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INTRODUCTION: The primary objective of the core data set is to reduce heterogeneity and promote harmonization among data sources in EM, thereby reducing the time needed to execute real life data collection efforts. Recently, a group led by the Multiple Sclerosis Data Alliance has developed a core data set for collecting real-world data on multiple sclerosis (MS) globally. Our objective was to adapt this global data set to the needs of Latin America, so that it can be implemented by the registries already developed and in the process of development in the region. MATERIAL AND METHODS: A working group was formed regionally, the core data set created globally was adapted (translation process into Spanish, incorporation of regional variables and consensus on variables to be used). Consensus was obtained through the remote Delphi methodology of a round of questionnaires and remote discussion of the core data set variables. RESULTS: A total of 25 professionals from Latin America carried out the adaptation process between November 2022 and July 2023. Agreement was established on a core data set of nine categories and 45 variables, version 2023 to suggest its implementation in developed or developing registries, and MS cohorts in the region. CONCLUSION: The core data set seeks to harmonize the variables collected by registries and cohorts in MS in Latin America in order to facilitate said collection and allow collaboration between sources. Its implementation will facilitate real life data collection and collaboration in the region.
TITLE: Core data set para la generación de datos de la vida real en esclerosis múltiple: adaptación de una iniciativa global para América Latina.Introducción. Los objetivos primarios del core data set son reducir la heterogeneidad y promover la armonización entre las fuentes de datos en la esclerosis múltiple (EM), reduciendo así el tiempo necesario para ejecutar esfuerzos en la recolección de datos de vida real. Recientemente, un grupo liderado por la Multiple Sclerosis Data Alliance ha desarrollado un core data set para la recolección de datos del mundo real en EM a nivel global. Nuestro objetivo ha sido adaptar y consensuar este conjunto de datos globales a las necesidades de América Latina para que pueda ser implementado por los registros ya desarrollados y en proceso de desarrollo en la región. Material y métodos. Se conformó un grupo de trabajo regionalmente y se adaptó el core data set creado globalmente (proceso de traducción al español, incorporación de variables regionales y consenso sobre variables que se iban a utilizar). El consenso se obtuvo a través de la metodología Delphi remoto de ronda de cuestionarios y discusión a distancia de las variables del core data set. Resultados. Veinticinco profesionales de América Latina llevaron adelante el proceso de adaptación entre noviembre de 2022 y julio de 2023. Se estableció un acuerdo sobre un core data set de nueve categorías y 45 variables, versión 2023, con la sugerencia de implementarlo en registros desarrollados o en vías de desarrollo y cohortes de EM en la región. Conclusión. El core data set busca armonizar las variables recolectadas por los registros y las cohortes de EM en América Latina con el fin de facilitar dicha recolección y permitir una colaboración entre fuentes. Su implementación facilitará la recolección de datos de vida real y la colaboración en la región.
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Esclerose Múltipla , Humanos , América Latina/epidemiologia , Esclerose Múltipla/epidemiologia , Comitês Consultivos , Consenso , Sistema de RegistrosRESUMO
Janzen's hypothesis (JH) posits that low thermal variation selects for narrow physiological tolerances, and thus small species distributional ranges and high species turnover along tropical elevational gradients. Although this hypothesis has been intensely revisited, it does not explain how many tropical species may exhibit broad distributions, encompassing altitudinal gradients. Moreover, the physiological responses of tropical species remain largely unknown, limiting our understanding on how they respond to climate variation. To fill these knowledge gaps, we tested a major component of JH, the climate variability hypothesis (CVH), which predicts broader thermal tolerance breadth (Tbr = CTmax - CTmin) with broader temperature variation. Specifically, we sampled populations of five amphibian species distributed in two mountain ranges in Brazil's Atlantic Forest to test how CTmin and CTmax vary along elevational gradients. Since both thermal and water balance traits are pivotal to the evolutionary history of amphibians, we also measured