RESUMEN
El estudio tuvo por finalidad explicar de qué manera se correlaciona la ejecución de gasto público y la fuente de financiamiento de la Dirección de Red de Salud Yunguyo del periodo 2013 al 2023, Perú. Se optó por un diseño metodológico no experimental, longitudinal, cuantitativo y contraste Rho de Spearman. Los resultados identificaron que la ejecución de gasto público se correlaciona significativa y positivamente con la fuente de financiamiento por recursos ordinarios [rho (11) =0.77; p < 0.001], con la fuente de financiamiento por recursos directamente recaudados [rho (11) =0.83; p < 0.001] y, con la fuente de financiamiento por recursos determinados [rho (11) =0.74; p < 0.001]. Se concluye que, ejecutar eficazmente las intervenciones priorizadas por la Dirección de Red de Salud Yunguyo están ligadas a los lineamientos del Presupuesto Público y normatividad del sector con transparencia.
The purpose of the study was to explain how the execution of public spending and the source of financing of the Yunguyo Health Network Directorate are correlated from the period 2013 to 2023, Peru. A non-experimental, longitudinal, quantitative methodological design and Spearman's Rho contrast was chosen. The results identified that the execution of public spending is significantly and positively correlated with the source of financing through ordinary resources [rho (11) =0.77; p < 0.001], with the source of financing being directly raised resources [rho (11) =0.83; p < 0.001], and with the source of financing for determined resources [rho (11) =0.74; p < 0.001]. It is concluded that, effectively executing the interventions prioritized by the Yunguyo Health Network Directorate are linked to the guidelines of the Public Budget and regulations of the sector with transparency
O objetivo do estudo foi explicar como a execução dos gastos públicos e a fonte de financiamento da Diretoria da Rede de Saúde Yunguyo estão correlacionadas no período de 2013 a 2023, Peru. Optou-se por um desenho metodológico não experimental, longitudinal, quantitativo e contraste Rho de Spearman. Os resultados identificaram que a execução dos gastos públicos está significativa e positivamente correlacionada com a fonte de financiamento através de recursos ordinários [rho (11) =0,77; p < 0,001], sendo a fonte de financiamento recursos captados diretamente [rho (11) =0,83; p < 0,001], e com a fonte de financiamento de determinados recursos [rho (11) =0,74; p < 0,001]. Conclui-se que a execução eficaz das intervenções priorizadas pela Direção da Rede de Saúde Yunguyo está vinculada às diretrizes do Orçamento Público e à regulamentação do setor com transparência
Asunto(s)
Recursos en SaludRESUMEN
El estudio tuvo por finalidad explicar de qué manera se correlaciona la ejecución de gasto público y la fuente de financiamiento de la Dirección de Red de Salud Yunguyo del periodo 2013 al 2023, Perú. Se optó por un diseño metodológico no experimental, longitudinal, cuantitativo y contraste Rho de Spearman. Los resultados identificaron que la ejecución de gasto público se correlaciona significativa y positivamente con la fuente de financiamiento por recursos ordinarios [rho (11)=0.77; p < 0,001], con la fuente de financiamiento por recursos directamente recaudados [rho (11)=0.83; p < 0,001] y, con la fuente de financiamiento por recursos determinados [rho (11)=0.74; p < 0,001]. Se concluye que, ejecutar eficazmente las intervenciones priorizadas por la Dirección de Red de Salud Yunguyo están ligadas a los lineamientos del Presupuesto Público y normatividad del sector con transparencia.
The purpose of the study was to explain how the execution of public spending and the source of financing of the Yunguyo Health Network Directorate are correlated from the period 2013 to 2023, Peru. A non-experimental, longitudinal, quantitative methodological design and Spearman's Rho contrast was chosen. The results identified that the execution of public spending is significantly and positively correlated with the source of financing through ordinary resources [rho (11) =0.77; p < 0.001], with the source of financing being directly raised resources [rho (11) =0.83; p < 0.001], and with the source of financing for determined resources [rho (11) =0.74; p < 0.001]. It is concluded that, effectively executing the interventions prioritized by the Yunguyo Health Network Directorate are linked to the guidelines of the Public Budget and regulations of the sector with transparency.
