RESUMEN
BACKGROUND: Recent trends in prostate biopsy analgesia suggest a combination anesthetic to provide better pain relief than periprostatic nerve block (PPNB) alone. This study aimed to demonstrate the efficacy and safety of three intrarectal local anesthesia (IRLA) combined with PPNB in patients undergoing transrectal ultrasonography (TRUS)-guided prostate biopsy. METHODS: In this prospective, randomized study, 120 prostate biopsy patients were equally divided into four IRLA groups: group 1 (placebo) received simple lubrication; group 2 received 2% lidocaine gel; group 3 received 100 mg indomethacin suppository and group 4 received 5% prilocaine/lidocaine (EMLA) cream. PPNB with 2% lidocaine was applied in all groups. A ten-point visual analog scale evaluated both pain associated with the probe insertion and pain associated with prostate sampling. Adverse effects or complications due to anesthesia during and after the procedure were documented. RESULTS: Compared with group 1, groups 3 and 4 had significantly lower pain scores at both probe insertion and prostate sampling while group 2 showed no significant differences at both pain scores. Moreover, group 4 showed significantly lower pain scores at probe insertion compared to group 3, while no significant difference was observed at prostate sampling. Mild complications were observed in all groups with no significant difference in the incidence of complications between groups. CONCLUSION: Intrarectal application of EMLA cream is a more efficient pain reduction than either 2% lidocaine gel or 100 mg indomethacin suppository when applied combined with PPNB. This combination represents an effective option of pain relief for patients undergoing TRUS-guided prostate biopsy.
Asunto(s)
Anestésicos Locales/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Indometacina/uso terapéutico , Lidocaína/uso terapéutico , Bloqueo Nervioso/métodos , Dolor Asociado a Procedimientos Médicos/prevención & control , Prilocaína/uso terapéutico , Próstata/patología , Administración Tópica , Anciano , Anestesia Local/métodos , Biopsia con Aguja Gruesa/métodos , Endosonografía/métodos , Humanos , Biopsia Guiada por Imagen/métodos , Combinación Lidocaína y Prilocaína , Masculino , Persona de Mediana Edad , Dimensión del Dolor , RectoRESUMEN
HDV infection still remains a serious public health problem in Amazonia. There are few data regarding the biomolecular aspects of HBV/HDV co-infection in this region. We studied 92 patients HBsAg(+) /anti-HDV IgG(+) followed at the Hepatitis Referral Centers of Porto Velho (RO), Rio Branco and Cruzeiro do Sul (AC), Brazil, from March 2006 to March 2007 for whom the HDV and/or the HBV genotype could be determined. The HDV genotype could be determined in 90 patients, while the HBV genotypes could be positively determined in 74. HBV subgenotype F2 is the most prevalent (40.2%), followed by the subgenotypes A1 (15.2%) and D3 (8.7%), while 16.4% were other subgenotypes or genotypes, 4.3% were discordant and 15.2% were unamplifiable. Surprisingly, HDV genotype 3 (HDV-3) was found in all of the HBV/HDV-infected patients that could be genotyped for HDV, confirming that HDV-3 can associate with non-F HBV genotypes. However, a HDV-3 mutant was found in 29.3% of patients and was more frequently associated with non-F HBV genotypes (P < 0.001) than were nonmutant strains, suggesting that the mutation may facilitate association of HDV-3 with non-F HBV genotypes.
