RESUMEN
STUDY DESIGN: Cross-sectional study. OBJECTIVES: The present study aims to analyze and correlate the interlimb reflexes (ILRs), through a standard methodology, in tetraplegic and healthy subjects. The study of the connectivity between the injured spinal cord and the ILR transmission empowers new rehabilitation pathways for tetraplegic patients. SETTING: University Hospital-UNICAMP, Campinas, Brazil. METHODS: A total of 15 chronic tetraplegic patients and 10 healthy subjects were analyzed with the same methodology. Two tests were performed: (i) In test 1, the stimulus was applied to the right-arm radial nerve and the electromyography (EMG) signal collected in contralateral left tibial muscle. (ii) In test 2, the stimulus was applied to the left-leg fibular nerve and EMG collected in contralateral limb biceps, exploring the opposite direction of the pathway. In both tests, the subjects were stimulated with intensities from 5 to 30 mA (5 mA step) and 40 × 500 µs current modulated pulses. Reflexes were detected from the averaging of the 40 EMG sweeps. RESULTS: Each group was analyzed with regard to the reflexes' incidence, amplitude and latency. ILRs were found with similar prominence in both groups. A correlation between the ILR amplitude and the subject injury level was verified. Significant differences were found in the correlation of ILR latency with stimulation charge between healthy and tetraplegic subjects. CONCLUSION: The ILR transmission parameters of healthy and tetraplegic subjects were studied. The results obtained strongly suggest a different ILR transmission between healthy and tetraplegic subjects, reinforcing the hypothesis of nerve regeneration after injury.
Asunto(s)
Fenómenos Electrofisiológicos , Lateralidad Funcional/fisiología , Cuadriplejía/fisiopatología , Reflejo/fisiología , Adulto , Edad de Inicio , Brasil , Estudios Transversales , Estimulación Eléctrica , Electromiografía , Femenino , Humanos , Incidencia , Pierna , Masculino , Músculo Esquelético/fisiopatología , Regeneración Nerviosa , Cuadriplejía/epidemiología , Cuadriplejía/rehabilitación , Nervio Radial/fisiopatología , Adulto JovenRESUMEN
BACKGROUND AND PURPOSE: We carried out a door-to-door survey in rural areas of the Cordillera Province, Santa Cruz Department, Bolivia. A cluster sample of 10 124 inhabitants was selected, and 9955 subjects were screened. The aim was to determine the prevalence of the most common neurological diseases (epilepsy, stroke, parkinsonism, and peripheral neuropathy) in this population. METHODS: We used a modified version of the World Health Organization screening instrument. On screening we found that 1130 subjects tested positive, and 1027 underwent a complete neurological examination. According to the World Health Organization guidelines, we defined stroke as "rapidly developing clinical signs of focal (or global) disturbance of cerebral functions, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin." We considered only first stroke and excluded a possible stroke. RESULTS: We found 16 subjects (cases) who had experienced 1 complete stroke on prevalent day (November 1, 1994). The crude prevalence of stroke was 174/100 000 (322/100 000 age-adjusted to the world standard population) and 663/100 000 in subjects aged >/=35 years. Prevalence was >2-fold higher in men than in women (247/100 000 and 99/100 000, respectively) and increased rapidly with age. Seven cases were hospitalized and received specific treatment. CONCLUSIONS: Our crude prevalence is lower compared with rates from developed countries, probably because of a high case fatality rate. Our findings are comparable with those reported from other surveys carried out in rural developing countries.
Asunto(s)
Encuestas Epidemiológicas , Salud Rural , Accidente Cerebrovascular/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Bolivia , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Examen Neurológico , Prevalencia , Distribución por Sexo , Accidente Cerebrovascular/diagnósticoRESUMEN
OBJECTIVE: To carry out a door-to-door survey in rural areas of the Cordillera Province, Santa Cruz Department, Bolivia, to determine the prevalence of neurologic diseases (epilepsy, stroke, parkinsonism, and peripheral neuropathy) in a sample of approximately 10,000 inhabitants. METHODS: A team of nondoctor health workers administered a standard screening instrument for neurologic diseases-a slightly modified version of the World Health Organization protocol. All subjects found positive during the screening underwent a neurologic examination. RESULTS: On screening, the authors found 1,130 positive subjects, of whom 1,027 were then investigated by neurologists. On the basis of the definition proposed by the International League Against Epilepsy, we detected 124 epileptic patients (prevalence, 12.3/1,000), 112 of whom had active epilepsy (prevalence, 11.1/1,000) on the prevalence day (November 1, 1994). Peak age-specific prevalence occurred in the 15 to 24-year age group (20.4/1,000). Sex-specific prevalence was higher in women (13.1/1,000) than men (11.4/1,000). Eighty-nine patients (71.8%) underwent a standard EEG recording. Considering both EEG and clinical data, partial seizures were the most common type (53.2%) based on the classification of the International League Against Epilepsy. The mean age at onset was 20.7 years for partial seizures and 13.6 years for generalized seizures. Only 10.5% of patients had received specific treatment for more than 2 months of their life. CONCLUSION: This report on epilepsy prevalence in Bolivia confirms that epilepsy is a major health problem in rural areas of developing countries.