O objetivo do estudo foi explicar como a execução dos gastos públicos e a fonte de financiamento da Diretoria da Rede de Saúde Yunguyo estão correlacionadas no período de 2013 a 2023, Peru. Optou-se por um desenho metodológico não experimental, longitudinal, quantitativo e contraste Rho de Spearman. Os resultados identificaram que a execução dos gastos públicos está significativa e positivamente correlacionada com a fonte de financiamento através de recursos ordinários [rho (11) =0,77; p < 0,001], sendo a fonte de financiamento recursos captados diretamente [rho (11) =0,83; p < 0,001], e com a fonte de financiamento de determinados recursos [rho (11) =0,74; p < 0,001]. Conclui-se que a execução eficaz das intervenções priorizadas pela Direção da Rede de Saúde Yunguyo está vinculada às diretrizes do Orçamento Público e à regulamentação do setor com transparência.
RESUMEN
Brucellosis has been an endemic disease of cattle and humans in Costa Rica since the beginning of XX century. However, brucellosis in sheep, goats, pigs, water buffaloes, horses and cetaceans, has not been reported in the country. We have performed a brucellosis survey in these host mammal species, from 1999-2016. In addition, we have documented the number of human brucellosis reported cases, from 2003-2016. The brucellosis seroprevalence in goat and sheep herds was 0.98% and 0.7% respectively, with no Brucella isolation. Antibodies against Brucella were not detected in feral or domestic pigs. Likewise, brucellosis seroprevalence in horse and water buffalo farms was estimated in 6.5% and 21.7%, respectively, with no Brucella isolation. Six cetacean species showed positive reactions against Brucella antigens, and B. ceti was isolated in 70% (n = 29) of striped dolphins (Stenella coeruleoalba). A steady increase in the diagnosis of human brucellosis cases was observed. Taking into account the prevalence of brucellosis in the various host mammals of Costa Rica, different measures are recommended.
Asunto(s)
Brucelosis/veterinaria , Adolescente , Adulto , Anciano , Animales , Brucelosis/epidemiología , Búfalos/microbiología , Niño , Costa Rica/epidemiología , Delfines/microbiología , Femenino , Enfermedades de las Cabras/epidemiología , Enfermedades de las Cabras/microbiología , Cabras/microbiología , Enfermedades de los Caballos/epidemiología , Enfermedades de los Caballos/microbiología , Caballos , Humanos , Masculino , Persona de Mediana Edad , Estudios Seroepidemiológicos , Ovinos/microbiología , Enfermedades de las Ovejas/epidemiología , Enfermedades de las Ovejas/microbiología , Porcinos , Enfermedades de los Porcinos/epidemiología , Enfermedades de los Porcinos/microbiología , Adulto JovenRESUMEN
Brucellosis, caused by Brucella abortus is a major disease of cattle and a zoonosis. In order to estimate the bovine brucellosis prevalence in Costa Rica (CR), a total 765 herds (13078 bovines) from six regions of CR were randomly sampled during 2012-2013. A non-random sample of 7907 herds (532199 bovines) of the six regions, arriving for diagnoses during 2014-2016 to the Costa Rican Animal Health Service was also studied. The prevalence estimated by Rose Bengal test (RBT) ranged from 10.5%-11.4%; alternatively, the prevalence estimated by testing the RBT positives in iELISA, ranged from 4.1%-6.0%, respectively. However, cattle in CR are not vaccinated with B. abortus S19 but with RB51 (vaccination coverage close to 11%), and under these conditions the RBT displays 99% specificity and 99% sensitivity. Therefore, the RBT herd depicted in the random analysis stands as a feasible assessment and then, the recommended value in case of planning an eradication program in CR. Studies of three decades reveled that bovine brucellosis prevalence has increased in CR. B. abortus was identified by biochemical and molecular studies as the etiological agent of bovine brucellosis. Multiple locus variable-number tandem repeat analysis-16 revealed four B. abortus clusters. Cluster one and three are intertwined with isolates from other countries, while clusters two and four have only representatives from CR. Cluster one is widely distributed in all regions of the country and may be the primary B. abortus source. The other clusters seem to be restricted to specific areas in CR. The implications of our findings, in relation to the control of the disease in CR, are critically discussed.
