RESUMEN
BACKGROUND: Multiple sclerosis (MS) is a neurological chronic disease that causes a number of physical, cognitive and emotional symptoms. The identification of these factors will allow mitigating unemployment and improve quality of life of patients. The Buffalo Vocational Monitoring Survey (BVMS) is a tool to characterize Work-Challenged patients. OBJECTIVE: To describe and analyze BVMS data in people with multiple sclerosis (PwMS) from Argentina. To study the association with physical, cognitive and psychiatric morbidity in employed patients, comparing the performance of MS Work-Challenged and MS Work-Stable patients, with and without accommodations. METHODS: 119 MS patients were administered the Argentina adaptation of the BVMS, and completed measures of physical disability, fatigue, depression, cognitive processing speed, memory and verbal fluency. RESULTS: 65.54% of the patients were employed and 19.32% were unemployed, the remaining having roles of housewife, students and disability retirees. Within the employed subgroup, 60.26% were working as employees and 39.74% were self-employed. Cognitive and clinical variables differentiate patients with and without negative events and accommodations (pâ> â0.05). CONCLUSIONS: This Spanish version BVMS is considered a new tool to monitor employment difficulties in Spanish-speaking MS patients. MS Work-Challenged had a higher depression, fatigue and worse performance in cognitive variables.
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Esclerosis Múltiple , Países en Desarrollo , Empleo , Fatiga , Humanos , Esclerosis Múltiple/complicaciones , Calidad de Vida , DesempleoRESUMEN
INTRODUCTION: The identification, diagnosis, follow-up, and treatment of patients with secondary progressive multiple sclerosis (SPMS) show significant differences between health care professionals in Argentina. AIM: To provide consensus recommendations on the management of patients with SPMS in Argentina to optimize patient care. DEVELOPMENT: A panel of expert neurologists from Argentina dedicated to the diagnosis and care of multiple sclerosis patients gathered during 2019 and 2020 to carry out a consensus recommendation on the diagnosis and treatment of SPMS patients in Argentina. To achieve consensus, the methodology of 'formal consensus-RAND/UCLA method' was used. Recommendations were established based on published evidence and the expert opinion. Recommendations focused on how to define SPMS and how to follow SPMS patients. CONCLUSION: The recommendations of this consensus guidelines attempt to optimize the care of SPMS patients in Argentina.
TITLE: Consenso sobre la identificación y seguimiento de la esclerosis múltiple secundaria progresiva en Argentina.Introducción. Existen diferencias significativas en el diagnóstico, la identificación y el seguimiento de pacientes con esclerosis múltiple secundaria progresiva (EMSP) entre los profesionales de la salud a cargo de su tratamiento. Objetivo. Proveer recomendaciones sobre el tratamiento de los pacientes con EMSP en Argentina con el fin de optimizar su cuidado. Desarrollo. Un grupo de neurólogos expertos en esclerosis múltiple de Argentina elaboró un consenso para el tratamiento de pacientes con EMSP en la región mediante metodología de ronda de encuestas a distancia y reuniones presenciales. Se establecieron 33 recomendaciones basadas en la evidencia publicada y en el criterio de los expertos que participaron. Las recomendaciones se enfocaron en el diagnóstico y el seguimiento de los pacientes con EMSP. Conclusión. Las recomendaciones establecidas en el presente consenso permitirían optimizar el cuidado y el seguimiento de los pacientes con EMSP en Argentina.