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Coinfección/epidemiología , Virus de la Hepatitis B/genética , Hepatitis B/epidemiología , Hepatitis D/epidemiología , Virus de la Hepatitis Delta/genética , Mutación , Brasil/epidemiología , Genotipo , Anticuerpos Antihepatitis/sangre , Hepatitis B/complicaciones , Antígenos de Superficie de la Hepatitis B/sangre , Virus de la Hepatitis B/clasificación , Hepatitis D/complicaciones , Virus de la Hepatitis Delta/clasificación , Humanos , Inmunoglobulina G/sangre , Datos de Secuencia Molecular , ARN Viral/química , ARN Viral/genética , Análisis de Secuencia de ADNRESUMEN
BACKGROUND: Knee osteoarthritis (OA) is one of the most common and disabling disorders of the musculoskeletal system. It may affect any ethnic group and causes variable degrees of disability. Various risk factors have been associated with the development and progression of this condition, such as: age, genetic and occupational factors, trauma, menopause, diabetes mellitus, obesity, and gender, among others. Distinguishing these factors, whether individually or altogether, is important to prevent or diagnose and treat the disease early on. METHODS: A case-control study was conducted in 260 females in Torre6n, Coahuila, to analyze the relationship between primary knee osteoarthritis and the D-repeat polymorphism in the ASPN gene (asporin). 130 females with knee osteoarthritis and 130 healthy female controls were included. RESULTS: In this study, menopause and the D16 allele variant were found to be significant risk factors for knee osteoarthritis (p = 0.002, OR 2.656, CI 95% 1.412-4.998; p = 0.026, OR 2.418, CI 95% 1.111-5.263, respectively). The D12 variant was found to be a significant protective allele. CONCLUSIONS: As far as we know, this is the first case-control study in Mexican women that suggests that menopause and the D-repeat polymorphism in the ASPN gene are associated with knee OA.
Asunto(s)
Proteínas de la Matriz Extracelular/genética , Osteoartritis de la Rodilla/genética , Polimorfismo Genético , Estudios de Casos y Controles , Femenino , Humanos , Persona de Mediana Edad , Factores de RiesgoRESUMEN
Cervical human papillomavirus (HPV+) infection is associated with an increased risk of cervical dysplasia. Although the frequency of HPV+ in systemic lupus erythematosus (SLE) has been investigated in some races its prevalence in Hispanic women is still unknown. This cross-sectional study evaluated the prevalence of cervical HPV+ in Mexican women with SLE (n = 34) or rheumatoid arthritis (RA) (n = 43) and in healthy controls (n = 146). These women were interviewed about risk factors for sexually transmitted infections and cervical cytology analysis was performed. HPV+ viral types were identified using PCR: HPV+ was observed in 14.7% of SLE, 27.9% of RA and 30.8% of controls. High-risk HPV types were observed in 11.7% of women with SLE, 27.9% of women with RA, and in 26% of the controls. High-risk viral types 58, 35 and 18 were the most frequently identified in SLE. Two women with SLE had a high-grade squamous intraepithelial lesion and one had cervical cancer. An association was observed between methotrexate utilization, longer duration of therapy with prednisone, and HPV+ in RA or SLE. Thus, there is a high prevalence of cervical HPV infection in Mexican women with SLE or RA, and physicians must be vigilant in preventing the development of cervical dysplasia.