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Brucelosis Bovina/epidemiología , Animales , Brucella abortus/genética , Brucella abortus/aislamiento & purificación , Brucelosis Bovina/microbiología , Bovinos , Costa Rica/epidemiología , Femenino , Tipificación Molecular , PrevalenciaRESUMEN
INTRODUCTION: In order to address the mental health problems of the Colombian population it is necessary to have diagnostic tools (local and international) that are valid, easy to apply, and comparable. OBJECTIVE: To compare the sensitivity and specificity between the CIDI 3.0 and the SCID-I for major depressive disorder, bipolar I and II disorder, and substance dependence disorder. METHODOLOGY: Cross-sectional study comparing the life prevalence of three mental disorders in 100 subjects using the CIDI 3.0 and the SCID-I. The study was approved by the Institutional Ethics Committee. The two diagnostic interviews were performed that measured by sensitivity, specificity, positive predictive value and negative predictive value with confidence intervals of 95%. The SPSS version 21.0 software was used for data analysis. RESULTS: The median age was 43.5 years, with an interquartile interval of 30 years. The highest sensitivity (Se) and specificity (Sp) was observed for drug dependence diagnosis - with 80%, (95%CI, 34.94-100), and 98.46 (95%CI, 94.7-100), respectively. CONCLUSIONS: SCID-I and CIDI 3.0 showed different levels of sensitivity and specificity for the three disorders studied with: high for substance dependence disorder, moderate for bipolar disorder I and II, and low for major depressive disorder.
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Trastorno Bipolar/epidemiología , Trastorno Depresivo Mayor/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Anciano , Trastorno Bipolar/diagnóstico , Colombia/epidemiología , Estudios Transversales , Trastorno Depresivo Mayor/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Sensibilidad y Especificidad , Trastornos Relacionados con Sustancias/diagnóstico , Adulto JovenRESUMEN
Introducción: El abordaje de los problemas de salud mental de la población colombiana hace necesario disponer de instrumentos diagnósticos válidos, fáciles de aplicar y comparables (local e internacionalmente). Objetivo: Comparar la sensibilidad y la especificidad diagnóstica entre el CIDI 3.0 y el SCID-! para el trastorno depresivo mayor, el trastorno afectivo bipolar I y II y el trastorno por dependencia de sustancias. Metodología: Estudio transversal que comparó en 100 sujetos las prevalencias de vida de tres trastornos mentales por medio del CIDI 3.0 y el SCID-I. La investigación fue aprobada por el Comité de Ética Institucional. Se midieron la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo (con sus respectivos intervalos de confianza del 95%) de las dos entrevistas diagnósticas. Para el análisis de la información se utilizó el software SPSS® versión 21.0. Resultados: La mediana de edad fue 43,5 [intervalo intercuartílico, 30] anos. La sensibilidad (Se) y la especificidad (Es) más altas se observaron en el diagnóstico de trastorno por dependencia de drogas -Se, 80% (IC95%, 34,94%-100%); Es, 98,46% (IC95%, 94,7%-100%)-. Conclusiones: El SCID-I y el CIDI 3.0 mostraron diferentes niveles de sensibilidad y especificidad para los tres trastornos estudiados así: altas para el trastorno por dependencia de sustancias, moderadas para el trastorno afectivo bipolar I y II y bajas para el trastorno depresivo mayor.
Introduction: In order to address the mental health problems of the Colombian population it is necessary to have diagnostic tools (local and international) that are valid, easy to apply, and comparable. Objective: To compare the sensitivity and specificity between the CIDI 3.0 and the SCID-I for major depressive disorder, bipolar I and II disorder, and substance dependence disorder. Methodology: Cross-sectional study comparing the life prevalence of three mental disorders in 100 subjects using the CIDI 3.0 and the SCID-I. The study was approved by the Institutional Ethics Committee. The two diagnostic interviews were performed that measured by sensitivity, specificity, positive predictive value and negative predictive value with confidence intervals of 95%. The SPSS version 21.0 software was used for data analysis. Results: The median age was 43.5 years, with an interquartile interval of 30 years. The highest sensitivity (Se) and specificity (Sp) was observed for drug dependence diagnosis - with 80%, (95%CI, 34.94-100), and 98.46 (95%CI, 94.7-100), respectively. Conclusions: SCID-I and CIDI 3.0 showed different levels of sensitivity and specificity for the three disorders studied with: high for substance dependence disorder, moderate for bipolar disorder I and II, and low for major depressive disorder.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Programas Informáticos , Salud Mental , Encuestas Epidemiológicas , Trastornos Mentales , Investigación , Trastorno Bipolar , Estudios Transversales , Valor Predictivo de las Pruebas , Encuestas y Cuestionarios , Comités de Ética , Trastornos Relacionados con Sustancias , Trastorno Depresivo Mayor , Análisis de DatosRESUMEN
OBJECTIVE: Monogenic congenital cataract is one of the most genetically heterogeneous ocular conditions with almost 30 different genes involved in its etiology. In adult patients, genotype-phenotype correlations are troubled by eye surgery during infancy and/or long-term ocular complications. Here, we describe the molecular diagnosis of GALK1 deficiency as the cause of autosomal recessive congenital cataract in a family from Costa Rica. METHODS: Four affected siblings were included in the study. All of them underwent eye surgery during the first decade but medical records were not available. Congenital cataract was diagnosed by report. Molecular analysis included genome wide homozygosity mapping using a 250K SNP Affymetrix microarray followed by PCR amplification and direct nucleotide sequencing of candidate gene. RESULTS: Genome wide homozygosity mapping revealed a 6Mb region of homozygosity shared by two affected siblings at 17q25. The GALK1 gene was included in this interval and direct sequencing of this gene revealed a homozygous c.1144C>T mutation (p.Q382) in all four affected subjects. CONCLUSIONS: This work demonstrates the utility of homozygosity mapping in the retrospective diagnosis of a family with congenital cataracts in which ocular surgery at early age, the lack of medical records, and the presence of long term eye complications, impeded a clear clinical diagnosis during the initial phases of evaluation.