rates of dehydration and rehydration and their relations with thermal tolerances. We found that broader temperature variation with increasing altitude did not always lead to broader Tbr, since changes in CTmin and CTmax were species-specific. In addition, we found that water balance did not show consistent variation with altitude, also with low correlations between hydric and thermal traits. While we also found that highland populations are at lower risk of thermal stress than lowland counterparts, both are living far from their upper thermal limits. As a consequence of intraspecific variation in physiological traits and spatial variation in climate along altitude, responses to climate variation in tropical amphibian species were context-dependent and heterogeneous. Together with recent studies showing thermal tolerances of some tropical amphibians comparable to temperate taxa, our findings highlight that several responses to climate variation in tropical species may not conform to predictions made by either the CVH or other important hypotheses concerning physiological variation. This reinforces the need to overcome geographical bias in physiological data to improve predictions of climate change impacts on biodiversity. (Portuguese abstract) Resumo A Hipótese de Janzen (JH) postula que a baixa variação térmica seleciona tolerâncias fisiológicas estreitas e, portanto, amplitudes restritas de distribuição das espécies e alta substituição de espécies ao longo de gradientes altitudinais tropicais. Embora intensamente revisitada, essa hipótese não explica como espécies tropicais podem exibir amplas distribuições geográficas, abrangendo gradientes altitudinais. Além disso, as respostas fisiológicas das espécies tropicais permanecem amplamente desconhecidas, limitando nossa compreensão sobre como elas respondem à variação climática. Para preencher essas lacunas de conhecimento, testamos um componente importante da JH, a Hipótese de Variabilidade Climática (CVH), que prevê uma maior amplitude de tolerância térmica (Tbr = CTmax - CTmin) quando a variação da temperatura ambiental é mais ampla. Especificamente, amostramos populações de cinco espécies de anfíbios distribuídas em duas cadeias montanhosas na Mata Atlântica do Brasil para testar como CTmin e CTmax variam ao longo de gradientes de altitude. Dado que parâmetros térmicos e do balanço hídrico são fundamentais para a história evolutiva dos anfíbios, também medimos as taxas de desidratação e reidratação e suas relações com as tolerâncias térmicas. Encontramos que uma variação de temperatura ambiental mais ampla com o aumento da altitude nem sempre conduz a uma Tbr mais ampla, uma vez que as mudanças em CTmin e CTmax foram espécie-específicas. Além disso, encontramos que o balanço hídrico não apresentou variação consistente com a mudança de altitude, e que as correlações entre parâmetros hídricos e térmicos foram baixas. Embora populações das maiores altitudes apresentaram menor risco de estresse térmico do que populações da mesma espécie em altitudes menores, ambas estão vivendo longe de seus limites térmicos superiores. Em consequência da variação intraespecífica em parâmetros fisiológicos e variação espacial no clima ao longo da altitude, as respostas à variação climática em espécies de anfíbios tropicais foram contexto-dependentes e heterogêneas. Juntamente com estudos recentes indicando tolerâncias térmicas de alguns anfíbios tropicais comparáveis a de táxons temperados, nossas descobertas destacam que várias respostas à variação climática em espécies tropicais podem não estar de acordo com as previsões feitas pela CVH ou outras hipóteses importantes sobre a variação fisiológica. Isso reforça a necessidade de superar o viés geográfico em dados fisiológicos para aperfeiçoar previsões dos impactos das mudanças climáticas sobre a biodiversidade. (Spanish abstract) Resumen La hipótesis de Janzen (JH) postula que la baja variación térmica selecciona tolerancias fisiológicas estrechas y, por lo tanto, rangos de distribución de especies restringidos con alta rotación de especies a lo largo de gradientes de elevación tropicales. Aunque esta hipótesis ha sido intensamente discutida, no explica cómo várias especies tropicales pueden exhibir distribuciones amplias, abarcando gradientes altitudinales. Además, las respuestas fisiológicas de las especies tropicales siguen siendo bastante desconocidas, lo que limita la comprensión de cómo responden a la variación climática. Para llenar estos vacíos de conocimiento, examinamos un componente importante de JH, la Hipótesis de Variabilidad Climática (CVH), que predice mayor amplitud de tolerancia térmica (Tbr = CTmax - CTmin) cuando la variación de