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Esclerosis Múltiple Crónica Progresiva/diagnóstico , Esclerosis Múltiple Crónica Progresiva/terapia , Argentina , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
Los Trastornos del Neurodesarrollo, en particular, los Trastornos del Espectro Autista (TEA) afectan la comunicación e interacción social, además de caracterizarse por conductas estereotipadas que en muchos casos se desajustan de la norma social. Dichas características nucleares de TEA pueden afectar el desarrollo afectivo-sexual y esto se puede ver exacerbado según el nivel de funcionamiento del niño o Adolescente. En este artículo revisaremos aspectos en conflicto en la sexualidad de Adolescentes con TEA de alto funcionamiento. Métodos: Se efectuó una revisión sistematizada de la evidencia reciente publicada y anexada a bases de datos en relación a conflictos en el área afectivo-sexual vivenciados por adolescentes con diagnóstico de Trastorno del Espectro Autista de alto funcionamiento. Se incluyeron estudios específicos respecto al tema, principalmente auto-reportes, denotando la escasez de revisiones sistemáticas. Se compara con literatura clásica de autismo. En la revisión se excluyó la población infantil con TEA, o sea, menores a 12 años al igual que jóvenes con TEA de bajo funcionamiento debido a las dificultades implícitas que la discapacidad intelectual y/o alteraciones del lenguaje generan en la interacción social y desarrollo afectivo-sexual. Resultados: En la revisión del tema se pesquisaron estudios enfocados en la comprensión de las dimensiones afectivo-sexuales afectadas en adolescentes con TEA de alto funcionamiento, comparaciones del desarrollo normativo en adolescentes sin TEA considerados casos controles y sus contrapartes con TEA, así mismo, se hizo énfasis en conflictos en común v/s conflictos específicos en TEA. Se evaluaron además, factores de riesgo en el ámbito sexual de jóvenes con TEA y las problemáticas en torno a educación sexual. Al respecto los estudios coincidieron en mayores porcentajes de conductas hipersexualizadas y parafílicas (principalmente fantasías sádicas y conductas voyeuristas y masoquistas) en adolescentes con TEA de alto funcionamiento. Además reportaron tasas más altas de orientación sexual "no heterosexual", disforia de género e identidad de género Trans. Discusión y Conclusiones: Del análisis de estudios en población específica de Adolescentes con diagnóstico de TEA catalogados como de alto funcionamiento, y en comparación con individuos controles sin TEA, la evidencia muestra un amplio espectro de dificultades relacionadas al desarrollo afectivo-sexual y su enfrentamiento en esta etapa del ciclo vital, así como la relación de los síntomas nucleares de TEA con conductas no normativas en torno a sexualidad del tipo "Hipersexualización" y "Parafilias". Se discuten además conflictos en orientación sexual e identidad de género. Se logró establecer una asociación entre las variables, lo que afecta su desempeño social global. Se evidenció además, la escasa educación sexual que reciben éstos adolescentes a nivel familiar y académico, lo que perpetúa tales conflictivas y establece un escenario de riesgo en su desarrollo. Se requiere mayor evaluación y utilización de escalas específicas adaptadas a TEA para mejorar y suplir tales falencias y así mejorar la calidad de vida de dichos jóvenes.
Neurodevelopmental Disorders, in particular Autism Spectrum Disorders (ASDs), affect social communication and interaction, as well as being characterized by stereotypical behaviors that in many cases are mismatched from the social norm. Such nuclear characteristics of ASD can have an impact on affective-sexual development and this may be exacerbated by the function level of the child or adolescent. In this article we will review conflicting aspects in the sexuality of adolescents with high-functioning ASD. Methods: A systematized review of recent evidence published and annexed to databases related to conflicts in the affective-sexual area lived by adolescents diagnosed with high-functioning Autism Spectrum Disorder was conducted. Specific studies were included on the subject, mainly self-reports, denoting the scarcity of systematic reviews. It was compared to classical autism literature. The review excluded the child population with ASD, i.e., under 12 years of age, as well as young people with low-functioning ASD due to the implicit difficulties that intellectual disability and/or language alterations generate in social interaction and affective-sexual development. Results: The review looked at studies focused on understanding the affective-sexual dimensions affected in adolescents with high-functioning ASD, comparisons of normative development in adolescents without ASD, considered control cases and their counterparts with ASD, as well as emphasizing common conflicts v/s specific conflicts in ASD. Risk factors in the sexual field of young people with ASD and sexual education issues were also assessed. In this regard, studies coincided with higher percentages of hypersexualized and paraphilic behaviors (mainly sadistic fantasies and voyeuristic and masochistic behaviors) in adolescents with high-functioning ASD. They also reported higher rates of "non-heterosexual" sexual orientation, gender dysphoria and transgender identity. Discussion and