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Catarata/congénito , Catarata/genética , Galactoquinasa/genética , Genes Recesivos , Mutación , Anciano , Mapeo Cromosómico/métodos , Análisis Mutacional de ADN/métodos , Ojo , Femenino , Galactoquinasa/deficiencia , Ligamiento Genético/genética , Estudio de Asociación del Genoma Completo/métodos , Homocigoto , Humanos , Masculino , Persona de Mediana Edad , Patología Molecular/métodos , Linaje , Estudios Retrospectivos , HermanosRESUMEN
The etiological treatment of Chagas disease is recommended for all patients with acute or recent chronic infection, but controversies remain regarding the benefit of chemotherapy and interpretations of the parasitological cure after etiological treatment. This study compares the laboratory and clinical evaluations of Chagas disease patients who were diagnosed 13 years earlier. Fifty-eight Chagas disease patients (29 treated with benznidazole and 29 untreated) were matched at the time of treatment based on several variables. Conventional serology revealed the absence of seroconversion in all patients. However, lower serological titres were verified in the treated group, primarily among patients who had the indeterminate form of the disease. Haemoculture performed 13 years after the intervention was positive for 6.9% and 27.6% of the treated and untreated patients, respectively. Polymerase chain reaction tests were positive for 44.8% and 13.8% of the treated and untreated patients, respectively. Patients who presented with the indeterminate form of the disease at the beginning of the study exhibited less clinical progression (17.4%) compared with the untreated group (56.5%). Therefore, this global analysis revealed that etiological treatment with benznidazole may benefit patients with respect to the clinical progression of Chagas disease and the prognosis, particularly when administered to patients with the indeterminate form of the disease.
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Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Adulto Joven , Enfermedad de Chagas/tratamiento farmacológico , Nitroimidazoles/uso terapéutico , Tripanocidas/uso terapéutico , Trypanosoma cruzi/inmunología , Estudios de Casos y Controles , Enfermedad de Chagas/parasitología , Progresión de la Enfermedad , Reacción en Cadena de la Polimerasa , Pronóstico , Estudios RetrospectivosRESUMEN
The etiological treatment of Chagas disease is recommended for all patients with acute or recent chronic infection, but controversies remain regarding the benefit of chemotherapy and interpretations of the parasitological cure after etiological treatment. This study compares the laboratory and clinical evaluations of Chagas disease patients who were diagnosed 13 years earlier. Fifty-eight Chagas disease patients (29 treated with benznidazole and 29 untreated) were matched at the time of treatment based on several variables. Conventional serology revealed the absence of seroconversion in all patients. However, lower serological titres were verified in the treated group, primarily among patients who had the indeterminate form of the disease. Haemoculture performed 13 years after the intervention was positive for 6.9% and 27.6% of the treated and untreated patients, respectively. Polymerase chain reaction tests were positive for 44.8% and 13.8% of the treated and untreated patients, respectively. Patients who presented with the indeterminate form of the disease at the beginning of the study exhibited less clinical progression (17.4%) compared with the untreated group (56.5%). Therefore, this global analysis revealed that etiological treatment with benznidazole may benefit patients with respect to the clinical progression of Chagas disease and the prognosis, particularly when administered to patients with the indeterminate form of the disease.