temperatura es más amplia. Específicamente, tomamos muestras de poblaciones de cinco especies de anfibios distribuidas en dos cadenas montañosas en el Bosque Atlántico de Brasil para verificar cómo CTmin y CTmax varían a lo largo de este gradiente de elevación. Dado que los rasgos de equilibrio térmico y hídrico son fundamentales para la historia evolutiva de los anfibios, también medimos las tasas de deshidratación y rehidratación y sus relaciones con las tolerancias térmicas. Encontramos que una variación de temperatura más amplia con el aumento de la altitud no siempre conduce a una Tbr más amplia, ya que los cambios en CTmin y CTmax son específicos de la especie. Además, encontramos que el balance hídrico no muestra variación consistente con la altitud, con bajas correlaciones también entre los rasgos hídricos y térmicos. Si bien las poblaciones de las tierras altas tienen un menor riesgo de estrés térmico que las contrapartes de las tierras bajas, ambas se encuentran lejos de sus límites térmicos superiores. Como consecuencia de la variación intraespecífica en los rasgos fisiológicos y la variación espacial en el clima a lo largo de la altitud, las respuestas a la variación climática en las especies de anfibios tropicales fueron dependientes del contexto y heterogéneas. Junto con estudios recientes que muestran tolerancias térmicas de algunos anfibios tropicales comparables a los taxones de zonas templadas, nuestros hallazgos resaltan que varias respuestas a la variación climática en especies tropicales pueden no ajustarse a las predicciones hechas por el CVH u otras hipótesis importantes sobre la variación fisiológica. Esto refuerza la necesidad de superar el sesgo geográfico en los datos fisiológicos para mejorar las predicciones de los impactos del cambio climático en la biodiversidad.
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OBJECTIVES: Decide how prison infrastructure guarantees health's right a suitable environment of Establecimiento Penitenciario Anexo de Mujeres de Chorrillos (EPAMCh) prisoners. MATERIAL AND METHOD: For the materials was used an interview guide addressed to 10 specialist and interview guide addressed to 30 prisoners. About the method, it was selected the qualitative approach, the applied type with the phenomenological design. RESULTS: The interview experts said that Establecimiento Penitenciario Anexo de Mujeres de Chorrillos current infrastructure and don´t give minima sanitary services. In the polls, the prisoners unanimously answered that conditions were precarious, but mostly said that they were willing to incorporate to a health education program and bet for a preventive medicine without forget the curative. DISCUSSION: Is Important foment the preventive medicine in order to get a strong health education in jails. To reverse this reality would mean change a guarantee in their health rights and a suitable environment.
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Atitude Frente a Saúde , Serviços Preventivos de Saúde , Prisioneiros/psicologia , Prisões/organização & administração , Direito à Saúde , Saúde da Mulher , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Entrevistas como Assunto , Peru , Pesquisa Qualitativa , Ajustamento SocialRESUMO
El Virus ZIKA se extendió por muchos países y se vinculó a Sindrome de Guillain Barre en una alta proporción de pacientes. Objetivos: determinar el comportamiento clínicoepidemiológico de Síndrome de Guillain Barré (SGB) e infección por ZIKV en el Hospital Ruíz y Páez, Ciudad Bolívar, Estado Bolívar, Venezuela, en 2015-2016. Métodos: estudio descriptivo, prospectivo, diseño longitudinal. La muestra correspondió a 30 pacientes ingresados con diagnóstico de SGB e infección por ZIKV. Resultados: Los síntomas principales fueron: debilidad muscular progresiva (66.67%), parestesias (40.00%) y parálisis (26.67%). El 40.00% refirió infección previa por ZIKV; Se realizaron pruebas serológicas al 100% de los pacientes y en 93.33% se encontró hiperproteinorraquia; De acuerdo a los criterios de Brighton se estableció que todos los pacientes en estudio eran casos de SGB (nivel de certeza tipo 2) Al menos 63.33% eran nivel de certeza tipo 1, al tener los reportes electrofisiológicos. Todos, cumplían con los criterios de Asbury & Cornblath (1990) para diagnóstico de SGB. Evolución: recibió plasmaféresis el 46,66% de la muestra y 83.33% egresó por mejoría. Conclusión: Los resultados expuestos establecen clara vinculación ZIKV-SGB(AU)