Asunto(s)
Alphapapillomavirus/aislamiento & purificación , Artritis Reumatoide/epidemiología , Lupus Eritematoso Sistémico/epidemiología , Infecciones por Papillomavirus/epidemiología , Enfermedades Virales de Transmisión Sexual/epidemiología , Displasia del Cuello del Útero/epidemiología , Neoplasias del Cuello Uterino/epidemiología , Adulto , Alphapapillomavirus/genética , Análisis de Varianza , Estudios de Casos y Controles , Estudios Transversales , ADN Viral/aislamiento & purificación , Femenino , Humanos , México/epidemiología , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/virología , Prevalencia , Enfermedades Virales de Transmisión Sexual/diagnóstico , Enfermedades Virales de Transmisión Sexual/virología , Displasia del Cuello del Útero/diagnóstico , Displasia del Cuello del Útero/virología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/virología , Frotis VaginalRESUMEN
La versión argentina de Health Assessment Questionnaire (HAQ-A) es un instrumento útil para documentar el estado clínico, la evolución y el pronóstico funcional de nuestros pacientes con Artritis Reumatoidea (AR). Sin embargo, presenta algunas limitaciones. Esto dio lugar a una versión más simple: el HAQ-II, el cual consta de 10 preguntas. Nuestro objetivo fue determinar la reproducibilidad y validez de una versión argentina del HAQ-II en pacientes con AR. Material y métodos: Se incluyeron pacientes consecutivos con diagnóstico de AR (ACR 87) de 4 centros reumatológicos de Argentina. La versión original del HAQ-II fue traducida por 3 reumatólogos argentinos y retraducida al inglés por un individuo bilingüe no relacionado. La reproducibilidad del cuestionario fue evaluada en el 30% de los pacientes con un segundo cuestionario completado dentro de los 3 a 7 días de la primera visita. La validez constructiva fue evaluada comparando el HAQ-II con parámetros clásicos de actividad de la enfermedad, capacidad funcional y compromiso radiológico (medido por el método de Sharp van der Heijde). Se evaluó también el tiempo y dificultad para realizarlo, así como la confiabilidad y correlación con HAQ-A. Resultados: 97 pacientes fueron incluidos, de los cuales el 82% eran mujeres, 95% seropositivas para factor reumatoideo, 87% erosivas y 22% nodulares. La reproducibilidad del HAQ-II fue buena (r=0,94). En la correlación intraítem se halló una única redundancia (entre la pregunta 8 y 9 (r=0,92)), por este motivo la pregunta 8 fue reemplazada manteniendo excelente correlación con la versión original (r=0,99). El HAQ-II tuvo buena correlación con EVA (escala visual análoga) para dolor, EVA para actividad y articulaciones dolorosas; regular correlación con recuento de articulaciones inflamadas, menor nivel educativo y eritrosedimentación (ERS). No se observó correlación con daño radiológico.
Asunto(s)
Artritis Reumatoide , Estudio de EvaluaciónRESUMEN
Las demencias frontotemporales y las demencia de cuerpos de Lewy, son la segunda causa de demencias degenerativasdespués de la enfermedad de Alzheimer. Estas demencias son un grupo complejo y variado que tiene dentrode sus variantes mas frecuentes: la demencia de tipo frontal, la cual compromete más el comportamiento; la afasiaprimaria progresiva y la demencia semántica, que implican un mayor deterioro del lenguaje y unas variantes menosfrecuentes, pero no menos importantes, como parálisis supranuclear progresiva, y la degeneración corticobasal lacual compromete algunas praxias. Debido a la importancia de estas demencias en este artículo se presentan cuatrocasos ilustrativos.
Asunto(s)
Humanos , Afasia , Demencia , NeurologíaRESUMEN
OBJECTIVE: To determine the efficacy of minimally invasive surgery (MIS) in the treatment of type III acromioclavicular dislocations using the UCLA and DASH evaluations. MATERIAL AND METHODS: Prospective, longitudinal, observational study; clinical series of patients with a diagnosis of type III acromioclavicular dislocation who underwent MIS consisting of percutaneous reduction, placement of a 4.5 mm cortical screw, an 11 mm metallic washer and 1.6 mm Kirschner nails at the Polanco Red Cross Hospital from July 2007 to July 2009. The evaluations were done using the UCLA test and the DASH questionnaire. RESULTS: The total number of patients was 42; 5 females and 37 males. According to the UCLA test, 86% of them had excellent to good results and 14% partial to poor results. The results of the DASH questionnaire were as follows: 80% had no difficulty to mild difficulty; 18% had moderate to severe difficulty, and 2% had disability for performing daily life activities. CONCLUSIONS: MIS is a good treatment for the management of type III acromioclavicular dislocation with long-term results based on the UCLA test and the DASH questionnaire.