Asunto(s)
Enfermedad de Chagas/tratamiento farmacológico , Nitroimidazoles/uso terapéutico , Tripanocidas/uso terapéutico , Trypanosoma cruzi/inmunología , Adolescente , Adulto , Estudios de Casos y Controles , Enfermedad de Chagas/parasitología , Niño , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Reacción en Cadena de la Polimerasa , Pronóstico , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJETIVO. Descrever as características epidemiológicas da malária e seus principais determinantes no Município de Cruzeiro do Sul, no Estado do Acre, Brasil, entre 1998 e 2008 MÉTODOS. Este estudo descritivo, retrospectivo, utilizou dados secundários disponíveis nos sistemas de informação em malária desenvolvidos pelo Ministério da Saúde do Brasil (SISMAL/SIVEP-Malária). Os dados foram analisados no software TABLEAU®. Dados geo-espaciais foram obtidos para avaliar a distribuição dos casos de malária. RESULTADOS: A incidência parasitária anual (IPA) de 27 casos/1-000 habitantes em 1998 chegou a 571,5 casos/1-000 habitantes em 2006, quando a cidade registrou sua maior epidemia, subsequente ao estabelecimento de um programa estadual de incentivo à perfuração de tanques para piscicultura, em 2005. As localidades rurais apresentaram maior número de casos. Entretanto, as localidades periurbanas que possuíam tanques de piscicultura tiveram IPAs mais elevadas do que áreas sem tanques. Após a intensificação das ações do Programa Nacional de Controle da Malária, a IPA diminuiu para 152,9 casos/1-000 habitantes em 2008. CONCLUSÕES. O incentivo a atividades econômicas em áreas periurbanas de transmissão instável de malária, típicas da América Latina, deve ser muito bem planejado. O controle da malária em Cruzeiro do Sul baseou-se em estratégias integradas implementadas simultaneamente pelos governos federal, estadual e municipal, como preconizado pelo Plano Nacional de Controle da Malária. É importante ressaltar a utilidade de um bom sistema de informação como o SIVEP-Malária para estimar a carga de doença e monitorar de forma eficiente o impacto das intervenções.
OBJECTIVE: To describe the epidemiological characteristics of malaria and its main determinants in the municipality of Cruzeiro do Sul, State of Acre, Brazil, between 1998 and 2008. METHODS: This descriptive, retrospective study was carried out with secondary data available from the malaria information systems developed by the Brazilian Ministry of Health (SISMAL/SIVEP-Malária). The data were analyzed using the TABLEAU® software. Geospatial data were obtained to assess the distribution of malaria cases. RESULTS: The annual parasite incidence (API) of 27 cases/1 000 population in 1998 reached 571.5 cases/1 000 population in 2006, the year in which the city recorded its largest epidemics, following the establishment of a state program that encouraged the digging of tanks for fish farming in 2005. Rural sites had the highest number of cases. However, peri-urban locations with fish tanks had higher APIs than peri-urban areas without tanks. Following the strengthening of control actions by the National Malaria Control Program, the API in Cruzeiro do Sul dropped to 152.9 cases/1 000 population in 2008. CONCLUSIONS: The type of economic activity fostered in peri-urban areas characterized by unstable malaria transmission, which are typical of Latin America, must be very well planned. Malaria control in Cruzeiro do Sul relied on integrated strategies implemented simultaneously by federal, state, and city governments, as recommended by the National Malaria Control Program. It is important to underscore the usefulness of a reliable information system such as SIVEP-Malária to estimate the burden of disease and efficiently monitor the impact of interventions.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Malaria/epidemiología , Brasil/epidemiología , Estudios Retrospectivos , Factores de TiempoRESUMEN
OBJECTIVE: To describe the epidemiological characteristics of malaria and its main determinants in the municipality of Cruzeiro do Sul, State of Acre, Brazil, between 1998 and 2008. METHODS: This descriptive, retrospective study was carried out with secondary data available from the malaria information systems developed by the Brazilian Ministry of Health (SISMAL/SIVEP-Malária). The data were analyzed using the TABLEAU® software. Geospatial data were obtained to assess the distribution of malaria cases. RESULTS: The annual parasite incidence (API) of 27 cases/1,000 population in 1998 reached 571.5 cases/1,000 population in 2006, the year in which the city recorded its largest epidemics, following the establishment of a state program that encouraged the digging of tanks for fish farming in 2005. Rural sites had the highest number of cases. However, peri-urban locations with fish tanks had higher APIs than peri-urban areas without tanks. Following the strengthening of control actions by the National Malaria Control Program, the API in Cruzeiro do Sul dropped to 152.9 cases/1,000 population in 2008. CONCLUSIONS: The type of economic activity fostered in peri-urban areas characterized by unstable malaria transmission, which are typical of Latin America, must be very well planned. Malaria control in Cruzeiro do Sul relied on integrated strategies implemented simultaneously by federal, state, and city governments, as recommended by the National Malaria Control Program. It is important to underscore the usefulness of a reliable information system such as SIVEP-Malária to estimate the burden of disease and efficiently monitor the impact of interventions.