ZIKA virus has extended to many countries and was the cause of Guillain-Barre Syndrome in a high proportion of the patients. Objectives: to determinate the clinical and epidemiological behavior of this combination in the Hospital Ruíz y Páez, Ciudad Bolívar, Venezuela. Methods: this was a descriptive, prospective, longitudinal study. The sample was of 30 patients admitted with Guillain-Barre´s Syndrome (GBS) and ZIKA Virus infection. Results: the major symptoms were: progressive muscular weakness 66.67%, paresthesias 40.00% and paralysis 26.67%. 40.00% had presented previous ZIKV. In 93.33% high contents in CSF were found. Serologic studies were realized in all patients: positive ZIKV IgM was present in 73.33% and IgG in 26.67% positiva para ZIKV. Due to their clinical conditions, 36.67% wwere admitted to the ICU. Following Brighton´s criteria and Asbury & Cornblath, all had the diagnosis of GBS. Evolutión: plasmapheresis was used in 46,66% and 83.33% improved and left the hospital. Conclusion: In this study there was a clear evidence of ZIKV infection in patients con GBS(AU)
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Humanos , Masculino , Feminino , Doenças Transmissíveis , Síndrome de Guillain-Barré/patologia , Zika virus , Venezuela , Epidemiologia , Medicina InternaRESUMO
La administración de nutrición enteral (NE) se menciona de modo frecuente como causa de aparición de diarrea en el paciente en la Unidad de Cuidados Intensivos (UCI), por lo cual existe la tendencia a disminuir su aporte o incluso suspenderla, conducta que en muchas ocasiones causa un retraso en la recuperación nutricional del paciente, incrementando además el riesgo de infecciones asociadas. Realizamos un estudio descriptivo de serie de casos, realizado en la UCI de la Clínica Reina Sofía entre los meses de julio y octubre de 2015, siendo el principal criterio de inclusión la aparición de diarrea en pacientes a quienes se les inició NE en la UCI. El análisis estadístico se realizó mediante distribuciones de frecuencias absolutas y relativas expresadas en porcentajes. En variables cuantitativas se utilizaron medidas de tendencia central (promedio y mediana) y medidas de dispersión (rango y desviación estándar). La normalidad se analizó con el estadístico de Shapiro-Wilks. Hay que agregar que durante el período de estudio se identificaron siete pacientes con NE y episodios de EDA. La edad promedio de los pacientes incluidos fue de 73 años. Sin embargo, en ninguno de los casos se pudo establecer una relación directa entre los episodios de EDA y la administración de nutrición enteral
The administration of enteral nutrition (EN) is frequently mentioned as a cause of diarrhea in patients in Intensive Care Units (ICUs). Because of this, there is a tendency to reduce the use of EN or to even suspend it which often delays patients nutritional recovery and incurs risks of associated infections. This is a descriptive study of seven patients that was conducted in the ICU of the Clínica Reina Sofía from July to October 2015. The main criterion for inclusion was the occurrence of diarrhea in patients had been started on EN in the ICU. Statistical analyses used distributions of absolute and relative frequencies expressed in percentages. Measures of central tendency (mean and median) and measures of dispersion (range and standard deviation) were used for quantitative variables. The Shapiro-Wilk test was used to analyze normality. During the study period seven patients receiving EN who had episodes of diarrhea were identified. The average age of the patients was 73 years. No direct relationships between episodes of of diarrhea and administration of enteral nutrition could be established
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Humanos , Masculino , Feminino , Idoso , Disenteria , Nutrição Enteral , Unidades de Terapia IntensivaRESUMO
In this review, we discuss the observations that, following chronic high-fat diet (HFD) exposure, male mice have higher levels of saturated fatty acids (FAs) and total sphingolipids, whereas lower amounts of polyunsaturated FAs in the central nervous system (CNS) than females. Furthermore, males, when compared with female mice, have higher levels of inflammatory markers in the hypothalamus following exposure to HFD. The increase in markers of inflammation in male mice is possibly due to the reductions in proliferator-activated receptor gamma coactivator 1 alpha (PGC-1α) and estrogen receptor alpha (ERα), which is not recapitulated in female mice. Consistently, hypothalamic inflammation is induced both in male and female ERα total-body knockout mice when exposed to a HFD, thus confirming the key role of ERα in the regulation of HFD-induced hypothalamic inflammation. Finally, the HFD-induced depletion of hypothalamic ERα is associated with dysregulation in metabolic homeostasis, as evidenced by reductions in glucose tolerance and decrements in myocardial function.
