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OBJECTIVE: Previous isolated reports have hypothesized that chewing coca leaves, a pre-Columbian tradition found in certain regions of South America, may be associated with the development of oral squamous cell carcinoma (OSCC). Coca chewing (CC) is a habit that shares many characteristics with the well-known practice of betel chewing observed in Asia. The aim of this study is to analyze the association between CC and OSCC among patients who attended the Señor del Milagro Hospital in Salta, Argentina. STUDY DESIGN: A case-control study was conducted from 2013 to 2018. For each case of OSCC, three healthy control patients were included. Odds ratios were calculated to compare demographics, concurrent oral conditions, and other classical risk factors for OSCC. RESULTS: A total of 62 cases and 180 controls were included, adjusted for sex and age. OSCC was significantly associated with tobacco use (27.4% vs 9.4%, P = .001), CC (62.9% vs 32.2%, P < .001), and poor oral condition (81.1% vs 67.7%, P = .02). In the multivariate analysis, smoking (OR = 2.77, 95% CI 1.23-6.25, P = .0139), CC (OR = 2.98, 95% CI 1.58-5.63, P = .0007), and poor oral condition (OR = 3.1, 95% CI 1.62-5.85, P = .0006) remained independently associated with OSCC development. CONCLUSIONS: Chewing coca leaves could be considered a risk factor for oral cancer in a subset of Argentinean patients. Further studies are necessary to validate our findings and to elucidate the underlying pathways linking this habit to oral carcinogenesis.
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Carcinoma de Células Escamosas , Coca , Neoplasias de la Boca , Humanos , Estudios de Casos y Controles , Argentina , Femenino , Masculino , Neoplasias de la Boca/epidemiología , Neoplasias de la Boca/etiología , Persona de Mediana Edad , Factores de Riesgo , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/etiología , Anciano , Masticación , Adulto , Hojas de la PlantaRESUMEN
BACKGROUND: Strongyloidiasis and Chagas disease are endemic in northern Argentina. In this study we evaluate the association between S. stercoralis and T. cruzi infections in villages with diverse prevalence levels for these parasites. Further understanding in the relationship between these Neglected Tropical Diseases of South America is relevant for the design of integrated control measures as well as exploring potential biologic interactions. METHODOLOGY: Community based cross-sectional studies were carried in different villages of the Chaco and Yungas regions in Argentina. Individuals were diagnosed by serology for S. stercoralis and T. cruzi. The association between S. stercoralis and T. cruzi, and between anemia and the two parasites was evaluated using two approaches: marginal (Ma) and multilevel regression (Mu). RESULTS: A total of 706 individuals from six villages of northern Argentina were included. A total of 37% were positive for S. stercoralis, 14% were positive for T. cruzi and 5% were positive for both. No association was found between infection with S. stercoralis and T. cruzi in any of the models, but we found a negative correlation between the prevalence of these species in the different villages (r = -0.91). Adults (> 15 years) presented association with S. stercoralis (Ma OR = 2.72; Mu OR = 2.84) and T. cruzi (Ma OR = 5.12; Mu OR = 5.48). Also, 12% and 2% of the variance of infection with S. stercoralis and T. cruzi, respectively, could be explained by differences among villages. On the other hand, anemia was associated with infection with S. stercoralis (Ma OR = 1.73; Mu OR = 1.78) and was more prevalent in adults (Ma OR = 2.59; Mu OR = 2.69). CONCLUSION: We found that coinfection between S. stercoralis and T. cruzi is not more frequent than chance in endemic areas. However, the high prevalence for both parasites, raises the need for an integrated strategy for the control of STH and Chagas disease.