Conclusions: From the analysis of studies in the specific population of adolescents diagnosed with ASD listed as high functioning, and compared to individuals controls without ASD, the evidence shows a wide affective-sexual development and its confrontation at this stage of the life cycle, as well as the relationship of nuclear symptoms of ASD with non-normative behaviors around sexuality of the type "Hypersexualization" and "Paraphilias". Conflicts in sexual orientation and gender identity are also discussed. It was possible to establish a partnership between variables, which affects their overall social performance. It was also evident that these adolescents receive poor sex education within their families and at the academic levels, perpetuating such conflicts and establishing a scenario of developmental risk. Further evaluation and use of specific scales adapted to ASD are required to improve and supplement such false conditions and thus improve the quality of life of such young people.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Conducta Sexual/psicología , Sexualidad/psicología , Trastorno del Espectro Autista/psicología , Disfunciones Sexuales Fisiológicas/psicologíaRESUMEN
Several studies in multiple sclerosis (MS) suggest a trend of increasing disease frequency in women during the last decades. A direct comparison of gender ratio trends among MS populations from Argentina remains to be carried out. The objective of the study was to compare gender ratio trends, over a 50-year span in MS populations from Argentina. METHODS: multicenter study that included patients from 14 MS Centers of Argentina. Patients with definite MS with birth years ranging from 1940 to 1989 were included. Gender ratios were calculated by five decades based on year of birth and were adjusted for the F/M born-alive ratio derived from the Argentinean national registry of births. The F/M ratios were calculated using a multivariate logistic regression per five decades by the year of birth approach. Analyses were performed using Stata 10.1. RESULTS: 1069 patients were included. Gender ratios showed a significant increase from the first to the last decade in the whole MS sample (from 1.8 to 2.7; p value for trend=0.023). The Gender ratio did not show differences considering MS subtype. CONCLUSION: our study showed a modest increase of the F/M ratio (from 1.8 to 2.7) over time among patients affected by MS in Argentina.
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Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/epidemiología , Razón de Masculinidad , Adulto , Argentina/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Estudios RetrospectivosRESUMEN
UNLABELLED: In 1996, the prevalence of multiple sclerosis (MS) for the metropolitan area of Buenos Aires using the capture-recapture method was estimated to be between 14 and 19.8 cases per 100,000 inhabitants. The aim of this study was to update the prevalence to 2014 following the same methodology. METHODS: Gran Buenos Aires is the denomination that refers to the megalopolis comprised by the autonomous city of Buenos Aires and the surrounding conurbation of the province of Buenos Aires. The study was carried out taking December 2014 as the prevalence month. We used the capture-recapture method to estimate the prevalence of MS cross-matching registries from 6 MS Centers from the metropolitan area of Buenos Aires. Log-linear model Poisson regression was used to estimate the number of affected MS patients not detected by any of the 6 sources considered. RESULTS: 1035 registries were obtained from the 6 lists from 910 different patients detected. The population of the area based on 2010 census was 12,806,866, the number of MS cases estimated amongst source interactions were 4901. The estimated prevalence was 38.2 per 100,000 inhabitants (95% CI 36.1-41.2). CONCLUSION: The study is an update almost 20 years after the first one in the area showing a significant increase in the previous reported prevalence. Our findings are in line with previous studies performed in other regions of the world.
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Esclerosis Múltiple/epidemiología , Argentina/epidemiología , Humanos , Prevalencia , Sistema de RegistrosRESUMEN
UNLABELLED: The present study was carried out to assess if there is an anticipation of age at onset in younger generations of familial multiple sclerosis (FMS) vs. sporadic MS (SMS) in Argentina. METHODS: multicenter study that included patients from 14 MS Centers of Argentina. Patients were considered as FMS if they had in their family at least one relative of first or second degree diagnosed with MS; otherwise, patients were considered to have SMS. We compared the age at onset between familial and sporadic cases as well as the age at onset between relatives from different generations in FMS vs. SMS. RESULTS: 1333 patients were included, 97 of them were FMS (7.3%). A lower age at onset in the younger generations of FMS cases was found compared with older generations of FMS as well as. SMS cases (24.1±3.7 years vs. 30.3±5.7 years, and 32.4±9.4 respectively; p<0.001). No differences were observed between older generations of FMS vs. SMS cases (p=0.12). CONCLUSION: we observed an anticipation of age at onset of MS in younger generations of patients with FMS vs. older generations of FMS and SMS.
