RESUMO
BACKGROUND: In 2016, the Hospital Dr. Félix Bulnes Cerda (HDFBC) implemented the mandatory screening of anti Trypanosoma cruzi antibodies in pregnant women, thus complying with national regulations to detect new Chagas disease cases (CHD) in mother and child, whose early detection mediates timely pharmacological treatment. This, because the congenital transmission continues the main active transmission mechanisms of T. cruzi and a major public health problem for the country. AIM: To present the epidemiological information generated after the implementation of the ECH screening in the SSFCC HFBC, two years after its operation began. METHODS: Screening test: inmunequimioluminiscence (IQLU), certification by IFI, ELISA and/or western blot. Follow up of newborn infants with PCR, IFI, ELISA and IQLU. RESULTS: Between April 2016 and July 2018, 14.012 subject's samples were examined of which 62 resulted reactive (0.53% seropositivity) in the total studied population where 28 patients resulted positive for CHD, which corresponds to a 0.2% prevalence. Of the total population, 11.780 were pregnant women, of these 41 were reactive and 10 were confirmed with CHD thus showing a prevalence of 0.085%. The other 18 positive cases of non-pregnant patients corresponded a prevalence of 0.81%. Also, 10 newborn and infant children of mothers with CHD were followed up. In all, congenital transmission (0%) was ruled out. Nifurtimox treatment of the mothers were completed in 30% of them. It is concluded that the implementation of the program in the HDFBC fulfills the objectives of screening, detection and diagnosis of CHD, so as the timely follow-up and pharmacologic treatment of the newborn. The 0.085% prevalence of CHD in pregnant women as the 0.20% in total population are significantly lower (p-valor < 0.01) than the 0.7% reported in 2016 for the Metropolitan Region (MR), a fact that we suggest is a consequence of the national program implementation. Likewise, the 0% transplacental transmission is accorded to the rate of 0.91 x 10.000 live births reported in 2017 for the MR. Based on the learning acquired during the development of the research, recommendations are given to contribute to the operation of the program.
Assuntos
Doença de Chagas , Trypanosoma cruzi , Animais , Chile , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Gravidez , Atenção Primária à SaúdeRESUMO
Resumen Introducción: El año 2016, el Hospital Dr. Félix Bulnes Cerda (HDFBC) implementó el tamizaje obligatorio de anticuerpos anti Trypanosoma cruzi, para pesquisar nuevos casos de la enfermedad de Chagas (ECH) en mujeres embarazadas y recién nacidos (RN) y brindar tratamiento antiparasitario oportuno. Ello, porque la transmisión transplacentaria de T. cruzi continúa siendo un importante problema de salud pública. Objetivo: Presentar la información epidemiológica generada luego de la implementación del cribado de la ECH en el HDFBC del SSMOCC, al cabo de dos años de iniciada su operación. Material y Métodos: Cribado por inmunoquimioluminiscencia (IQLU), confirmación por IFI, ELISA y/o western blot. Seguimiento de RN: mediante RPC, IFI, ELISA e IQLU. Resultados: Entre abril de 2016 y julio de 2018 se analizó un total de 14.012 muestras de pacientes; 62 resultaron reactivas (0,53% seropositividad) y 28 fueron confirmadas positivas (prevalencia de 0,2%). Del total, 11.780 fueron de mujeres gestantes (n: 41 casos reactivos y 10 confirmadas con ECH), con prevalencia de 0,085%. Los restantes 18 casos positivos fueron usuarios no gestantes, con sospecha clínica de ECH y casos de estudios familiares, mostrando una prevalencia de 0,81%. El seguimiento a 10 RN y lactantes hijos de madres chagásicas descartó la transmisión transplacentaria Completaron tratamiento con nifurtimox 30% de las madres. Discusión: La implementación del programa en el HDFBC cumple los objetivos de cribado, pesquisa y diagnóstico de la ECH así como el seguimiento y tratamiento oportuno del RN. La prevalencia de 0,085% de la ECH en la población gestante como la de 0,2% en población total son significativamente menores (p-valor < 0,01) que la prevalencia de 0,7% reportada (año 2016) para la Región Metropolitana (RM); sugerimos que es consecuencia de la implementación del programa nacional y local. La transmisión congénita de 0% es acorde a la tasa de [0,91 x 10.000] reportada el 2017 para la RM. En base al aprendizaje adquirido, durante el desarrollo de la investigación, se entrega sugerencias para aportar al funcionamiento del programa.