Asunto(s)
Articulación Acromioclavicular/lesiones , Luxaciones Articulares/cirugía , Adolescente , Adulto , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Luxaciones Articulares/clasificación , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Estudios Prospectivos , Adulto JovenRESUMEN
PURPOSE: To identify clinical and biologic variables with significant impact on survival in patients with carcinomas of an unknown primary site (CUP) and to develop a simple prognostic model. PATIENTS AND METHODS: In this retrospective study, univariate and multivariate prognostic factors analyses were conducted in a population of 100 patients with CUP. Patients with features requiring well defined treatments had previously been excluded. RESULTS: Overall survival (OS) was significantly related to the following pretreatment adverse prognostic clinical factors: a poor performance status (2 or 3), weight loss more than 10% in the last six months, the presence of liver metastases and more than two metastatic sites. Two biological parameters predicted a significantly shorter survival: elevated serum levels of alkaline phosphatase and of lactate dehydrogenase. In the multivariate analysis, only two independent adverse prognostic parameters were retained: a poor performance status and the presence of liver metastases. We developed a prognostic model for OS based on the following subgroups: good prognosis (PS 0 or 1 and absence of liver metastases), intermediate prognosis (PS> or =2 or presence of liver metastases) and poor prognosis (PS> or =2 or presence of liver metastases). Median OS for the three groups was 10.8, 4 and 1.9 months respectively, p<0.0001. CONCLUSION: A simple prognostic model using performance status and presence of liver metastases was developed. It allowed the assignment of patients into three subgroups with different outcomes. Treatment strategies could be adapted for each subgroup. We think that this prognostic model could be useful and should be validated in other patient series.
Asunto(s)
Carcinoma/diagnóstico , Carcinoma/secundario , Neoplasias Primarias Desconocidas/diagnóstico , Neoplasias Primarias Desconocidas/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/sangre , Carcinoma/mortalidad , Femenino , Humanos , Masculino , Modelos Biológicos , Modelos Estadísticos , Análisis Multivariante , Pronóstico , Estudios Retrospectivos , Albúmina Sérica/metabolismo , Análisis de SupervivenciaRESUMEN
Foram avaliados alguns parâmetros inerentes ao ELISA, por meio de ensaios de reatividade de soros-controle positivos e negativos para a cisticercose bovina com relação a três tipos de antígenos de larva de Taenia solium: total, de escólex e de membrana. As concentrações de antígeno de 0,25; 0,5; 1; 2 e 4µg por orifício, e as diluições de soro de 1:25, 1:50, 1:100 e 1:200, foram os parâmetros que menos influenciaram no desempenho do teste. A substância bloqueadora, o leite desnatado e as diluições de conjugado, 1:1.250, 1:2.500 e 1:5.000, representaram os melhores indicadores de desempenho do teste. Concluiu-se que essa combinação de critérios deve ser considerada no diagnóstico da cisticercose bovina, em atividades de rotina ou de padronização do referido teste, considerando os três antígenos de larva de T. solium estudados.
Some parameters of ELISA were evaluated using positive and negative bovine sera for cysticercosis and three types of antigens of Taenia solium larvae: total, scolex and membrane. The antigen concentrations (0.25; 0.5; 1; 2 and 4µg/well) and the serum dilutions (1:25, 1:50, 1:100 and 1:200) were the parameters that influenced less the test performance; while blocking substance, skimmed milk, and conjugate dilutions, 1:1.250, 1:2.500 and 1:5.000 were the best indexes of the test performance. It was concluded that this combination of criteria should be considered in the diagnosis of bovine cysticercosis, in routine diagnosis and for the ELISA test standardization.