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Esclerosis Múltiple/epidemiología , Adulto , Edad de Inicio , Argentina/epidemiología , Familia , Estudios de Seguimiento , Humanos , Masculino , Esclerosis Múltiple/genética , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: Despite advances in neonatal care between 20% and 63% of children with necrotizing enterocolitis (NEC) require surgery. The aim was correlation the risk factors of infants with NEC "IIB / IIIA / IIIB" Bell and the clinical, surgical and pathological findings. METHOD: In the children with diagnosis of NEC surgically treated, were analyzed of variables: clinical, surgical and pathological findings. We studied two groups: control (n=5) and NEC group (n=12). Comparisons were made between groups using the Mann-Whitney U- and the Spearman coefficient (r). To assess the risk of morbidity / mortality associated with the extent of intestinal resection we applied the Cox regression. RESULT: We found differences (p < 0.05) between control group and the NEC group regarding Bell, the mean height of villi, Chiu and the number of goblet cells. In the NEC group we find correlations (p < 0.05) from Bell, regarding Chiu (r = 0.761), resection of the colon (r = 0.687), pneumatosis / perforation (r = 1) and the mean height of villi (r = -0.878). The gut reseccion was at 26 cm (3-107). We observed a risk of 1.04 in the neonatal period (p > 0.05) of mortality or consequence post-enterocolitis associated with the extent of bowel resection. CONCLUSION: The decrease in the average height of villi, the highest level of microscopic intestinal injury and reduced goblet cell population contributes to a greater extent of intestinal resection, which favors the risk of death or developing consequence post-enterocolitis.
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Enterocolitis Necrotizante/patología , Enterocolitis Necrotizante/cirugía , Femenino , Humanos , Recién Nacido , Masculino , Medición de RiesgoRESUMEN
Patients with clinically isolated syndrome (CIS) by definition do not have multiple sclerosis (MS) but are at risk of developing it. While studies show earlier immunomodulating drug use is effective, treatment must consider likely patient prognosis. In this paper we review current diagnosis, prognosis, and treatment literature for patients with CIS within Latin American clinical settings. Latin American MS experts, convened by ACINDES (The Civil Association for Research and Development in Health), reviewed current CIS (and early MS) literature and drew consensus conclusions. Three subgroups addressed separate questionnaires on CIS issues: prognosis, diagnosis, and treatment. MRI can contribute to predicting MS risk in patients with CIS; in Latin America, investigation of haplotype presence associated with CIS would be appropriate. McDonald's criteria and subsequent revisions enable earlier, more accurate MS diagnosis. Type A evidence exists supporting all leading immunomodulating MS drugs for effective treatment of CIS with a high risk of conversion to MS. In conclusion, patients with CIS are usually young, with often-limited symptomatic manifestations, and must be adequately prepared to receive preventive treatment. This consensus review should contribute to the dialogue between physicians and patients.
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Esclerosis Múltiple/terapia , Biomarcadores , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/psicología , Congresos como Asunto , Progresión de la Enfermedad , Humanos , Inmunoglobulina G/uso terapéutico , Factores Inmunológicos/uso terapéutico , América Latina , Imagen por Resonancia Magnética , Metaanálisis como Asunto , Esclerosis Múltiple/diagnóstico , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Esteroides/uso terapéuticoRESUMEN
BACKGROUND: The influence of pregnancy on Multiple Sclerosis (MS) has been extensively studied but such influence on Latin American women with MS has not been characterized. Our objective was to describe the course of pregnancy and birth outcome in Argentinean MS patients and the evolution of MS during pregnancy and after delivery. METHOD: We used a retrospective design in eight MS centers in Argentina and administered a survey to women with definite MS (Mc Donald) with pregnancies during or after MS onset. We contacted 355 women of which 81 met inclusion criteria. We recorded 141 pregnancies. RESULTS: Involuntary abortion was observed in 16% of pregnancies (95% CI = 10-23). Thirty five women received immunomodulatory therapy (IMT) before 42 pregnancies. Twenty three (55%) out of 42 pregnancies were exposed to IMT. The mean time of IMT discontinuation before conception in 19 (45.2%) pregnancies without exposure, was 104 days (95% CI = 61.0-147.0). There were 103 deliveries: 79% full term. Birth defects were detected in 19% of pregnancies exposed to IMT (95% CI = 4-46) and in 2% of non-exposed (95% CI = 0.3-8.0). The mean relapse rate was: pre-pregnancy year: 0.22 (95% CI = 0.12-0.32); pregnancy: 0.31 in 1st (95% CI = 0.10-0.52), 0.19 (95% CI = 0.03-0.36) in 2nd, and 0.04 in 3rd trimester (95% CI = -0.04-0.12); 1st trimester post delivery: 0.82 (95% CI = 0.42-1.22). CONCLUSION: We observed a higher rate of birth defects among infants exposed to immunomodulators in utero than those not exposed. The reduction in MS relapses during 2nd and 3rd trimester of pregnancy and its increase during postpartum is consistent with previous reports.
