C in the AZ-Pro group over time. Mean glycemia values decreased from 195 mg/dL to 159.2 mg/dL (∆35.8 mg/dL; p < 0.05) in the AZ-Sca group whereas a decrease from 194 mg/dL to 174.8 mg/dL (∆19.2 mg/dL) in the PB-Sca group at 9 mo was observed. There were no differences between the AZ-Sca and PB-Sca groups for glycemic parameters. No improvement in glycemic values in the AZ-Pro group was observed. CONCLUSIONS: A modest improvement in glycemic control was detected with a trend towards the use of non-surgical therapy plus AZ as compared to the placebo.
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Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Glucemia/análisis , Diabetes Mellitus Tipo 1/prevención & control , Diabetes Mellitus Tipo 2/prevención & control , Hemoglobina Glucada/análisis , Desbridamiento Periodontal/métodos , Terapia Combinada , Profilaxis Dental/métodos , Raspado Dental/métodos , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 2/sangre , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pérdida de la Inserción Periodontal/terapia , Índice Periodontal , Bolsa Periodontal/terapia , Periodontitis/terapia , PlacebosRESUMEN
BACKGROUND: Confirmation of cure for multidrug-resistant tuberculosis (MDR-TB) patients requires laboratory tests for Mycobacterium tuberculosis growth on culture media. Outcome decisions dictate patient management, and inaccuracies place patients at an increased risk of morbidity and mortality, and may contribute to continued transmission of MDR-TB. OBJECTIVE: To examine concordance between programmatic and laboratory-based MDR-TB treatment outcomes. METHODS: The study population included 1658 MDR-TB patients in Peru treated between 1996 and 2002 with both program and laboratory-based outcomes. Laboratory-based outcomes were assigned according to international standards requiring at least five consecutive negative cultures in the last 12 months of treatment to confirm cure. RESULTS: Compared to the global culture-defined standard classification, only 1.1% of treatment successes, but 54.3% of failures, were misclassified programmatically. Overall, 10.4% of patients identified by a clinician as having a successful treatment outcome still had cultures positive for MDR-TB. CONCLUSION: Most patients with successful treatment outcomes by strict culture definitions were also classified by clinicians as having successful outcomes. However, many culture-confirmed failures were missed. In light of delays and incomplete access to culture in MDR-TB programs, efforts should be made to improve the accuracy of programmatically determined treatment outcomes.
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Antituberculosos/uso terapéutico , Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adolescente , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Perú , Estudios Retrospectivos , Insuficiencia del Tratamiento , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Adulto JovenRESUMEN
Chagas disease is still an important health problem in Central and South America. However, the only drugs currently available for specific treatment of this disease may induce toxic side effects in the host. The aim of this work was to determine the activity of N-benzenesulfonylbenzotriazole (BSBZT) against the protozoan parasite Trypanosoma cruzi. The effects of BSBZT and benzotriazole (BZT) were compared to those of benznidazole (BZL) on epimastigote and trypomastigote forms. BSBZT was found to have an in vitro growth inhibitory dose-dependent activity against epimastigotes, with flow cytometry analysis confirming that the treated parasites presented size reduction. BSBZT showed an IC(50) of 21.56 µg/mL (81.07 µM) against epimastigotes at 72 h of incubation, whereas BZT did not affect the growth of this parasite form. Furthermore, the toxic effect of BSBZT, was stronger and appeared earlier (at 24h) in trypomastigotes than in epimastigotes, with the LC(50) of this compound being 28.40 µg/mL (106.79 µM) against trypomastigotes. The concentrations of BSBZT used in this study presented low hemolytic activity and cytotoxicity. Consequently, at concentrations near IC(50) and LC(50) (25µg/mL), BSBZT caused only 2.4% hemolysis and 15% of RAW 264.7 cell cytotoxicity. These results reveal the potential of BSBZT as a prototype in drug design for developing new anti-T. cruzi compounds.