Asunto(s)
Animales , Cisticercosis/diagnóstico , Cisticercosis/epidemiología , Cisticercosis/prevención & control , Cysticercus/aislamiento & purificación , Ensayo de Inmunoadsorción Enzimática , Taenia solium/aislamiento & purificación , Pruebas Serológicas/métodosRESUMEN
Foram avaliados alguns parâmetros inerentes ao ELISA, por meio de ensaios de reatividade de soros-controle positivos e negativos para a cisticercose bovina com relação a três tipos de antígenos de larva de Taenia solium: total, de escólex e de membrana. As concentrações de antígeno de 0,25; 0,5; 1; 2 e 4mg por orifício, e as diluições de soro de 1:25, 1:50, 1:100 e 1:200, foram os parâmetros que menos influenciaram no desempenho do teste. A substância bloqueadora, o leite desnatado e as diluições de conjugado, 1:1.250, 1:2.500 e 1:5.000, representaram os melhores indicadores de desempenho do teste. Concluiu-se que essa combinação de critérios deve ser considerada no diagnóstico da cisticercose bovina, em atividades de rotina ou de padronização do referido teste, considerando os três antígenos de larva de T. solium estudados.(AU)
Some parameters of ELISA were evaluated using positive and negative bovine sera for cysticercosis and three types of antigens of Taenia solium larvae: total, scolex and membrane. The antigen concentrations (0.25; 0.5; 1; 2 and 4mg/well) and the serum dilutions (1:25, 1:50, 1:100 and 1:200) were the parameters that influenced less the test performance; while blocking substance, skimmed milk, and conjugate dilutions, 1:1.250, 1:2.500 and 1:5.000 were the best indexes of the test performance. It was concluded that this combination of criteria should be considered in the diagnosis of bovine cysticercosis, in routine diagnosis and for the ELISA test standardization.(AU)
Asunto(s)
Animales , Cisticercosis/diagnóstico , Cisticercosis/prevención & control , Cisticercosis/epidemiología , Cysticercus/aislamiento & purificación , Taenia solium/aislamiento & purificación , Ensayo de Inmunoadsorción Enzimática/métodos , Pruebas Serológicas/métodosRESUMEN
The phenotypic profile of bovine lymphocytes was evaluated in 18 bovines (Bos taurus) from three different breeds, being nine Holstein, six Hereford, and three Brown Swiss. All animals were free from ticks and hemoparasites, as determined after jugular vein blood sampling. The immunophenotypes of peripheral lymphocytes were evaluated by flow cytometry. Peripheral lymphocytes were exposed to bovine fluorescein-labeled monoclonal antibodies including anti-CD4, anti-CD8, and anti-purified bovine CD21 specificities. After lysing the erythrocytes with a commercial lysing solution (FACS TM ), the lymphocytes were washed, fixed, and evaluated by flow cytometry. Significant differences in the phenotypic profiles of peripheral lymphocytes among all breeds were found. Holstein animals showed a lower percentage of total T lymphocytes (CD4 and CD8) and higher percentage of B lymphocytes (CD21). In addition, the lymphocytes from Holstein animals showed a lower T/B ratio than the lymphocytes from Hereford animals. These results suggest the existence of different phenotypic profiles of peripheral lymphocytes from European breeds of cattle. Such differences may be related to the different pattern of immune response described for these breeds in the literature and may account to varying disease resistance among breeds.