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Anomalías Congénitas/epidemiología , Parto Obstétrico/estadística & datos numéricos , Esclerosis Múltiple/epidemiología , Complicaciones del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Adulto , Anciano , Argentina/epidemiología , Lactancia Materna/estadística & datos numéricos , Recolección de Datos , Femenino , Humanos , Inmunosupresores/uso terapéutico , Recién Nacido , Persona de Mediana Edad , Esclerosis Múltiple/tratamiento farmacológico , Periodo Posparto , Embarazo , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Scarce data exist about multiple sclerosis (MS) prevalence in South America. The objective of the study is to determine the prevalence of MS in a high populated area from Argentina (Greater Buenos Aires Metropolitan area) using the capture-recapture methodology. METHODS: Greater Buenos Aires is the generic denomination that refers to the megalopolis comprised by the autonomous city of Buenos Aires and the surrounding conurbation of the province of Buenos Aires. The study was carried out taking July 1996 as the prevalence month. We used capture-recapture method to estimate the prevalence of MS cross matching registries from four MS Centers. RESULTS: A total of 803 registries were obtained from the four lists. Log-linear model for capture-recapture method was used to analyze the data. The population of the area based on the 1990 census was 12,594,974; the number of MS cases estimated amongst sources interactions were between 1833 and 2359; the prevalence estimated ranged from 14 to 19.8 cases per 100,000 inhabitants. CONCLUSIONS: This is the first study to provide epidemiological data on the prevalence of MS in a large population in Argentina (Greater Buenos Aires Metropolitan area). Further epidemiological studies will clarify the true prevalence of MS in South America.
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Esclerosis Múltiple/epidemiología , Argentina/epidemiología , Humanos , Modelos Estadísticos , Prevalencia , Sistema de RegistrosRESUMEN
BACKGROUND: Considering the lack of screening technology that would permit neurologists to identify patients who may benefit from formal or more comprehensive assessment of neuropsychological status in patients with multiple sclerosis (MS) in Argentina, we felt the need to validate the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ) developed by Benedict, et al. OBJECTIVE: The objective in this multicenter study was to test the reliability and validity of the MSNQ after translation into Spanish in Argentina. We also compared the MSNQ yield by the patient report with that of the two different informants. The sample included 125 patients with MS and 36 normal controls, 27 patients had two informants available and 23 patients and their informants were examined twice at 1-week intervals (test-retest group). All participants completed the MSNQ, RAO BRB, Beck Depression Inventory-Fast Screen, EDSS, and MS Functional Composite. RESULTS: We found that an MSNQ-I score of 26 or more resulted in classifications yielding sensitivity of 0.91 and specificity of 0.80, suggesting some utility for this Argentine, informant-report measure. CONCLUSIONS: This Spanish version of the MSNQ is reliable and useful as a screening test for identifying patients at high risk for cognitive impairment in MS.