Asunto(s)
Malaria/epidemiología , Adolescente , Brasil/epidemiología , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios Retrospectivos , Factores de TiempoRESUMEN
Twenty-eight Chagas disease patients (CD), 22 with the indeterminate clinical form (IND) and six with the cardiac or digestive form (CARD/DIG), were treated with benznidazole and underwent clinical and laboratorial analysis before (IND and CARD/DIG) and nine years after [patients after treatment (CDt), patients with the indeterminate clinical form at treatment onset (INDt) and with the cardiac or digestive form at treatment onset (CARD/DIGt)] treatment. The data demonstrate that 82.1 percent of CDt patients (23/28) remained clinically stable and 95.4 percent of the INDt (21/22) and 33.3 percent of the CARD/DIGt (2/6) patients showed unaltered physical and laboratorial examinations. The clinical evolution rate was 2 percent/year and was especially low in INDt patients (0.5 percent/year) relative to CARD/DIGt patients (7.4 percent/year). Positive haemoculture in treated patients was observed in 7.1 percent of the cases. None of the INDt (0/21) and 33.3 percent of the CARD/DIGt (2/6) patients displayed positive cultures. The PCR presented a positive rate significantly higher (85.2 percent, 23/27) than haemoculture and two samples from the same patient revealed the same result 57.7 percent of the patients. Conventional serology-ELISA on 16 paired samples remained positive in all individuals. Semi-quantitative ELISA highlighted significant decreases in reactivity, particularly in INDt relative to IND. Non-conventional serology-FC-ALTA-IgG, after treatment, showed positive results in all sera and 22 paired samples examined at seven and nine years after treatment, demonstrated significantly lower reactivity, particularly in INDt patients. This study was retrospective in nature, had a low number of samples and lacked an intrinsic control group, but the data corroborate other results found in the literature. The data also demonstrate that, even though a cure has not been detected in the none-treated patients, the benefits for clinical evolution ...
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Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Adulto Joven , Enfermedad de Chagas/tratamiento farmacológico , Nitroimidazoles/uso terapéutico , Tripanocidas/uso terapéutico , Trypanosoma cruzi/inmunología , Anticuerpos Antiprotozoarios/sangre , Brasil , Enfermedad Crónica , Cardiomiopatía Chagásica/tratamiento farmacológico , Cardiomiopatía Chagásica/inmunología , Enfermedad de Chagas/inmunología , Ensayo de Inmunoadsorción Enzimática , Inmunoglobulina G/inmunología , Resultado del Tratamiento , Adulto JovenRESUMEN
Twenty-eight Chagas disease patients (CD), 22 with the indeterminate clinical form (IND) and six with the cardiac or digestive form (CARD/DIG), were treated with benznidazole and underwent clinical and laboratorial analysis before (IND and CARD/DIG) and nine years after [patients after treatment (CDt), patients with the indeterminate clinical form at treatment onset (INDt) and with the cardiac or digestive form at treatment onset (CARD/DIGt)] treatment. The data demonstrate that 82.1% of CDt patients (23/28) remained clinically stable and 95.4% of the INDt (21/22) and 33.3% of the CARD/DIGt (2/6) patients showed unaltered physical and laboratorial examinations. The clinical evolution rate was 2%/year and was especially low in INDt patients (0.5%/year) relative to CARD/DIGt patients (7.4%/year). Positive haemoculture in treated patients was observed in 7.1% of the cases. None of the INDt (0/21) and 33.3% of the CARD/DIGt (2/6) patients displayed positive cultures. The PCR presented a positive rate significantly higher (85.2%, 23/27) than haemoculture and two samples from the same patient revealed the same result 57.7% of the patients. Conventional serology-ELISA on 16 paired samples remained positive in all individuals. Semi-quantitative ELISA highlighted significant decreases in reactivity, particularly in INDt relative to IND. Non-conventional serology-FC-ALTA-IgG, after treatment, showed positive results in all sera and 22 paired samples examined at seven and nine years after treatment, demonstrated significantly lower reactivity, particularly in INDt patients. This study was retrospective in nature, had a low number of samples and lacked an intrinsic control group, but the data corroborate other results found in the literature. The data also demonstrate that, even though a cure has not been detected in the none-treated patients, the benefits for clinical evolution were selectively observed in the group of INDt patients and did not occur for CARD/DIGt patients.
