RESUMEN
A total of 39 patients with a clinical diagnosis of mucocutaneous leishmaniasis, in an endemic area for leishmaniasis in Salta, Argentina, were examined between June 1990 and December 1992. Of these cases, 87% (34/39) presented the cutaneous simple form, 10.3% the cutaneous multiple form and 2.6% the mucosal form. Lesions were more frequently located in legs and arms (71.8%), followed by trunk and multiple location (10.3%). Of the patients, 43% were housewives, students or children, suggesting that the infection could be contracted in the domestic or peridomestic environment. Of 39 patients diagnosed, in 22 (56.4%) the parasite was found. Direct microscopy (smear) permitted a diagnosis in 13 (59.4%) of these 22 patients. Among these, 5 (22.7%) had positive diagnosis by culture, and 9 (40.9%) by inoculation in hamsters. Ten parasite isolates (45.4%) were obtained. The smear is recommended as a diagnostic method for epidemiological surveillance due to the sensibility demonstrated herein and its easy application in the endemic area. The time of clinical evolution, from the appearance of the lesion up to the detection of the patient by Sanitary Agents, was approximately 90 days. This would be related to the frequency of the visits, usually every 3 months. Only one of 30 treated patients had a relapse at 6 months, due to non fulfillment of the treatment.
Asunto(s)
Pruebas Intradérmicas , Leishmaniasis Mucocutánea/diagnóstico , Leishmaniasis Mucocutánea/epidemiología , Adolescente , Adulto , Análisis de Varianza , Antiprotozoarios/uso terapéutico , Argentina/epidemiología , Niño , Enfermedades Endémicas , Femenino , Humanos , Leishmaniasis Mucocutánea/tratamiento farmacológico , Leishmaniasis Mucocutánea/transmisión , Masculino , Persona de Mediana Edad , Prevención Secundaria , Sensibilidad y EspecificidadRESUMEN
BACKGROUND AND METHODS: The safety of long-term immunosuppression with cyclosporine in renal-transplant recipients is not well understood. This drug may cause a progressive toxic nephropathy, but it also preserves renal function because it prevents rejection. To determine the effect of cyclosporine on renal function and graft rejection, we conducted a retrospective analysis of data on 1663 renal-transplant recipients at six centers. RESULTS: The rate of graft survival was 78 percent (median follow-up, 36 months). Grafts were was lost in 279 patients (17 percent), mostly because of acute rejection (68 patients) or chronic graft dysfunction that was unresponsive to a reduction in the dose of cyclosporine (125 patients); 92 patients died with functioning grafts. The median change in the serum creatinine concentration in all patients after transplantation was less than 0.001 mg per deciliter per month (< 0.09 mumol per liter per month). Patients who had episodes of rejection had decreased rates of long-term graft function and survival. Eight percent of patients with functioning grafts at one year had first episodes of rejection more than one year after transplantation. These late first rejections were associated with noncompliance with therapy (in 34 percent), blood cyclosporine concentrations that were marginally lower than those of patients who had no episodes of rejection, and a low rate of successful reversal of rejection (77 percent, vs. 97 percent in patients with rejection during the first year; P < 0.001). CONCLUSIONS: The majority of renal-transplant patients tolerate long-term cyclosporine therapy without evidence of progressive toxic nephropathy. Graft failure is most often due to rejection.
Asunto(s)
Ciclosporina/uso terapéutico , Supervivencia de Injerto/efectos de los fármacos , Trasplante de Riñón , Adulto , Creatinina/sangre , Ciclosporina/efectos adversos , Femenino , Estudios de Seguimiento , Rechazo de Injerto/complicaciones , Rechazo de Injerto/prevención & control , Humanos , Riñón/efectos de los fármacos , Riñón/fisiopatología , Masculino , Recurrencia , Insuficiencia Renal/inducido químicamente , Estudios RetrospectivosRESUMEN
Se describen los resultados entomológicos de un estudio sobre transmisión del Tripanosoma cruzi realizado en un caserío rural de Argentina. Se determinó la prevalencia de infección y el perfil alimentario de los Triatoma infestans domiciliados, relacionándose su densidad con el tipo de vivienda. Seis de las 18 viviendas estudiadas eran nuevas o mejoradas y en 16 los habitantes aplicaban hexaclorociclohexano. La menor densidad de vinchucas correspondió a las casas higiénicas o mejoradas con tratamiento químico. Los ranchos tratados presentaron un número de insectos 10 veces menor que un rancho no tratado, indicando la efectividad del control autogestado. Se hallaron T. infestans en el 100% de los dormitorios pero en sólo el 53% de los locales peridomiciliarios. Un 39% de las vinchucas intradomiciliarias estaban infectadas. El 96% de los insectos de dormitórios se alimentaron hombre, perro, pollo y gato, siendo elíndice afinidad para el perro 13 veces superior al correspondiente al hombre. Se discute la importancia epidemiológica de la concentración de vectores dentro de los dormitorios y su asociación trófica con los perros convivientes, así como la necesidad de combinar la mejora de vivienda con educación sanitaria