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Trastornos del Conocimiento/fisiopatología , Esclerosis Múltiple Crónica Progresiva/fisiopatología , Esclerosis Múltiple Recurrente-Remitente/fisiopatología , Pruebas Neuropsicológicas/normas , Encuestas y Cuestionarios/normas , Adulto , Argentina/epidemiología , Trastornos del Conocimiento/epidemiología , Femenino , Humanos , Masculino , Tamizaje Masivo/normas , Persona de Mediana Edad , Esclerosis Múltiple Crónica Progresiva/epidemiología , Esclerosis Múltiple Recurrente-Remitente/epidemiología , Psicometría/normas , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Adulto JovenRESUMEN
There are few studies reporting multiple sclerosis prevalence rates in the Buenos Aires region, Argentina (latitude 34 degrees S) (between 12-18.5/100 000 inhabitants), and no studies have been performed in the larger region between parallels 36 degrees and 55 degrees S. The aim of this study is to determine the prevalence rates and clinical features of multiple sclerosis in residents of the Argentine Patagonia. Four cities from the region were selected for this study, giving a sample population of 417 666 inhabitants (approximately 24% of the total Patagonia population). 1(st) March 2002 was determined as prevalence day. Patients were ascertained using multiple case-finding methods. The point prevalence rate was 17.2/100 000 (17.2 age-adjusted to the world population). Prevalence rates were higher for women than for men, 22.1 versus 12.2/100 000 inhabitants (21.4 versus 12.7 sex-adjusted to the world population). The study population was mainly of European descent and mestizoes. Clinical features were similar to those reported in other countries. This study shows that Argentine Patagonia is a medium-risk area with no south-north gradient between parallels 55 degrees and 36 degrees S. The Patagonia population shows recent internal migration that makes it difficult to determine whether the exposure to potential risk factors has been long enough to modify the disease incidence.
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Esclerosis Múltiple Crónica Progresiva/epidemiología , Esclerosis Múltiple Recurrente-Remitente/epidemiología , Adolescente , Adulto , Argentina/epidemiología , Femenino , Humanos , Incidencia , Indígenas Sudamericanos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Dinámica Poblacional , Prevalencia , Factores de Riesgo , Distribución por Sexo , Población Blanca/estadística & datos numéricosRESUMEN
OBJECTIVES: To better understand the paradox in the Dominican Republic of a relatively high maternal mortality ratio despite nearly universal institutionalized deliveries with trained attendants, a rapid assessment using an adaptation of the strategic assessment method was conducted. METHODS: A multi-disciplinary team reviewed national statistics and hospital records, inventoried facilities, and observed peripartum client-provider interactions at 14 facilities. RESULTS: The major referral hospitals, where more than 40% of births in the country occur, were overcrowded and understaffed, with inexperienced residents overseeing care provided by medical students, interns and nurses. Uncomplicated labor and deliveries were overmedicalized, while complicated ones were not managed appropriately; emergencies were not dealt with in a timely fashion. In the peripheral hospitals physicians were seldom present and clients were either turned away or delivered by unprepared nursing staff. Providers in the busiest facilities suffered from compassion fatigue, and were demoralized and overworked. In all facilities, quality of care was lacking and the delivery and birthing process was dehumanized. CONCLUSIONS: Access and availability of institutional delivery alone is not enough to decrease MMR, it is also the quality of emergency obstetric care that saves lives.
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Salas de Parto/normas , Parto Obstétrico/mortalidad , Parto Obstétrico/normas , Mortalidad Materna , Calidad de la Atención de Salud/organización & administración , Actitud del Personal de Salud , Competencia Clínica , República Dominicana/epidemiología , Femenino , Adhesión a Directriz , Hospitalización , Humanos , EmbarazoRESUMEN
INTRODUCTION: Multiple sclerosis (MS) is the second most important/common cause of neurological disability in young adults. Current treatment includes the new immunomodulating agents and various drugs used in symptomatic management. Neurorehabilitation (NR) complements these treatments, forms an integral therapeutic strategy and is orientated to improve the activity and participation of the patient from a biopsychosocial point of view. DEVELOPMENT: Although there is a generally favorable opinion towards NR, there is little scientifically validated evidence regarding the benefits of its use. Correct measurement of the results is essential for their interpretation in terms of efficiency and efficacy. Of the various instruments for measurement of the results of NR, there are scales which have been shown to be of satisfactory clinical usefulness and scientifically sound for use in NR programmes in MS. In spite of methodological difficulties for the design of protocols in this field, in recent years several well-designed studies (randomised, controlled, double or single blind) have shown the usefulness of NT in MS (both outpatients and inpatients and including progressive forms) since handicap has been reduced and quality of life improved. These studies refer to NR as a multidisciplinary approach (a specially trained team of professionals) with concrete objectives and established job descriptions, a suitable battery of instruments for measurement of the results, active participation of the patient and his family and correct follow-up in the community.
