RESUMO
OBJETIVO: Describir el comportamiento del dengue y su vector en Cáqueza, Colombia, (1 746 msnm), mediante vigilancia serológica, entomológica y virológica, entre Marzo y Junio de 2004. MÉTODOS: Se realizaron dos tipos de estudio: Un estudio de corte transversal para la vigilancia serológica poblacional y el levantamiento de los indicadores entomológicos donde los participantes fueron seleccionados de la población general por muestreo aleatorio de conglomerados. El segundo estudio fue de vigilancia centinela sobre casos febriles sospechosos de dengue durante cuatro semanas, incluyendo el comportamiento del vector (tasa de picadura y horas de actividad) mediante la técnica de aterrizaje sobre el humano. Durante el mismo periodo se realizó una jornada de aseo lo que permitió evaluar la efectividad a corto plazo de esta intervención. RESULTADOS: La prevalencia total de infección por dengue (IgG positivos) fue de 23,3 % en 252 personas examinadas en la encuesta poblacional. El índice de infestación de viviendas fue de 32,9 %, el índice de depósito fue de 8,4 % y el de Bretau de 43,9. Después de la jornada de aseo el índice de infestación se redujo en un 56 % (14,5 % post intervención), el de depósito disminuyó en un 43 % (4,8 % post intervención) y el de Bretau en un 59 % (17,9 post intervención). Entre los pacientes febriles (n=83) dos fueron positivos para IgM. CONCLUSIONES: El estudio sugiere que aunque hay presencia del vector, la transmisión interepidémica de dengue es baja en esta población. Con respecto al vector es importante porque hay pocos estudios del comportamiento del dengue en poblaciones por encima de 1 500 metros en Latinoamérica.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aedes , Dengue/epidemiologia , Insetos Vetores , Aedes/fisiologia , Colômbia/epidemiologia , Estudos Transversais , Dengue/diagnóstico , Insetos Vetores/fisiologia , Prevalência , Estações do Ano , Vigilância de Evento Sentinela , Estudos SoroepidemiológicosRESUMO
The presence of anomalous intraventricular flows of high velocity and dynamic ejective obstruction of the left ventricle post aortic valve replacement, generally by severe aortic stenosis, is a relatively infrequent, but severe complication. An early diagnosis is of crucial importance, since the usual treatments applied to postoperative heart failure are often inefficacious or even harmful. Even in cases of severe pump failure, when the clinical case is diagnosed adequately, endovenous short-action beta-blockers are useful.
Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Próteses Valvulares Cardíacas/efeitos adversos , Propanolaminas/administração & dosagem , Disfunção Ventricular Esquerda/tratamento farmacológico , Idoso , Valva Aórtica , Insuficiência Cardíaca/etiologia , Humanos , Infusões Intravenosas , Masculino , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/etiologiaRESUMO
Colombia is a country rich in natural resources, with a steadily developing economy. Occupational and environmental medicine (OEM) education and practice have developed relatively recently in Colombia, mainly in response to a series of long overdue (and still partially implemented) reforms to the health care, social benefits, and education systems. Expansion in general and occupational health coverage of the Colombian population and development of OEM education and training were to be achieved through a clear stimulus to private sector initiatives. Despite some measurable overall progress, the goals remain elusive. This article discusses several aspects and the perspectives for further development of the specialty in this country, in the context of the socioeconomic factors involved in that process.
Assuntos
Medicina Ambiental , Medicina do Trabalho , Colômbia , Humanos , Medicina do Trabalho/educaçãoRESUMO
AIMS: The objective of this study was to ascertain the effect of intravenous and oral amiodarone on morbidity and mortality in patients during the first hours after the onset of an acute myocardial infarction. METHODS AND RESULTS: A cohort of 1073 patients admitted to the CCU within 24 h of the onset of symptoms of an acute myocardial infarction and heart failure (Killip and Kimball A-B) were randomized to receive amiodarone (n=542) or placebo (n=531) for 6 months. Because of the higher mortality, on an interim analysis, from a 'high dose' of amiodarone or placebo (516 patients) the protocol was changed to a 'low dose' or placebo (557 patients). Mortality with high doses of amiodarone was 16.30% vs 10.16% in the placebo group (P=0.04), whereas mortality with low doses was 6.61% vs 9.47% in the control group (P=0.20). Several non-fatal adverse effects were observed in 108 and 73 patients treated with amiodarone and placebo, respectively. CONCLUSION: This study demonstrated that early administration of amiodarone in low doses to patients with an acute myocardial infarction may be used only if life-threatening arrhythmia justify its prescription. Conversely, when given in high doses, it might increase mortality.
Assuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/mortalidade , Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Estudos Prospectivos , Análise de Sobrevida , Fatores de TempoRESUMO
Exercise testing after acute myocardial infarction is commonly used, but in recent years alternative methods have been proposed. Standard exercise testing was compared with dobutamine electrocardiographic (ECG) stress testing in 100 patients after an acute initial myocardial infarction. Dobutamine ECG stress testing was performed in a standard manner at 5 +/- 1 days after the infarction and exercise testing was performed a mean of 10 +/- 2 days following the event. Agreement between both tests was observed in 91 cases (91%), P < .001, Fisher test kappa value, 0.79). The dobutamine test predicted the result of the exercise test with a sensitivity of 100% (95% confidence interval, 87-100) and a specificity of 88% (95% confidence interval 77-93) for a positive predictive value of 75% (95% confidence interval, 62-97) and a negative predictive value of 100% (95% confidence interval, 91-100). Dobutamine ECG stress testing is concluded to be an objective and reliable procedure, which accurately predicts the results of standard exercise testing. It is inexpensive, easy to perform, and although not yet confirmed, could be particularly useful in patients who cannot perform exercise.