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Animales , Babesiosis , Bovinos , Citometría de Flujo , Inmunofenotipificación , Linfocitos , Vacunas , Salud Pública VeterinariaRESUMEN
The phenotypic profile of bovine lymphocytes was evaluated in 18 bovines (Bos taurus) from three different breeds, being nine Holstein, six Hereford, and three Brown Swiss. All animals were free from ticks and hemoparasites, as determined after jugular vein blood sampling. The immunophenotypes of peripheral lymphocytes were evaluated by flow cytometry. Peripheral lymphocytes were exposed to bovine fluorescein-labeled monoclonal antibodies including anti-CD4, anti-CD8, and anti-purified bovine CD21 specificities. After lysing the erythrocytes with a commercial lysing solution (FACS TM ), the lymphocytes were washed, fixed, and evaluated by flow cytometry. Significant differences in the phenotypic profiles of peripheral lymphocytes among all breeds were found. Holstein animals showed a lower percentage of total T lymphocytes (CD4 and CD8) and higher percentage of B lymphocytes (CD21). In addition, the lymphocytes from Holstein animals showed a lower T/B ratio than the lymphocytes from Hereford animals. These results suggest the existence of different phenotypic profiles of peripheral lymphocytes from European breeds of cattle. Such differences may be related to the different pattern of immune response described for these breeds in the literature and may account to varying disease resistance among breeds.(AU)
Asunto(s)
Animales , Inmunofenotipificación , Citometría de Flujo , Babesiosis , Linfocitos , Bovinos , Salud Pública Veterinaria , VacunasRESUMEN
This research expresses the potential of the bacterial activity present in the organic extracts obtained from Penicillium sp., isolated from the esponge Irciniafelix. This activity was evaluated through agar diffusion test and Minimal Inhibitory Concentration (MIC). The susceptibility trials of organic fractions were carried out against Staphylococcus aureus, S. epidermidis, Bacillus cereus and B. subtilis. The use of the chromatographic techniques (CLV and TLC), permitted to obtain bioactive organic extracts of different polarities, of which only the EtOAc and MeOH fractions inhibited the growth of the bacteria used. Of the EtOAc fractionation, only fraction number 3 EtOAc/Hex presented greatest activity against the Gram-positive bacteria. Number 1 EtOAc/Hex fraction increased its activity against S. aureus (24 mm) and S. epidermidis (25 mm), which can be explained by the loss of possible antagonistic effect during the fractionation process. The CMI trials were carried out for the EtOAc number I subfraction against S. aureus, S. epidermidis, B. cereus and B. subtilis, wich was clinical interest, and shows the potential of this organic extract as antimicrobial agent.
Asunto(s)
Animales , Antibacterianos , Bacterias Grampositivas , Penicillium , Poríferos , Pruebas de Sensibilidad Microbiana , PenicilliumRESUMEN
This research expresses the potential of the bacterial activity present in the organic extracts obtained from Penicillium sp., isolated from the esponge Irciniafelix. This activity was evaluated through agar diffusion test and Minimal Inhibitory Concentration (MIC). The susceptibility trials of organic fractions were carried out against Staphylococcus aureus, S. epidermidis, Bacillus cereus and B. subtilis. The use of the chromatographic techniques (CLV and TLC), permitted to obtain bioactive organic extracts of different polarities, of which only the EtOAc and MeOH fractions inhibited the growth of the bacteria used. Of the EtOAc fractionation, only fraction number 3 EtOAc/Hex presented greatest activity against the Gram-positive bacteria. Number 1 EtOAc/Hex fraction increased its activity against S. aureus (24 mm) and S. epidermidis (25 mm), which can be explained by the loss of possible antagonistic effect during the fractionation process. The CMI trials were carried out for the EtOAc number I subfraction against S. aureus, S. epidermidis, B. cereus and B. subtilis, wich was clinical interest, and shows the potential of this organic extract as antimicrobial agent.
Asunto(s)
Antibacterianos/farmacología , Bacterias Grampositivas/efectos de los fármacos , Penicillium/aislamiento & purificación , Poríferos/microbiología , Animales , Pruebas de Sensibilidad Microbiana , Penicillium/químicaRESUMEN
The aim of this paper is to estimate the levels of arsenic (As) ingestion through cooked foods consumed in an arsenic endemic area and the assessment of their dietary intake of As. The study was conducted in two villages: a population chronically exposed to a high concentration of As via drinking water (410+/-35 microg/l) and to a low-exposure group (12+/-4 microg/l). A 24-h dietary recall questionnaire was applied to about 25 adult participants in each community. Samples of cooked food, ready for intake, were collected separately from each family's participants. To obtain the As estimate for each food item consumed, the mean quantity of food ingested in grams (wet weight) was calculated and the concentrations of total arsenic (TAs) in each cooked food were determined. The estimations of TAs intake were based on the sum over mean of As ingested from each food item consumed during the 24-h period for each participant. For the estimation of total daily As intake, we summed the mean obtained from food, plain water and hot beverage intakes. The TAs average intakes calculated for low-As-exposure group were 0.94 and 0.76 microg/kg body weight/day, for both summer and winter exposure scenarios, respectively. These values are 44.7 and 36% of the provisional tolerable daily intake (PTDI) for inorganic arsenic (2.14 microg/kg body weight/day), established by the World Health Organization (WHO) in 1989. The WHO reference value was obtained on a weekly basis intake estimation assuming an average body weight of 68 kg in adults. In contrast, for the high-exposure group the TAs average intakes were 16.6 and 12.3 microg/kg body weight/day for summer and winter, respectively. Ingestion via cooked food represented 32.5 and 43.9% of the total daily As intake in the high-exposure group; for summer and winter, respectively. None the less, the bioavailability of As through food can be different than via drinking water.