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Esclerosis Múltiple/terapia , Adyuvantes Inmunológicos/uso terapéutico , Adulto , Terapia Combinada , Evaluación de la Discapacidad , Humanos , Interferón beta/uso terapéutico , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/rehabilitación , Terapia Ocupacional , Modalidades de Fisioterapia , Calidad de Vida , Índice de Severidad de la EnfermedadRESUMEN
We report 10 HTLV-I virus seropositive subjects, eight of them with HTLV-I associated myelopathy (HAM), two of them also infected with HIV as well as two asymptomatic HTLV-I+ relatives of two unrelated patients. HTLV-I is endemic in several tropical areas, where it causes different neurological diseases. Only few patients have been reported in our country since 1994. We studied 8 patients, who fulfilled the clinical criteria for chronic spastic paraplegia, and 2 other non-symptomatic HTLV-I seropositive relatives, with electromyography (EMG), motor and sensory conduction velocities (NCV), somatosensory, visual and brainstem auditory evoked potentials (SSEP, VEP and BAEP), Magnetic Resonance Images (MRI) and cerobrospinal fluid (CSF) analysis. The latter was carried out only in seven symptomatic patients. In every case positive ELISA tests for HTLV-I/II were confirmed by Western Blot. The two asymptomatic persons were clinically and electromyographically assessed, one of them was also submitted to SSEPs studies. Three patients were males. Patient's ages ranged from 5 to 65 years old. All symptomatic patients showed muscular weakness, spasticity with pyramidal signs and sphincter disturbances. Five of them had paresthesias and 2 had burning pain on their feet. The EMGs and the NCVs were normal in 7 patients and in the 2 asymptomatic ones. SSEPs, obtained by stimulating the posterior tibial nerves, were impaired in 7 patients and in the asymptomatic person who received the procedure. The 7 symptomatic patients who underwent lumbar puncture had positive tests for HTLV-I in CSF, 3 out of these 7 patients had also high protein levels and 4 had increased number of lymphocytes. In 2 patients intrathecal IgG production could also be demonstrated. MRI were normal in 7 patients and in the 2 asymptomatics, the exception being a female who had bilateral hyperintense lesions in cerebral white matter in T2. In conclusion, tropical spastic paraparesis is apparently a rare disorder in Argentina. However, some cases have been reported recently. Most probably, its prevalence is currently underestimated. Its diagnosis should be considered in every patient with progressive spastic paraplegia.
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Potenciales Evocados , Paraparesia Espástica Tropical/fisiopatología , Adulto , Anciano , Argentina/epidemiología , Electromiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paraparesia Espástica Tropical/líquido cefalorraquídeo , Paraparesia Espástica Tropical/epidemiologíaRESUMEN
In 1995, the first Venezuelan equine encephalitis (VEE) outbreak in Colombia in 22 years caused an estimated 75,000 human cases, 3000 with neurologic complications and 300 fatal, in La Guajira State. Of the state's estimated 50,000 equines, 8% may have died. An epizootic IC virus, probably introduced from Venezuela, was rapidly amplified among unvaccinated equines. Record high rainfall, producing high densities of vector Aedes taeniorhynchus, led to extensive epidemic transmission (30% attack rate) in the four affected municipalities. Native Wayuu Indians, constituting 24% of the state's population, were at increased risk of infection (risk ratio, 3.3; 95% confidence interval, 2.2-5.3). Epidemiologic studies found no evidence of human-to-human transmission. A higher-than-expected number of abortions during the outbreak confirmed a previously suspected abortifacient role of VEE infection. Pesticide applications and a mass equine vaccination program contributed to preventing the outbreak's spread south of La Guajira.