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Nitroimidazoles/farmacología , Sulfonamidas/farmacología , Triazoles/farmacología , Tripanocidas/farmacología , Trypanosoma cruzi/efectos de los fármacos , Animales , Línea Celular , Supervivencia Celular/efectos de los fármacos , Enfermedad de Chagas/parasitología , Eritrocitos/efectos de los fármacos , Humanos , Concentración 50 Inhibidora , Macrófagos/efectos de los fármacos , Ratones , Ratones Endogámicos BALB C , Nitroimidazoles/toxicidad , Sulfonamidas/toxicidad , Triazoles/toxicidad , Tripanocidas/toxicidad , Trypanosoma cruzi/crecimiento & desarrolloRESUMEN
Monthly culture is usually recommended to monitor treatment of multidrug-resistant tuberculosis (MDR-TB). As mycobacterial laboratory capacity is limited in many settings, TB programs need evidence to decide whether monthly cultures are necessary compared to other approaches. We simulated three alternative monitoring strategies (culture every 2 or 3 months, and monthly smears alone) in a cohort of MDR-TB patients in Estonia, Latvia, Philippines, Russia and Peru from 2000 to 2004. This retrospective analysis illustrated that less frequent testing delays confirmation of bacteriological conversion. This would prolong intensive treatment, hospitalization and respiratory isolation, increasing cost and toxicity. After conversion, less frequent testing could delay diagnosis of possible treatment failure.
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Antituberculosos/uso terapéutico , Técnicas Bacteriológicas , Monitoreo de Drogas/métodos , Farmacorresistencia Bacteriana Múltiple , Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Adulto , Simulación por Computador , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Mycobacterium tuberculosis/crecimiento & desarrollo , Mycobacterium tuberculosis/aislamiento & purificación , Perú/epidemiología , Filipinas/epidemiología , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Esputo/microbiología , Factores de Tiempo , Insuficiencia del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/microbiologíaRESUMEN
BACKGROUND: Although multidrug-resistant tuberculosis (MDR-TB) is a major global health problem, there is a gap in programmatic treatment implementation. METHODS: This study describes MDR-TB treatment models in three countries--Peru, Russia and Lesotho-- using qualitative data collected over a 13-year period. RESULTS: A program analysis is presented for each country focusing on baseline medical care, initial implementation and program evolution. A pattern analysis revealed six overarching themes common to all three programs: 1) importance of baseline assessments, 2) early identification of key collaborators, 3) identification of initial locus of care, 4) minimization of patient-incurred costs, 5) targeted interventions for vulnerable populations and 6) importance of technical assistance and funding. Site commonalities and differences in each of these areas were analyzed. CONCLUSIONS: It is recommended that all programs providing MDR-TB treatment address these six areas during program development and implementation.
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Antituberculosos/uso terapéutico , Prestación Integrada de Atención de Salud/organización & administración , Farmacorresistencia Bacteriana Múltiple , Accesibilidad a los Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/organización & administración , Modelos Organizacionales , Programas Nacionales de Salud/organización & administración , Evaluación de Procesos y Resultados en Atención de Salud , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Servicios de Salud Comunitaria/organización & administración , Conducta Cooperativa , Prestación Integrada de Atención de Salud/economía , Financiación Personal , Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/economía , Disparidades en Atención de Salud , Humanos , Lesotho/epidemiología , Programas Nacionales de Salud/economía , Objetivos Organizacionales , Evaluación de Procesos y Resultados en Atención de Salud/economía , Grupo de Atención al Paciente/organización & administración , Perú/epidemiología , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Federación de Rusia/epidemiología , Factores de Tiempo , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/economía , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Poblaciones VulnerablesRESUMEN
BACKGROUND: Multidrug-resistant tuberculosis programs in DOTS-Plus pilot sites in five countries. OBJECTIVES: To calculate sputum conversion time and its relationship to treatment outcome, document the frequency of culture reversions and examine concordance of smear and culture to assess the potential consequences of monitoring by smear microscopy alone. DESIGN: Retrospective cohort analysis of 1926 patients receiving individualized, second-line therapy. RESULTS: Among 1385 sputum culture-positive cases at baseline, 1146 (83%) experienced at least one culture conversion during treatment. Conversion, however, was not sustained in all patients: 201 (15%) experienced initial culture conversion and at least one subsequent culture reversion to positive; 1064 (77%) achieved sustained culture conversion. Median time to culture conversion was 3 months. Among 206 patients whose nal conversion occurred 7-18 months after the initiation of therapy, 71% were cured or had completed treatment. CONCLUSIONS: Prolonged treatment for patients with delayed conversion may be beneficial, as 71% of late converters still achieved cure or completed treatment. This has implications for programs with de ned end points for treatment failure. The interval between rst and nal conversion among patients whose initial con- version is not sustained raises concern with respect to the ongoing debate regarding duration of treatment and the definition of cure.