Assuntos
Dobutamina/farmacologia , Eletrocardiografia/métodos , Teste de Esforço/métodos , Infarto do Miocárdio/fisiopatologia , Alta do Paciente , Idoso , Dobutamina/efeitos adversos , Teste de Esforço/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Valor Preditivo dos Testes , Estudos ProspectivosRESUMO
Exercise testing is a well known means of evaluating patients with unstable angina, but in recent years, alternative methods have been proposed. We prospectively compared standard exercise testing with dobutamine electrocardiographic stress testing for patients who were admitted with a diagnosis of unstable angina. A total of 43 patients were studied, divided into two different groups, according to the presence (group A n = 26) or absence (group B n = 17) of a previous history of coronary artery disease and/or electrocardiographic changes compatible with ischemia on admission. Dobutamine electrocardiographic stress testing was performed in a standard manner at 3 +/- 1 days after admission in group A and at 16 +/- 8 hours after admission in group B. Exercise testing was performed, on average 5 +/- 1 days following the event in group A and 2 days after admission in group B. Agreement between both tests was observed in 39 (91%) cases, Kappa value: 0.81. The dobutamine test predicted the result of the exercise test with a sensitivity of 79% (95% CI 54-90), and a specificity of 100% (95% CI 86-100), with a positive predictive value of 100% and a negative predictive value of 86%. It can be concluded that dobutamine electrocardiographic stress testing is an objective and reliable procedure that accurately predicts the results of standard exercise testing in patients with a diagnosis of unstable angina. If this result were confirmed with a greater number of patients, it would be a good option for definitive diagnosis and risk stratification, in addition to being inexpensive and easy to perform. It can also be particularly useful for patients who cannot perform exercise.
Assuntos
Angina Instável/diagnóstico , Angina Instável/fisiopatologia , Cardiotônicos , Dobutamina , Eletrocardiografia/métodos , Teste de Esforço , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Antituberculous (anti-TB) drug resistance has become a major tuberculosis control issue in the United States, where this situation has closely paralleled the current acquired immunodeficiency syndrome epidemic associated with human immunodeficiency virus type-1 (HIV-1) infections. In less developed countries, especially those like Nicaragua with an apparently low prevalence of known HIV-1 infections, less is known about the epidemiology of antituberculous drug resistance. To understand the potential extent of this problem in Nicaragua, we conducted a cross-sectional prevalence study at Nicaragua's only inpatient tuberculosis treatment facility, located in Leon, Nicaragua. A radiometric method was used during recovery, purification, and drug susceptibility testing of clinical Mycobacterium tuberculosis isolates. Resistance to at least one of the major anti-TB medications was found in 15 (40.5%) of 37 sputum isolates, of which seven (19%) were resistant to either isoniazid alone, or to isoniazid plus another agent other than rifampin. Five were resistant to at least isoniazid and rifampin (i.e., 13.5% demonstrated multidrug resistance). Two isolates were resistant to pyrazinamide alone, and one was resistant to streptomycin alone. These initial results suggest that anti-TB drug resistance is a defined problem for tuberculosis control programs in Nicaragua, a problem that is largely related to individual noncompliance, lack of extensive drug susceptibility testing facilities, and a general unavailability of expensive anti-TB medications for re-treatment. Ongoing surveillance for drug resistance, using the methodology presented here, might assist Nicaraguan public health officials in their tuberculosis control programs.
Assuntos
Antituberculosos/farmacologia , Resistência a Múltiplos Medicamentos , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Isoniazida/farmacologia , Masculino , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Nicarágua/epidemiologia , Prevalência , Pirazinamida/farmacologia , Radiometria , Rifampina/farmacologia , Escarro/microbiologia , Estreptomicina/farmacologia , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologiaRESUMO
The degree of eythrophagocytosis of two recently isolated strains of E. histolytica was measured by microscopic examination. Amebas isolated from a patient with amebic rectocolitis (strain HM22:IMSS, monoxenic) ingested human red blood cells faster and in larger numbers than trophozoites isolated from an asymptomatic carrier (HM27:IMSS, monoxenic). The results suggest that an increased rate of phagocytosis could be one of the surface properties characteristic of the invasive strains of E. histolytica.
Assuntos
Disenteria Amebiana/sangue , Entamoeba histolytica/fisiologia , Eritrócitos/parasitologia , Fagocitose , HumanosRESUMO
Mixed and monoxenic cultures of rectal exudates from three patients with amebiasis of colon, and of feces from three asymptomatic carriers of Entamoeba histolytica obtained after administration of a saline cathartic, and from a case of exudate of the perianal cutaneous lesion border produced by this parasite, were done. The culture media used were for: mixed culture, Boeck and Drbohlav modified culture and, for monoxenic culture, Diamond's monophasic TP-S-1 medium without vitamin mixture and using bovine serum. In order to inhibit the bacterial growth in the mixed culture, streptomycin sulphate and pencillin G were used. In order to eliminate the bacterial flora kanamicin sulphate, chloramphenicol, gentamycin and disodic carbenicillin were added. Mixed cultures of seven strains of Entamoeba histolytica were obtained: HM22:IMSS, HM23:IMSS, HM24:IMSS, HM26:IMSS, HM27:IMSS, HM28:IMSS y HM29:IMSS, and monoxenic culture with Bacteroids symbiosus of the strains HM22:IMSS and HM27:IMSS, with a previous adaptation in mixed culture. The adaptation of HM26:IMSS strain in monoxenic culture was obtained by means of direct seeding of the rectal exudate with Fusobacterium symbiosus.