Asunto(s)
Brotes de Enfermedades , Encefalomielitis Equina Venezolana/epidemiología , Adulto , Animales , Niño , Colombia/epidemiología , Encefalomielitis Equina Venezolana/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PIP: Data from the 1986 Demographic and Health Survey were used to assess the status of breast feeding in the Dominican Republic and to analyze its possible relationship to infant mortality in various population subgroups. The analysis was based on a model that explained infant mortality in the Dominican Republic as a function of eight variables. Care was taken to control for the influence of confounding variables, such as the possible exposure of bottle fed infants to impure water in formula and the possibly shorter birth intervals of women who do not breast feed. Respondents to the Demographic and Health Survey were asked how long their infants born in the previous five years were breast fed. Those infants who were 1 year to five years old at the survey date (and therefore exposed to risk of mortality for at least one year) were included in the study. The statistical technique known as proportional hazard models was selected because of its applicability to lactation, a complex determinant of infant survival because of its dependence on the child's age. Four age ranges were studied: under one month, one to two months, three to six months, and seven to eleven months. Child survival and breast feeding status were established for each age range. The risk of death associated with breast feeding status was thus considered as a function of age. The eight control variables were urban or rural residence, family economic status, maternal education and level of information, source of household water, previous birth interval. Prenatal care, and type of attendance at delivery. The results of the study demonstrated that, when the effects of infants' ages were controlled, breast feeding was an important determinant of infant mortality in the Dominican Republic in the first half of the 1980s. The effect of breast feeding on infant mortality is direct and is not a reflection of any of the other factors. Significant interactions were found between breast feeding and age, and between breast feeding and the household source of water. The risk of death was less for breast fed infants at all ages. The magnitude of the coefficients showed that breast feeding could be crucial during the first month of life. The influence of breast feeding decreased with age, and by 6 months the difference in the risk of death of breast fed and nonbreast fed infants was small. There was no true differential between mortality of breast fed infants who had or did not have potable water in the household. Nonbreast fed infants had a higher risk of death whether or not they lived in households with potable water, but those without potable water were at higher risk. A policy to increase infant survival in the Dominican Republic should promote breast feeding and should work to provide potable water.^ieng
Asunto(s)
Factores de Edad , Lactancia Materna , Demografía , Mortalidad Infantil , Mortalidad , Abastecimiento de Agua , Américas , Región del Caribe , Conservación de los Recursos Naturales , Países en Desarrollo , República Dominicana , Ambiente , Salud , Fenómenos Fisiológicos Nutricionales del Lactante , América Latina , América del Norte , Fenómenos Fisiológicos de la Nutrición , Población , Características de la Población , Dinámica PoblacionalRESUMEN
Se presentan dos pacientes con clínica de tromboflebitis del seno cavernoso, quienes desarrollaron complicaciones isquémicas del territorio carotídeo asociado. Uno de ellos presentó embolia de la arteria central de la retina y trombosis carotídea proximal. El segundo mostró un infarto silviano homolateral al proceso infeccioso. El mecanismo iniciador de este inusual tipo de complicación podría ser la arteritis y estenosis focal del segmento intravenoso de la carótida interna, a partir del cual se desencadenarían fenómenos embólicos (distales al estrechamiento) y/o trombóticos (proximales al mismo)
Asunto(s)
Trombosis de los Senos Intracraneales/complicaciones , Isquemia Encefálica/fisiopatología , Trombosis de los Senos Intracraneales/fisiopatología , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Isquemia Encefálica/etiología , Infarto Cerebral/etiología , Infecciones por Proteus/tratamiento farmacológico , Angiografía Cerebral , Arterias Carótidas , Arteria Retiniana/patología , Embolia y Trombosis Intracraneal/complicaciones , Embolia y Trombosis Intracraneal/etiologíaRESUMEN
Se presentan dos pacientes con clínica de tromboflebitis del seno cavernoso, quienes desarrollaron complicaciones isquémicas del territorio carotídeo asociado. Uno de ellos presentó embolia de la arteria central de la retina y trombosis carotídea proximal. El segundo mostró un infarto silviano homolateral al proceso infeccioso. El mecanismo iniciador de este inusual tipo de complicación podría ser la arteritis y estenosis focal del segmento intravenoso de la carótida interna, a partir del cual se desencadenarían fenómenos embólicos (distales al estrechamiento) y/o trombóticos (proximales al mismo)