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Arsénico/administración & dosificación , Arsénico/análisis , Dieta , Análisis de los Alimentos , Calor , Adulto , Peso Corporal , Exposición a Riesgos Ambientales , Femenino , Humanos , Masculino , Recuerdo Mental , Estaciones del Año , Encuestas y Cuestionarios , Agua/análisisRESUMEN
OBJECTIVE: To evaluate the results of laparoscopic Nissen-Rossetti funduplication and to compare them with the results obtained in open surgery. DESIGN: Prospective, observational, longitudinal, pre and post-procedure. CENTERS: Beneficencia Española, Hospital Angeles, and Hospital Francisco Galindo Chávez, ISSSTE, in Torreón, Coahuila, Mexico. PATIENTS AND METHOD: From December 1992 to February 1999, 100 patients with surgical indications due to gastroesophageal reflux disease (GERD) prospectively underwent a laparoscopic Nissen-Rossetti procedure. A clinical and endoscopic follow up from 3 months to 9 years was performed in 87 cases. RESULTS: Symptomatic control was achieved in 98% (85/87) of the cases and remission of overall endoscopic esophagitis in 79% (69/87); excluding Barrett cases, esophagitis remission was observed in 93% (67/72) of the subjects. The following recurrences took place: two with G-II and two with G-III esophagitis, one requiring pyloroplasty due gastric stasis, and other patient with G-IV esophagitis, who has needed to continue with postoperative dilations. Of 16 cases with Barrett's esophagus, two-showed remission and one did not return control. Perioperative complications included gastric perforations (3), acute pulmonary edema during the immediate postoperative period (1), deep vein thrombosis (1), and late esophageal perforation (1). All were resolved satisfactorily. Surgical mortality was 0 in the 100 cases undergoing the procedure. Eighty-six percent of cases had a 24-h hospital stay. Early morbidity: dysphagia in 60 patients, early satiety in 91 cases, abdominal distention in 25 cases, all this symptomatology disappears during the subsequent 3 months. Persistent morbidity: flatulence in 60% of patients, difficulty for vomiting in 10% of cases. CONCLUSION: The laparoscopic procedure is as effective as the open method with the advantage of being minimally invasive.
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Reflujo Gastroesofágico/cirugía , Laparoscopía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
A malaria control pilot project was developed in the Urupá agro-industrial farm that is situated in the State of Rondônia (Western Amazon Region, Brazil). Around 180 inhabitants had been surveyed for the past five years. The control measures were based on (1) training a community agent to perform on the spot microscopical diagnosis of malaria and to treat the uncomplicated cases of malaria; (2) limiting the use of insecticides to a short period before the high transmission season. This resulted in a significant reduction in the time between the onset of clinical symptoms and specific chemotherapy which fell from 3.5 to 1.3 days. In relation to the previous three reference years the total number of malaria cases was reduced to 50% in the first year and to 25% in the second year. The introduction of these measures coincided with pronounced reduction in the frequency of Plasmodium falciparum infections but this was less marked for P. vivax infections. In the second year of the pilot experiment there was no P. falciparum transmission on the farm. During the last decade there was a general decrease in the endemicity of malaria in the State of Rondônia. The linear regression coefficient values indicate that the decline was more pronounced in Urupá than in the general municipality and that the falciparum malaria API in Urupá farm is significantly lower than in the general municipality of Candeias were the farm is situated.