Asunto(s)
Enfermedad de Chagas/tratamiento farmacológico , Nitroimidazoles/uso terapéutico , Tripanocidas/uso terapéutico , Trypanosoma cruzi/inmunología , Adolescente , Adulto , Anticuerpos Antiprotozoarios/sangre , Brasil , Cardiomiopatía Chagásica/tratamiento farmacológico , Cardiomiopatía Chagásica/inmunología , Enfermedad de Chagas/inmunología , Niño , Enfermedad Crónica , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunoglobulina G/inmunología , Masculino , Resultado del Tratamiento , Adulto JovenRESUMEN
The need in resolving massive bone losses in hip region caused by tumors, infections, trauma or failed arthroplasties in 17 years of the Bone Tumors Department of the National Rehabilitation Institute, Mexico City, and data obtained from different studies: 1) Biomechanic study of an unconventional hip arthroplasty system, 2) Tridimensional model of a human femur by the finite element method, 3) Biomechanical analysis of a system bone-implant for reconstruction of the proximal third of the femur by the finite element method, 4) Incidence of tumor and pseudotumor bone and soft tissue lesions of the hip, generated the project of designing an unconventional interlocked hip arthroplasty system for femur reconstruction. Two processes were done for adequate manufacturing and dimensioning: Anthropomorphometric study of Mexican femora; 2) Design of an unconventional hip arthroplasty system with the following characteristics: first, the arthroplasty system is constituted by an intramedullar stem, is fixated to femur with interlocking screws, this fixation method was inspired from the design of intramedullar nails of Dr. Fernando Colchero Rosas. The system has a second fixation system in the femur cut region, resolved by a fenestrated support introduced in the cortical wall. Once data was processed, the need for manufacturing 2 models was determined: 1) One for the proximal 11 cm of the femur and 2) other for the 12 distal cm. The height of interlocking screws, 2 models of intracortical proximal support (one fixated and one fixable with an expansible screw), were designed. Diameter, length of the stems, size of spacers and supports were determined for adequate interlocking fixation. We designed the instruments for assembling, impaction and orientation of the arthroplasty system. The system was presented to the Mexican Institute of Industrial Property, at March 15, 1996 and the patent was conceded April 19, 2007 (#245717).
Asunto(s)
Fémur/anatomía & histología , Prótesis de Cadera , Antropometría , Humanos , México , Diseño de PrótesisRESUMEN
A prevalência da infecção pelo Trypanosoma cruzi foi avaliada no município de Berilo, Minas Gerais, Brasil, no período de janeiro a julho de 1997. Uma amostra de 2.261 indivíduos foi estudada sorologicamente mediante o teste de imunofluorescência indireta em sangue coletado em papel de filtro. A taxa de prevalência foi de 18 por cento no total da população estudada e 50 por cento em pessoas da área rural maiores de 30 anos. A percentagem de soropositividade foi 0,17 por cento entre os menores de 10 anos estudados, o que sugere que a transmissão vetorial está controlada na área. Observamos uma diminuição na taxa de soroprevalência entre as pessoas nascidas após 1960 e 1970 o que teria relação com o início das ações de controle. Observou-se também uma redução na taxa de infecção pelo T. cruzi quando comparamos os nossos achados com as estimativas de infecção registradas em um estudo sorológico realizado em Berilo em 1983.
Asunto(s)
Animales , Preescolar , Adolescente , Humanos , Masculino , Femenino , Recién Nacido , Niño , Adulto , Persona de Mediana Edad , Enfermedad de Chagas , Distribución por Edad , Anticuerpos Antiprotozoarios , Brasil , Enfermedad de Chagas , Ensayo de Inmunoadsorción Enzimática , Técnica del Anticuerpo Fluorescente Indirecta , Prevalencia , Población Rural , Estudios Seroepidemiológicos , Trypanosoma cruzi , Población UrbanaRESUMEN
The prevalence of Trypanosoma cruzi infection was evaluated in Berilo, Minas Gerais (MG), Brazil, from January to July 1997. A serological survey using the indirect immunofluorescence test (IFT) in dried blood collected on filter-paper was performed in a sample of 2,261 individuals. The overall prevalence rate of T. cruzi infection was 18%, and reached 50% in individuals older than 30 years from rural areas. The percentage of seropositivity was 0.17% among individuals younger than 10 years old, suggesting that vectorial transmission is controlled in the area. A decrease in prevalence rates among people born after 1960 and 1970 was observed and this appears to be correlated with the beginning of control programs. A reduction in T. cruzi infection rates was observed when comparing our results with the rates estimated in a serologic study carried out in Berilo in 1983.