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Enfermedad de Chagas/parasitología , Coinfección/parasitología , Strongyloides stercoralis/fisiología , Estrongiloidiasis/parasitología , Trypanosoma cruzi/fisiología , Adolescente , Adulto , Animales , Argentina/epidemiología , Enfermedad de Chagas/epidemiología , Niño , Preescolar , Coinfección/epidemiología , Estudios Transversales , Emigrantes e Inmigrantes/estadística & datos numéricos , Enfermedades Endémicas/estadística & datos numéricos , Heces/parasitología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Strongyloides stercoralis/genética , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/epidemiología , Trypanosoma cruzi/genética , Trypanosoma cruzi/aislamiento & purificación , Adulto JovenRESUMEN
Introducción: Salta tiene la incidencia máxima de Tuberculosis (TB) en Argentina. El abandono del tratamiento es relevante, su prevalencia en Argentina en el año 2020 fue del 15,3 %. La definición operativa de abandono es interrupción del tratamiento durante 2 meses consecutivos o más. Definición de abandono para el estudio suspensión del tratamiento durante un periodo mayor a un mes y luego de un mes de adherencia.OBJETIVOS A nivel general, evaluar factores asociados a la adherencia al tratamiento de TB durante los dos primeros años de la pandemia de COVID-19 en pacientes de la provincia de Salta. De manera específica, 1) estimar la prevalencia de pérdida de seguimiento del tratamiento en 2020/21; 2) identificar factores asociados a la pérdida de seguimiento del tratamiento; 3) describir factores asociados al cumplimiento del tratamiento. MÉTODOS Se realizó un estudio observacional de casos y controles retrospectivo en mayores de 18 años diagnosticados de TB en el Hospital Señor del Milagro durante 2020 y 2021. Fueron casos todos los pacientes que abandonaron el tratamiento y controles los sujetos con tratamiento finalizado seleccionados al azar en una proporción de 1 a 2. Se recogieron datos de historias clínicas. Se analizó la asociación de cada variable al evento abandono con un modelo multivariado. RESULTADOS Se diagnosticaron 457 casos, 268 (59 %) finalizaron el tratamiento y 73 (16 %) lo abandonaron. Se incluyó a 219 sujetos (73 casos y 146 controles). Se observó asociación significativa de DBT (ORa 4,2; IC95% 1,5-11,5; p=0,005) y de VIH (ORa 5,7; IC95% 2,5- 12,9; p=0,001) con abandono del tratamiento. Los efectos adversos durante el tratamiento se asociaron significativamente con un sentido de reducción del riesgo (ORa 0,30; IC95% 0,11- 0,8; p=0,017). DISCUSIÓN El abandono del tratamiento de TB fue frecuente en la pandemia de COVID-19. DBT y VIH aumentaron el riesgo de abandono. Las reacciones adversas a las drogas aumentaron la adherencia al tratamiento.
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Tuberculosis , Perdida de Seguimiento , COVID-19RESUMEN
OBJECTIVES: Describe the diagnostic characteristics of a conventional multiplex PCR for the diagnosis of S. stercoralis, N. americanus and Ancylostomas spp. METHODS: Fecal samples were collected from a cross-sectional study in Orán department, Salta province, Argentina. The stool samples were analyzed using concentration-sedimentation, Harada Mori, McMaster, and Baermann techniques. DNA was extracted from 50 mg fecal sample using the FastPrep® Spin Kit for Soil. Three pairs of primers were used for the amplification of three products of 101, 330, and 577 base pairs (bp) for S. stercoralis, N. americanus and Ancylostoma spp, respectively. The sensitivity and analytical specificity of multiplex PCR were evaluated, as well as the sensitivity and diagnostic specificity, using a composite standard and Bayesian approach. RESULTS AND CONCLUSIONS: Multiplex PCR did not present cross-reaction with other intestinal parasites, and the detection limit for multiplex PCR was between 2 and 20 pg of genomic DNA. In addition it presented a diagnostic sensitivity of 97.4% for S. stercoralis and 90.3% for hookworms with a specificity of 100% and 87.6%, respectively. PCR identified a higher proportion (p <0.01) of coinfections (15.3%) than microscopic techniques (3.5%). Also, multiplex PCR showed that there was a positive association between S. stercoralis and hookworms (odds ratio = 2.12). However, this association was due to N. americanus (odds ratio= 3.22), since no association was observed between S. stercoralis and Ancylostoma spp. Neither was an association observed between the two species of hookworms.