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Malaria Falciparum/prevención & control , Malaria Vivax/prevención & control , Adolescente , Adulto , Distribución por Edad , Brasil/epidemiología , Niño , Preescolar , Femenino , Encuestas Epidemiológicas , Humanos , Incidencia , Lactante , Recién Nacido , Modelos Lineales , Malaria Falciparum/epidemiología , Malaria Vivax/epidemiología , Masculino , Proyectos Piloto , Prevalencia , Salud Rural/estadística & datos numéricos , Estaciones del Año , Distribución por SexoRESUMEN
Seventy-nine adults with Plasmodium vivax malaria, from the Porto Velho area of Rond nia (western Amazon region, Brazil), gave informed consent to participate in a blind, clinical study of two regimens of treatment with chloroquine (CQ) and primaquine. The effectiveness of the 'classical' regimen (CQ for 3 days, followed by primaquine for 14 days) was compared with that of a 'short' regimen in which the two drugs were given simultaneously for 5 days. There were no cases of recrudescence indicative of CQ resistance (i.e. within 30 days of the first treatment dose) among the 73 patients who each completed a full, supervised course of treatment. However, 10 cases of apparent relapse were observed (all > 60 days after first treatment dose), representing 6.5% (2/31) of the patients who completed 60 days of follow-up after the classical treatment and 26.7% (8/30) of the short-regimen patients who completed the same period of follow-up. PCR-based comparison of parasitic DNA collected pre- and post-treatment was successful for eight of the 10 cases of apparent relapse and indicated that two such cases, both given the short regimen of treatment, were, in fact, probable cases of re-infection rather than of relapse. The results indicate that the classical schedule of treatment with chloroquine and primaquine was more effective at preventing relapses than the short regimen. However, since prolonged treatment with primaquine often produces side-effects that are severe enough to reduce compliance, the short schedule could be a useful alternative for malaria control in endemic areas of the Amazon region.
Asunto(s)
Antimaláricos/uso terapéutico , Cloroquina/uso terapéutico , Malaria Vivax/tratamiento farmacológico , Primaquina/uso terapéutico , Adolescente , Adulto , Anciano , Análisis de Varianza , Brasil , ADN Protozoario , Esquema de Medicación , Farmacorresistencia Microbiana , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Resultado del TratamientoRESUMEN
We report on a longitudinal study concerning the incidence of malaria in a riverine population (Portuchuelo) settled on the riverbanks of Rio Madeira, in the State of Rondonia, Brazil. We found the incidence of malaria to be seasonal, prevailing in the dry months of June and July. The Annual Parasite Index (API) was 292/1000 inhabitants, almost three times that of the state of Rondonia for the same period. In contrast with other studied Rondonian populations, malaria in Portuchuelo was more prevalent in youngsters < 16 years old, particularly in the 0-1 year age group. Adults were relatively spared, particularly those over 50 years. Besides being indicative of indoor transmission, these facts may suggest the existence of a certain degree of acquired resistance to infection and/or of lessened symptoms in older people. Riverine populations are spread over the entire Amazon region where most of its members were born. Due to the permanent presence of malaria among riverine populations, we are proposing that they may act as perennial reserves of malaria and, therefore, as sources of infection for migrants or eventual settlers at their vicinity. To date, the opposite view has been generally held. Anopheles darlingi, the main vector species in the area, is essentially sylvatic, which contributes to make the control of malaria highly problematic. The only hopes for control rest on permanent surveillance and the prompt treatment of patients, which are also problematic considering the vastness of the Amazon region and the remoteness of some of its riverine settlements.