Asunto(s)
Países en Desarrollo , Epilepsia/epidemiología , Población Rural/estadística & datos numéricos , Adolescente , Adulto , Anciano , Bolivia/epidemiología , Niño , Preescolar , Estudios Transversales , Epilepsias Parciales/epidemiología , Epilepsia Generalizada/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana EdadRESUMEN
A door-to-door survey was carried out in rural areas of the Cordillera province, Santa Cruz Department, Bolivia. A cluster sample of 10,124 inhabitants was selected. The aim was to determine the prevalence of the most common neurological diseases (epilepsy, stroke, parkinsonism and peripheral neuropathy) in this population using a modification of the World Health Organization screening instrument. 1,130 subjects screened positive and were then investigated by neurologists. In this paper we describe the background and methods of the survey and the characteristics of the population.
Asunto(s)
Encefalopatías/epidemiología , Enfermedades del Sistema Nervioso Periférico/epidemiología , Población Rural/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Bolivia/epidemiología , Niño , Preescolar , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Ocupaciones , Prevalencia , Distribución por SexoRESUMEN
A survey on toxocara canis-IgG seroprevalence was carried out in two Bolivian communities (Mora and Zanja Honda) living in the Cordillera Province, Department of Santa Cruz. Two hundred and sixteen people, both males and females, 2 to 85 years old were sampled. Altogether, 73 people were positive (34%). The seroprevalence was 27% in Mora and 42% in Zanja Honda (p = 0.022). No statistical correlations were found with sex and age. High prevalences were also found for intestinal helminths (hookworms, Trichuris trichiura, Ascaris lumbricoides, Hymenolepis nana and Strongyloides stercoralis). Positive association between T. canis seropositivity and presence of T. trichiura and between T. trichiura and hookworms were found. T. canis egg prevalence in dog population was found consistently higher in Zanja Honda than in Mora (40% vs 27%).
Asunto(s)
Anticuerpos Antihelmínticos/sangre , Inmunoglobulina G/sangre , Toxocara canis/inmunología , Toxocariasis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Bolivia/epidemiología , Niño , Preescolar , Vectores de Enfermedades , Enfermedades de los Perros/epidemiología , Enfermedades de los Perros/parasitología , Perros , Ensayo de Inmunoadsorción Enzimática , Heces/parasitología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Seroepidemiológicos , Toxocara canis/aislamiento & purificaciónRESUMEN
OBJECTIVE: To determine the prevalence of anterior and vertical atlantoaxial subluxation (AAS) and its neurological effect in a consecutive sample of Mexican patients with ankylosing spondylitis (AS). METHODS: Consecutive patients with a diagnosis of AS who attended 2 secondary care outpatient rheumatology clinic in the city of Guadalajara within a period of 6 mo were included in the study. Patients had prospective rheumatologic and neurologic assessments using structured questionnaires and examinations. Recorded variables included demographic data, disease characteristics, neurologic symptoms and signs, and axial mobility measurements. Somatosensory evoked potentials (SSEP) were performed in all patients. Patients also underwent standard cervical spine radiography with anteroposterior open mouth, and neutral, full flexion and extension lateral views. RESULTS: We studied 103 patients. Mean age was 35 yrs, 74% were male, and mean disease duration was 10 yrs (S/- SD 7.9). Anterior AAS was observed in 22 patients (21%, 95% CI 13-29%) and vertical AAS in 2 cases (2%, 95% CI 0-7%). Ossification of the posterior longitudinal ligament (OPLL) was present in 16 patients. Statistically significant associations were observed between anterior AAS and SSEP (p < 0.0001) and OPLL (p = 0.04). The degree of radiologic sacroiliitis was also associated with anterior AAS. After completion of the study, 2 patients required surgical fusion due to severe cervical cord compression. CONCLUSION: The prevalence of AAS and OPLL in this population was higher than previously reported in other settings. The association of anterior AAS with OPLL and radiological sacroiliitis could identify a subgroup of patients with more severe axial enthesopathy. Although clinically significant neurologic complications are not frequent in these patients, AAS may cause severe spinal cord compression requiring surgical fusion.