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Parasitosis Intestinales , Strongyloides stercoralis , Estrongiloidiasis , Ancylostomatoidea/genética , Animales , Teorema de Bayes , Estudios Transversales , Heces , Humanos , Reacción en Cadena de la Polimerasa Multiplex , Sensibilidad y Especificidad , Strongyloides stercoralis/genética , Estrongiloidiasis/diagnósticoRESUMEN
The threadworm, Strongyloides stercoralis, is endemic in tropical and subtropical areas. Data on the prevalence and distribution of infection with this parasite species is scarce in many critical regions. We conducted a seroprevalence study of S. stercoralis infection in 13 locations in the Gran Chaco and Yungas regions of Argentina and Bolivia during the period 2010-2016. A total of 2803 human serum samples were analyzed by ELISA-NIE which has a sensitivity of 75% and specificity of 95%. Results showed that 551 (19.6%) of those samples were positive. The adjusted prevalence was 20.9%, (95% confidence interval (CI) 19.4%-22.4%). The distribution of cases was similar between females and males with an increase of prevalence with age. The prevalence in the different locations ranged from 7.75% in Pampa del Indio to 44.55% in Santa Victoria Este in the triple border between Argentina, Bolivia, and Paraguay in the Chaco region. Our results show that S. stercoralis is highly prevalent in the Chaco and Yungas regions, which should prompt prospective surveys to confirm our findings and the design and deployment of control measures.
RESUMEN
BACKGROUND: Recommendations for soil-transmitted helminth (STH) control give a key role to deworming of school and pre-school age children with albendazole or mebendazole; which might be insufficient to achieve adequate control, particularly against Strongyloides stercoralis. The impact of preventive chemotherapy (PC) against STH morbidity is still incompletely understood. The aim of this study was to assess the effectiveness of a community-based program with albendazole and ivermectin in a high transmission setting for S. stercoralis and hookworm. METHODOLOGY: Community-based pragmatic trial conducted in Tartagal, Argentina; from 2012 to 2015. Six communities (5070 people) were enrolled for community-based PC with albendazole and ivermectin. Two communities (2721 people) were re-treated for second and third rounds. STH prevalence, anemia and malnutrition were explored through consecutive surveys. Anthropometric assessment of children, stool analysis, complete blood count and NIE-ELISA serology for S. stercoralis were performed. PRINCIPAL FINDINGS: STH infection was associated with anemia and stunting in the baseline survey that included all communities and showed a STH prevalence of 47.6% (almost exclusively hookworm and S. stercoralis). Among communities with multiple interventions, STH prevalence decreased from 62% to 23% (p<0.001) after the first PC; anemia also diminished from 52% to 12% (p<0.001). After two interventions S. stercoralis seroprevalence declined, from 51% to 14% (p<0.001) and stunting prevalence decreased, from 19% to 12% (p = 0.009). CONCLUSIONS: Hookworm' infections are associated with anemia in the general population and nutritional impairment in children. S. stercoralis is also associated with anemia. Community-based deworming with albendazole and ivermectin is effective for the reduction of STH prevalence and morbidity in communities with high prevalence of hookworm and S. stercoralis.