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Hipotálamo/patologia , Inflamação/metabolismo , Obesidade/metabolismo , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/metabolismo , Animais , Dieta Hiperlipídica , Modelos Animais de Doenças , Receptor alfa de Estrogênio/metabolismo , Feminino , Hipotálamo/metabolismo , Inflamação/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Obesidade/patologia , Ácido Palmítico/metabolismo , Fatores Sexuais , Esfingolipídeos/metabolismo , Fatores de Transcrição/metabolismoRESUMO
La lepra es una enfermedad infecciosa crónica causada por el Mycobacterium leprae. Afecta la piel, mucosa de las vías respiratorias altas, ojos y nervios periféricos. El período de incubación de la enfermedad es, en promedio, de cinco años. Los síntomas pueden tardar hasta veinte años en aparecer. Es una enfermedad muy antigua; las antiguas civilizaciones de China, Egipto e India, muestran evidencia de casos de lepra, aproximadamente hacia el año 600 a. C. Actualmente existen zonas con alta incidencia en África, Asia y América Latina. En el presente artículo se describe un caso de Lepra lepromatosa, proveniente del suroriente de Venezuela y sus características inmunológicas, clínicas y diagnósticas con el fin de generar interés por la sospecha diagnóstica en pacientes con manifestaciones como las vistas en este paciente.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It affects the skin, upper respiratory mucosae, eyes and peripheral nerves. The incubation period of the disease is, on average, five years. Symptoms can take up to twenty years to appear. It is a very ancient disease, the eartly civilizations of China, Egypt and India, show evidence of leprosy cases, around the year 600 B. C. referido a nuestro hospital, donde se ingresa. Currently there are areas with high incidence in Africa, Asia and Latin America. In this article a case of lepromatous leprosy, from the southeastern Venezuela and its immunological characteristics are described in order to generate interest and social conscience in this epidemiological problem.
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Humanos , Masculino , Adulto , Hanseníase Virchowiana/diagnóstico , Mycobacterium leprae , Tempo de ReaçãoAssuntos
Humanos , Masculino , Pessoa de Meia-Idade , Antibióticos Antituberculose/uso terapêutico , Antituberculosos/uso terapêutico , Cavidade Pleural/patologia , Dispneia/patologia , Hidropneumotórax/complicações , Hidropneumotórax/diagnóstico , Tuberculose Latente/diagnóstico , Tuberculose Latente/patologiaRESUMO
Variation in squamate foot morphology is likely relevant during evolutionary processes of habitat colonization because distinct surfaces differ in energetic and functional demands for locomotion. We combined new foot morphological data with published information of limb and tail lengths to investigate evolutionary changes possibly associated with the differential usage of ecological settings by Tropidurinae species. Several traits exhibited significant phylogenetic signal, and we performed conventional and phylogenetic regressions of PC scores (retained from Principal Components Analyses of morphometric traits) on continuous ecological indices. Tropidurines from sandy habitats exhibit larger foot soles, opposite to the evolution of narrow feet in species that use branches and rocks. Also, species that usually move along trunks present longer femora. This study provides evidence for morphological adaptations associated with substrate usage in Tropidurinae, and suggests that opposite morphological profiles might evolve associated with the use of surfaces energetically and functionally contrasting, possibly leading to trade-offs.