Asunto(s)
Articulación Atlantoaxoidea/lesiones , Luxaciones Articulares/etiología , Enfermedades del Sistema Nervioso/etiología , Espondilitis Anquilosante/complicaciones , Adolescente , Adulto , Artritis/diagnóstico por imagen , Artrografía , Articulación Atlantoaxoidea/diagnóstico por imagen , Articulación Atlantoaxoidea/patología , Femenino , Humanos , Luxaciones Articulares/diagnóstico , Luxaciones Articulares/epidemiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/epidemiología , Prevalencia , Articulación Sacroiliaca/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
A study was carried out in the Cordillera Health District (Santa Cruz Department, Bolivia) from October 1988 to April 1989 to determine the seroprevalence of measles antibodies and the seroconversion rates among a group of previously unvaccinated children (9-36 months of age) from the urban and rural area of the province, before and after immunization with a standard dose of Schwarz measles vaccine. Among 265 previously unvaccinated children, 77 (29%) had measles IgG antibodies prior to immunization; 141 out of 147 (96%) seronegative children at the time of vaccination seroconverted. No difference in seroprevalence and in seroconversion rates was found between the urban and rural groups.
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Anticuerpos Antivirales/sangre , Inmunoglobulina G/sangre , Vacuna Antisarampión , Virus del Sarampión/inmunología , Sarampión/epidemiología , Sarampión/prevención & control , Vigilancia de la Población , Vacunación , Factores de Edad , Bolivia/epidemiología , Preescolar , Humanos , Lactante , Sarampión/sangre , Prevalencia , Evaluación de Programas y Proyectos de Salud , Población Rural , Estudios Seroepidemiológicos , Población UrbanaRESUMEN
The relative efficacy of a single 400 mg dose of albendazole or mebendazole in the treatment of nematode infections was assessed in 2- to 9-year-old children living in two different Bolivian rural communities. Both agents were equally very effective (100% cure rate) in treating ascariasis. Albendazole was clearly more active than mebendazole against hookworm infections, both in terms of egg reduction rate (92.8% vs. 62.4%) and cure rate (81.8% vs. 17.2%). As far as trichuriasis is concerned, albendazole produced a higher egg reduction rate than mebendazole (45.7% vs 15%), but a lower cure rate (33.3% vs 60%). Both drugs were well tolerated.
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Albendazol/administración & dosificación , Ascariasis/tratamiento farmacológico , Ascaris lumbricoides , Infecciones por Uncinaria/tratamiento farmacológico , Mebendazol/administración & dosificación , Tricuriasis/tratamiento farmacológico , Factores de Edad , Albendazol/uso terapéutico , Análisis de Varianza , Animales , Ascariasis/complicaciones , Ascariasis/epidemiología , Ascariasis/parasitología , Bolivia/epidemiología , Niño , Preescolar , Heces/parasitología , Infecciones por Uncinaria/complicaciones , Infecciones por Uncinaria/epidemiología , Infecciones por Uncinaria/parasitología , Humanos , Mebendazol/uso terapéutico , Recuento de Huevos de Parásitos , Prevalencia , Población Rural , Resultado del Tratamiento , Tricuriasis/complicaciones , Tricuriasis/epidemiología , Tricuriasis/parasitologíaRESUMEN
Staphylococcal strains obtained from cutaneous swabs of hospital staff and school students of Camiri and Boyuibe and healthy people living in Javillo, Bolivia, were tested for their in-vitro antimicrobial susceptibility. The highest percentages of resistance to the antibiotics tested were found in staphylococcal strains isolated from hospital personnel. All the S. aureus strains from these subjects were resistant to penicillin. Coagulase-negative staphylococci from hospital personnel evidenced a high rate of multiresistant strains, mainly to penicillin, ampicillin, tetracycline, and chloramphenicol. The staphylococcal strains isolated in the rural population of Javillo were highly susceptible to all the antibiotics tested.
Asunto(s)
Antibacterianos/farmacología , Infecciones Estafilocócicas/microbiología , Staphylococcus/efectos de los fármacos , Bolivia , Humanos , Pruebas de Sensibilidad Microbiana , Población Rural , Staphylococcus aureus/efectos de los fármacos , Staphylococcus epidermidis/efectos de los fármacos , Población UrbanaRESUMEN
The in vitro antimicrobial susceptibility of staphylococci isolated in two different communities, Camiri and Javillo, of the Santa Cruz region in south-eastern Bolivia was tested by the agar diffusion technique and by a micro dilution susceptibility test to determine the Minimum Inhibitory Concentrations. Staphylococcal strains isolated from hospital staff of the Camiri Hospital were compared to that isolated from healthy people of Javillo, a very small community isolated in the jungle. In the Camiri Hospital, staphylococci showed a high prevalence of penicillin resistance, 100% for S. aureus strains and 73.5% for coagulase-negative staphylococci. Among coagulase-negative strains we found a high rate of multiresistant strains, mainly to ampicillin, tetracycline and chloramphenicol. In the rural population of Javillo we found staphylococcal strains highly susceptible to all the antibiotics tested.