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Albendazol/uso terapéutico , Ancylostomatoidea , Infecciones por Uncinaria/tratamiento farmacológico , Ivermectina/uso terapéutico , Strongyloides stercoralis , Estrongiloidiasis/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Antihelmínticos/uso terapéutico , Argentina/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Prevalencia , Suelo/parasitología , Adulto JovenRESUMEN
Northwestern Argentina is endemic for soil-transmitted helminths, and annual deworming programs are carried out in prioritized areas. High prevalence of Strongyloides stercoralis was reported in this area; therefore, control programs including ivermectin are being evaluated. The NIE-enzyme linked immunosorbent assay (ELISA) was used for this purpose. In this community trial, two groups of patients, classified according to housing and living conditions were evaluated. Simultaneous with baseline survey, Group 1 was moved to new households with access to improved water and sanitation facilities (W and S), where deworming (MDA, massive drug administration) took place within 1 month; whereas Group 2 received MDA but remained living with unimproved W and S. The mean time interval between baseline and the follow-up was 331 days for Group 1 and 508 for Group 2. Anti-NIE levels were measured for each individual before and after interventions and follow-up optical density (OD) ratios were calculated to quantify the variation. A significant decrease of the anti-NIE levels between baseline and follow-up was observed in both groups. Nonetheless, the number of patients that achieved the cure criteria (OD ratio < 0.6) was higher in Group 1 than Group 2 with values of 72.7% (24/33) and 45.0% (18/40), respectively (P = 0.0197). Our results support the conclusion that a combined intervention including deworming and improvements in life conditions is more effective, in terms of the proportion of subjects cured than deworming alone. Furthermore, we found that NIE-ELISA is a useful test for assessing the response to treatment and to evaluate the outcome of control intervention programs.
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Antihelmínticos/uso terapéutico , Salud Pública/métodos , Estudios Seroepidemiológicos , Strongyloides stercoralis , Estrongiloidiasis/tratamiento farmacológico , Estrongiloidiasis/prevención & control , Adolescente , Animales , Anticuerpos Antihelmínticos/sangre , Argentina/epidemiología , Niño , Femenino , Humanos , Masculino , Estrongiloidiasis/epidemiologíaRESUMEN
BACKGROUND: Soil-transmitted helminth (STH) infections are a public health problem in resource-limited settings worldwide. Chronic STH infection impairs optimum learning and productivity, contributing to the perpetuation of the poverty-disease cycle. Regular massive drug administration (MDA) is the cardinal recommendation for its control; along with water, sanitation and hygiene (WASH) interventions. The impact of joint WASH interventions on STH infections has been reported; studies on the independent effect of WASH components are needed to contribute with the improvement of current recommendations for the control of STH. The aim of this study is to assess the association of lacking access to water and sanitation with STH infections, taking into account the differences in route of infection among species and the availability of adequate water and sanitation at home. METHODS AND FINDINGS: Cross-sectional study, conducted in Salta province, Argentina. During a deworming program that enrolled 6957 individuals; 771 were randomly selected for stool/serum sampling for parasitological and serological diagnosis of STH. Bivariate stratified analysis was performed to explore significant correlations between risk factors and STH infections grouped by mechanism of entry as skin-penetrators (hookworms and Strongyloides stercoralis) vs. orally-ingested (Ascaris lumbricoides and Trichuris trichiura). After controlling for potential confounders, unimproved sanitation was significantly associated with increased odds of infection of skin-penetrators (adjusted odds ratio [aOR] = 3.9; 95% CI: 2.6-5.9). Unimproved drinking water was significantly associated with increased odds of infection of orally-ingested (aOR = 2.2; 95% CI: 1.3-3.7). CONCLUSIONS: Lack of safe water and proper sanitation pose a risk of STH infections that is distinct according to the route of entry to the human host used by each of the STH species. Interventions aimed to improve water and sanitation access should be highlighted in the recommendations for the control of STH.