Abstract Background: In 2016, the Hospital Dr. Félix Bulnes Cerda (HDFBC) implemented the mandatory screening of anti Trypanosoma cruzi antibodies in pregnant women, thus complying with national regulations to detect new Chagas disease cases (CHD) in mother and child, whose early detection mediates timely pharmacological treatment. This, because the congenital transmission continues the main active transmission mechanisms of T. cruzi and a major public health problem for the country. Aim: To present the epidemiological information generated after the implementation of the ECH screening in the SSFCC HFBC, two years after its operation began. Methods: Screening test: inmunequimioluminiscence (IQLU), certification by IFI, ELISA and/or western blot. Follow up of newborn infants with PCR, IFI, ELISA and IQLU. Results: Between April 2016 and July 2018, 14.012 subject's samples were examined of which 62 resulted reactive (0.53% seropositivity) in the total studied population where 28 patients resulted positive for CHD, which corresponds to a 0.2% prevalence. Of the total population, 11.780 were pregnant women, of these 41 were reactive and 10 were confirmed with CHD thus showing a prevalence of 0.085%. The other 18 positive cases of non-pregnant patients corresponded a prevalence of 0.81%. Also, 10 newborn and infant children of mothers with CHD were followed up. In all, congenital transmission (0%) was ruled out. Nifurtimox treatment of the mothers were completed in 30% of them. It is concluded that the implementation of the program in the HDFBC fulfills the objectives of screening, detection and diagnosis of CHD, so as the timely follow-up and pharmacologic treatment of the newborn. The 0.085% prevalence of CHD in pregnant women as the 0.20% in total population are significantly lower (p-valor < 0.01) than the 0.7% reported in 2016 for the Metropolitan Region (MR), a fact that we suggest is a consequence of the national program implementation. Likewise, the 0% transplacental transmission is accorded to the rate of 0.91 x 10.000 live births reported in 2017 for the MR. Based on the learning acquired during the development of the research, recommendations are given to contribute to the operation of the program.
Assuntos
Humanos , Animais , Feminino , Gravidez , Recém-Nascido , Trypanosoma cruzi , Doença de Chagas , Atenção Primária à Saúde , Chile , Transmissão Vertical de Doenças InfecciosasRESUMO
One hundred consecutive asthmatic paediatric patients were evaluated and skin tested with a battery of skin prick test reagents, including 8 different standardized house dust mite extracts. Asthma severity was graded according to the Global Initiative for Asthma (GINA) document in mild persistent (52 patients), moderate persistent (39) and severe persistent (9). Sixty patients had asthma and allergic rhinitis, 12 asthma and eczema, and 8 asthma, allergic rhinitis and eczema. The patient population was divided into 2 different socioeconomic groups (50 patients per group) based on a standardized, validated questionnaire. A dust sample was collected with an adapted vacuum cleaner from the mattress of each patient and analysed for Der p 1, Der f 1 and Der p 2 allergen content using monoclonal antibodies. Eighty patients were skin test positive to at least one mite species. All positive skin test patients were positive to Dermatophagoides pteronyssinus, 99% to D. farinae, 92% to Euroglyphus maynei, 80% to Lepidoglyphus destructor, 73% to Tyrophagus putrescientae, 72% to Blomia tropicalis; 70% to Acarus siro and 68% to Chortoglyphus arcuatus. All patients with severe persistent asthma had a positive skin test to mites, 85% in the moderate group, and 73% in the mild group (p < 0.01). 95% of patients with asthma and allergic rhinitis had a positive skin test to mites, 92% of patients with asthma and eczema and 100% of patients with asthma, allergic rhinitis and eczema; (p < 0.01). Mean Der p 1, Der f 1 and Der p 2 allergen concentrations were 18.3, 0.6 and 5.6 microg/g of mattress dust, respectively. Mean Der p 1 allergen levels in the middle-low socioeconomic group were significantly higher than in the middle high group (p < 0.01). There is a high rate of allergic sensitisation among pediatric asthmatic patients in Chile. More than one species are implicated, although sensitisation and exposure to D. pteronyssinus predominates. Mite allergic patients are exposed to high mite allergen concentrations, exceeding previously established risk levels for sensitisation and symptoms.
Assuntos
Antígenos de Dermatophagoides/efeitos adversos , Antígenos de Dermatophagoides/imunologia , Exposição Ambiental/análise , Imunização , Adolescente , Alérgenos/efeitos adversos , Alérgenos/imunologia , Antígenos de Dermatophagoides/análise , Antígenos de Dermatophagoides/classificação , Asma/etiologia , Asma/terapia , Leitos , Criança , Pré-Escolar , Chile/epidemiologia , Dermatite Atópica/etiologia , Dermatite Atópica/terapia , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Masculino , Rinite Alérgica Perene/etiologia , Rinite Alérgica Perene/terapia , Índice de Gravidade de Doença , Testes Cutâneos , Classe Social , Inquéritos e QuestionáriosRESUMO
El examen urodinámico involucra una elevada complejidad y una cantidad de parámetros que pueden fácilmente confundir al becario de Urología, induciéndolo a producir un diagnóstico equivocado. Como una manera de ejercer un control sobre éste diagnóstico se ha diseñado un sistema de guía asistido por computador,basado en una red neural y funcionando en un computador personal, con el objeto de proporcionar un sistema de apoyo útil y de fácil instalación que permita evitar errores de diagnóstico y facilitar el entrenamiento en urodinámica de los becarios en las Cátedras de Urología. Además, ha demostrado ser una valiosa herramienta para el especialista quien la puede utilizar para hacer una validación rutinaria de sus archivos de exámenes urodinámicos, detectando cualesquier error eventual de transcripción, así como otros posibles errores involuntarios. Se usó un paquete de Software comercial (Ward Group Neuro Shell for DOS, v.41.1) que proporciona un ambiente amistoso para el desarrollo, entrenamiento, evaluación y operación de redes neurales que es capaz de generar una red neural de tipo de retropropagación y aprendizaje supervisado de tres capas; un modelo considerado adecuado para una gran mayoría de los problemas de clasificación