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Adaptação Fisiológica , Lagartos/anatomia & histologia , Filogenia , Animais , Pé/anatomia & histologia , Pé/fisiologia , Lagartos/fisiologia , Locomoção , Masculino , Análise de Regressão , Cauda/anatomia & histologia , Cauda/fisiologiaRESUMO
We investigated the evolution of anuran locomotor performance and its morphological correlates as a function of habitat use and lifestyles. We reanalysed a subset of the data reported by Zug (Smithson. Contrib. Zool. 1978; 276: 131) employing phylogenetically explicit statistical methods (n = 56 species), and assembled morphological data on the ratio between hind-limb length and snout-vent length (SVL) from the literature and museum specimens for a large subgroup of the species from the original paper (n = 43 species). Analyses using independent contrasts revealed that classifying anurans into terrestrial, semi-aquatic, and arboreal categories cannot distinguish between the effects of phylogeny and ecological diversification in anuran locomotor performance. However, a more refined classification subdividing terrestrial species into 'fossorials' and 'non-fossorials', and arboreal species into 'open canopy', 'low canopy' and 'high canopy', suggests that part of the variation in locomotor performance and in hind-limb morphology can be attributed to ecological diversification. In particular, fossorial species had significantly lower jumping performances and shorter hind limbs than other species after controlling for SVL, illustrating how the trade-off between burrowing efficiency and jumping performance has resulted in morphological specialization in this group.
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Adaptação Biológica/fisiologia , Anuros/fisiologia , Evolução Biológica , Ecossistema , Membro Posterior/anatomia & histologia , Locomoção/fisiologia , Animais , Anuros/anatomia & histologia , Membro Posterior/fisiologia , Filogenia , Análise de Regressão , Especificidade da EspécieRESUMO
Different components of complex integrated systems may be specialized for different functions, and thus the selective pressures acting on the system as a whole may be conflicting and can ultimately constrain organismal performance and evolution. The vertebrate cranial system is one of the most striking examples of a complex system with several possible functions, being associated to activities as different as locomotion, prey capture, display and defensive behaviours. Therefore, selective pressures on the cranial system as a whole are possibly complex and may be conflicting. The present study focuses on the influence of potentially conflicting selective pressures (diet vs. locomotion) on the evolution of head shape in Tropidurinae lizards. For example, the expected adaptations leading to flat heads and bodies in species living on vertical structures may conflict with the need for improved bite performance associated with the inclusion of hard or tough prey into the diet, a common phenomenon in Tropidurinae lizards. Body size and six variables describing head shape were quantified in preserved specimens of 23 species, and information on diet and substrate usage was obtained from the literature. No phylogenetic signal was observed in the morphological data at any branch length tested, suggesting adaptive evolution of head shape in Tropidurinae. This pattern was confirmed by both factor analysis and independent contrast analysis, which suggested adaptive co-variation between the head shape and the inclusion of hard prey into the diet. In contrast to our expectations, habitat use did not constrain or drive head shape evolution in the group.
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Evolução Biológica , Dieta , Comportamento Alimentar/fisiologia , Cabeça/anatomia & histologia , Lagartos/anatomia & histologia , Locomoção/genética , Animais , Lagartos/genética , Lagartos/fisiologia , Locomoção/fisiologia , MasculinoRESUMO
Some anurans have a peculiar casqued head with the skin co-ossified with the underlying bones. This type of skull usually is associated with phragmosis, a protective behaviour in which the animal enters a hole and closes it with the head. Although co-ossification of the head in lissamphibians frequently has been associated with water economy, recent studies of Corythomantis greeningi, a casque-headed tree frog from semi-arid areas in north-eastern Brazil, suggest that cranial co-ossification contributes little to conservation of water in the frog. Instead, during phragmotic behaviour, the co-ossified head protects the animal against predators and indirectly enhances water balance. Thus, the primary role of co-ossification is defence, a hypothesis that is the focus of this study, which describes the morphology of the head of C. greeningi with an emphasis on the co-ossification and the venom glands. We report on behavioural features and on the toxicity of the cutaneous secretion produced by the abundant venom glands that are associated with large spicules on the skull.
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Animais , Anuros/anatomia & histologia , Anuros/classificaçãoRESUMO
The authors carried out a three-phase door-to-door survey in Atahualpa, Ecuador to assess epidemiologic and pathogenetic mechanisms of stroke. They found 10 stroke patients among 1,568 individuals aged > or =15 years (crude prevalence, 638 per 100,000). There was only one incident case (incidence, 64 per 100,000). Six of the 10 patients had hypertensive arteriolopathy (five with ischemic and one with hemorrhagic stroke). Additional work is needed to increase knowledge on stroke in developing countries.