Asunto(s)
Enfermedad de Chagas/epidemiología , Adolescente , Adulto , Distribución por Edad , Animales , Anticuerpos Antiprotozoarios/sangre , Brasil/epidemiología , Enfermedad de Chagas/transmisión , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Femenino , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Prevalencia , Población Rural , Estudios Seroepidemiológicos , Trypanosoma cruzi/inmunología , Población UrbanaRESUMEN
Introducción: en Colombia se estima que existen 1.200.000 personas infectadas con T. cruzi. Los estudios publicados sobre cardiomiopatía chagásica en Colombia han sido usualmente descritos en hospitales de tercer nivel. Objetivo: caracterizar desde el punto de vista clínico y electrocardiográfico la cardiomiopatía chagásica crónica en centros de atención primaria en un área endémica. Diseño del estudio: estudio descriptivo, seccional de morbilidad en población chagásica y no chagásica no seleccionadas. Lugar del estudio: municipios de San Eduardo, Zetaquira y Campohermoso, Boyacá. Pacientes: 405 individuos. Mediciones: se consideraron: edad, sexo, escolaridad, antecedentes, síntomas y signos físicos y hallazgos electrocardiográfícos. Se practicaron serologías por test de ELISA e IFI. Se estableció como seropositivo aquel paciente con positividad en las dos pruebas y seronegativo aquél con resultado negativo en las dos técnicas. Análisis estadístico: se calcularon promedios y proporciones de las distintas variables para los dos grupos de acuerdo con el nivel de medición y se establecieron las diferencias de proporciones entre ellos, tomando un nivel de significación del 0.5 por ciento. Resultados: 405 individuos, 205 seropositivos y 200 seronegativos (control). Edad promedio 45 años, 58 por ciento del sexo femenino para ambos grupos. El 80 por ciento del total de los dos grupos no alcanzó un nivel de escolaridad mayor al de primaria completa. Los hallazgos significativos a favor del grupo de seropositivos fueron: contacto con triatominios (p.-O.OOOl), Chagas en hermanos (p :0.01), muerte súbita en hermanos (p:0.04), sensación de palpitaciones (p:0.05), presíncope (p:0.005), angina (p:0.03), insuficiencia mitral (p:0.004), bloqueo de rama derecha (p:0.01), bloqueo bifascicular (p :0.007) y trastornos de la repolarización (p;0.008). Conclusiones: los hallazgos observados en el grupo de pacientes seropositivos con diagnóstico de cardiomiopatía de Chagas, corresponden a estadios clínicos I y II de la enfermedad. La edad media, el predominio en el sexo femenino, el pobre nivel de escolaridad, los antecedentes personales y familiares, son de resaltar por su impacto socio-económico
Asunto(s)
Enfermedad de Chagas , Electrocardiografía/métodos , Electrocardiografía , MorbilidadRESUMEN
Entre noviembre de 1999 y abril de 2000 se presentó una epidemia de malaria en el departamento de La Guajira que alcanzó, 5.687 casos, 3.401 causados por Plasmodium falciparum, 2.256 por Plasmodium vivax y 30 casos diagnosticados como infección mixta. Dadas las características propias del departamento de La Guajira y de la transmisión de malaria allí, se consideró que existian las condiciones favorables para usar una prueba rápida de diagnóstico de campo. En este estudio se evaluó y comparó el diagnóstico por inmunocromatografía rápida con la gota gruesa como estándar de oro en los municipios de Dibulla, Manaure y Riohacha. La conducta con el paciente se basó en el resultado de la prueba rápida. Sin embargo, los resultados obtenidos en la gota gruesa se tuvieron en cuenta para modificar la conducta inicial con el paciente, en caso de que los resultados de las pruebas fueran discordantes. Se procesaron 231 muestras sanguíneas obtenidas por punción capilar. La sensibilidad y la especificidad generales del método inmunocromatográfico fueron de 98.7 por ciento y 99,3 por ciento, respectivamente, en tanto que para P. falciparum fueron de 98,1 por ciento y 76,9 por ciento, y para P. vivax de 90,9 por ciento y 100 por ciento. El índice de concordancia fue 0.98; el valor predictivo positivo, 98,7 por ciento, y el valor predictivo negativo, 99,3 por ciento. Los resultados obtenidos sugieren que la prueba inmunocromatográfica (OptiMal) es una alternativa adecuada para realizar el diagnóstico de malaria en lugares donde no se realiza el diagnóstico microscópico