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Antituberculosos/administración & dosificación , Técnicas Bacteriológicas , Terapia por Observación Directa , Monitoreo de Drogas/métodos , Farmacorresistencia Bacteriana Múltiple , Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Esquema de Medicación , Estonia , Femenino , Humanos , Letonia , Masculino , Pruebas de Sensibilidad Microbiana , Microscopía , Mycobacterium tuberculosis/aislamiento & purificación , Perú , Filipinas , Proyectos Piloto , Estudios Retrospectivos , Federación de Rusia , Esputo/microbiología , Factores de Tiempo , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/microbiologíaRESUMEN
OBJECTIVE: To evaluate the experience acquired in hallux valgus correction with percutaneous distal metatarsal osteotomy. MATERIAL AND METHODS: Retrospective study including patients who underwent percutaneous distal metatarsal osteotomy between May 2005 and May 2007. The age, sex, and number of feet operated on were recorded. The clinical evaluation of results 6 months after surgery using the AOFAS scale, the intermetatarsal angle and the hallux valgus angle were also recorded. RESULTS: A total of 40 patients were included; 38 females and 2 males; mean age was 49 years (28-73 years). Fifty-eight osteotomies were performed. According to the AOFAS scale, 28 patients (41/58 feet) had no pain. The mean functional capacity score was 41 points, and an excellent alignment was achieved in 74% of cases. The mean intermetatarsal angle was 7.5 degrees. Complications occurred in 2 patients (2 feet). CONCLUSIONS: The appropriate treatment for the correction of hallux valgus consists of minimally invasive procedures, except for the cases in which the metatarsophalangeal joint shows signs of arthrosis.
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Hallux Valgus/cirugía , Huesos Metatarsianos/cirugía , Osteotomía/métodos , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Infection with Equid Herpesvirus type 1 (EHV-1) leads to respiratory disease, abortion, and neurological disorders in horses. Molecular epidemiology studies have demonstrated that a single nucleotide polymorphism (A(2254)/G(2254)) in the genome region of the open reading frame 30 (ORF30), which results in an amino acid variation (N(752)/D(752)) of the EHV-1 DNA polymerase, is significantly associated with the neuropathogenic potential of naturally occurring strains. In order to estimate the prevalence of the EHV-1 neuropathogenic genotype in our country, we analyzed the ORF30 genome region of Argentinean EHV-1 isolates. The study was carried out by real time allelic discrimination PCR in 90 equine EHV-1-positive samples, being 89 from 54 cases of abortion outbreaks (two of which were in association with neurological disease) and one from the respiratory tract of a healthy horse in training. Our results indicate that 7% (4/54) of the abortion outbreaks studied were induced by the neuropathogenic (G(2254)) genotype of EHV-1 and 50% (2/4) of them were associated with simultaneous neurological disease. This information emphasizes the necessity to extreme the hygienic and preventive measures to diminish EHV-1 infections and consequently reduce the risk of epizootic neurological disease as has been recently observed in other countries.