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Infecciones por Nematodos/epidemiología , Agua/parasitología , Adolescente , Adulto , Animales , Argentina/epidemiología , Niño , Preescolar , Estudios Transversales , Heces/parasitología , Humanos , Higiene , Masculino , Infecciones por Nematodos/diagnóstico , Infecciones por Nematodos/tratamiento farmacológico , Infecciones por Nematodos/transmisión , Factores de Riesgo , Saneamiento , Abastecimiento de Agua , Adulto JovenRESUMEN
BACKGROUND: In resource-limited countries, stool microscopy is the diagnostic test of choice for intestinal parasites (soil-transmitted helminths and/or intestinal protozoa). However, sensitivity and specificity is low. Improved diagnosis of intestinal parasites is especially important for accurate measurements of prevalence and intensity of infections in endemic areas. METHODS: The study was carried out in Orán, Argentina. A total of 99 stool samples from a local surveillance campaign were analyzed by concentration microscopy and McMaster egg counting technique compared to the analysis by multi-parallel quantitative real-time polymerase chain reaction (qPCR). This study compared the performance of qPCR assay and stool microscopy for 8 common intestinal parasites that infect humans including the helminths Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, and the protozoa Giardia lamblia, Cryptosporidium parvum/hominis, and Entamoeba histolytica, and investigated the prevalence of polyparasitism in an endemic area. RESULTS: qPCR showed higher detection rates for all parasites as compared to stool microscopy except T. trichiura. Species-specific primers and probes were able to distinguish between A. duodenale (19.1%) and N. americanus (36.4%) infections. There were 48.6% of subjects co-infected with both hookworms, and a significant increase in hookworm DNA for A. duodenale versus N. americanus (119.6 fg/µL: 0.63 fg/µL, P < 0.001) respectively. qPCR outperformed microscopy by the largest margin in G. lamblia infections (63.6% versus 8.1%, P < 0.05). Polyparasitism was detected more often by qPCR compared to microscopy (64.7% versus 24.2%, P < 0.05). CONCLUSIONS: Multi-parallel qPCR is a quantitative molecular diagnostic method for common intestinal parasites in an endemic area that has improved diagnostic accuracy compared to stool microscopy. This first time use of multi-parallel qPCR in Argentina has demonstrated the high prevalence of intestinal parasites in a peri-urban area. These results will contribute to more accurate epidemiological survey, refined treatment strategies on a public scale, and better health outcomes in endemic settings.
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Ancylostomatoidea/aislamiento & purificación , Infecciones por Uncinaria/epidemiología , Parasitosis Intestinales/epidemiología , Parásitos/aislamiento & purificación , Ancylostomatoidea/genética , Animales , Argentina/epidemiología , Heces/parasitología , Femenino , Infecciones por Uncinaria/parasitología , Humanos , Parasitosis Intestinales/parasitología , Recuento de Huevos de Parásitos , Parásitos/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Especificidad de la Especie , Población UrbanaRESUMEN
Strongyloides stercoralis infections have a worldwide distribution with a global burden in terms of prevalence and morbidity that is largely ignored. A public health response against soil-transmitted helminth (STH) infections should broaden the strategy to include S. stercoralis and overcome the epidemiological, diagnostic, and therapeutic challenges that this parasite poses in comparison to Ascaris lumbricoides, Trichuris trichiura, and hookworms. The relatively poor sensitivity of single stool evaluations, which is further lowered when quantitative techniques aimed at detecting eggs are used, also complicates morbidity evaluations and adequate drug efficacy measurements, since S. stercoralis is eliminated in stools in a larval stage. Specific stool techniques for the detection of larvae of S. stercoralis, like Baermann's and Koga's agar plate, despite superiority over direct techniques are still suboptimal. New serologies using recombinant antigens and molecular-based techniques offer new hopes in those areas. The use of ivermectin rather than benzimidazoles for its treatment and the need to have curative regimens rather than lowering the parasite burden are also unique for S. stercoralis in comparison to the other STH due to its life cycle, which allows reproduction and amplification of the worm burden within the human host. The potential impact on STH of the benzimidazoles/ivermectin combinations, already used for control/elimination of lymphatic filariasis, should be further evaluated in public health settings. While waiting for more effective single-dose drug regimens and new sensitive diagnostics, the evidence and the tools already available warrant the planning of a common platform for STH and S. stercoralis control.