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Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/epidemiologia , Comorbidade , Complicações do Diabetes/epidemiologia , Equador/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Prevalência , Recidiva , População Rural , Sensibilidade e Especificidade , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate the accuracy of an screening questionnaire for stroke detection in speaking-speaking communities. PATIENTS AND METHODS: We performed a door-to-door survey in Atahualpa (a rural community in coastal Ecuador) using a modified version of the Spanish translation of the OMS questionnaire for stroke detection. Subjects suspected of having a stroke as well as a 2% sample of negative subjects were evaluated by neurologists to evaluate sensitivity, specificity, and predictive value of the questionnaire and that of each of its questions. RESULTS: We found 18 possible cases among 1,568 individuals around 15 years old. Of these, 10 were confirmed stroke patients and 8 were false-positive (crude stroke prevalence of 6.38 per 1,000). We did not find false-negative cases. Sensitivity of the questionnaire was 100%, specificity was 99.5%, positive predictive value was 0.55 and negative predictive value was 1. The accuracy of each question as well as the number of questions answered as affirmative were different between patients and false-positive cases. CONCLUSIONS: The current questionnaire is highly sensitive but its positive predictive value is poor. This causes problems in large-scale studies, as the detection of many false-positives may compromise its viability. We propose a modification of the questionnaire that will turn it more accurate.
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Acidente Vascular Cerebral/diagnóstico , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
A close relationship between morphology and habitat is well documented for anoline lizards. To test the generality of this relationship in lizards, snout-vent, tail, and limb lengths of 18 species of Tropidurus (Tropiduridae) were measured and comparisons made between body proportions and substrate usage. Phylogenetic analysis of covariance by computer simulation suggests that the three species inhabiting sandy soils have relatively longer feet than do other species. Phylogenetic ANCOVA also demonstrates that the three species inhabiting tree canopies and locomoting on small branches have short tails and hind limbs. These three species constitute a single subclade within the overall Tropidurus phylogeny and analyses with independent contrasts indicate that divergence in relative tail and hind limb length has been rapid since they split from their sister clade. Being restricted to a single subclade, the difference in body proportions could logically be interpreted as either an adaptation to the clade's lifestyle or simply a nonadaptive synapomorphy for this lineage. Nevertheless, previous comparative studies of another clade of lizards (Anolis) as well as experimental studies of Sceloporus lizards sprinting on rods of different diameters support the adaptive interpretation.
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Extremidades/anatomia & histologia , Lagartos/anatomia & histologia , Cauda/anatomia & histologia , Animais , Meio Ambiente , Extremidades/fisiologia , Locomoção , Nariz/anatomia & histologia , Filogenia , Cauda/fisiologiaRESUMO
Este trabajo fué realizado en la población de palmasola, dondese estudió las características geográficas de la región (temperatura media anual, humeda relativa, precipitación media anual y tipo de vegetación predominante. Para la muestra se tomó a toda la población comformada por 74 familiares a las cuales se les realizó una encuesta sobre la dinámica poblacional de los habitantes en los últimos dos años con la finalidad de determinar si existe un movimiento poblacional importante hacia y desde zonas potencialmente éndemicas y épidemicas de malaria. Para verificar la resencia de mosquitos anofelinos transmisores del paludismo, se capturó en cada casa los mosquitos intra y peridomiciliarioen horario de 6pm a 10pm, donde no se detectó la presencia del vector en el áreaestudiada, ni algun caso de malaria entre sus habitantes
Assuntos
Recém-Nascido , Lactente , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Anopheles/patologia , Malária/epidemiologia , Controle Biológico de Vetores , Atenção Primária à Saúde , Saúde PúblicaRESUMO
Multivariate analyses of clinical presentation, subspecies identity of the causal organism, and the Leishmania-specific immune response parameters (indirect fluorescent antibody test [IFAT], cutaneous delayed type hypersensitivity [DTH], and in vitro lymphocyte transformation [LT]) of 441 patients with tegumentary leishmaniasis were used to examine the human host-parasite interaction in L. braziliensis infection. Mucocutaneous disease (P less than .002) and L. braziliensis braziliensis infection (P less than .001) were independently associated with significantly higher IFAT titers and cutaneous DTH than were cutaneous disease or L. braziliensis panamensis infection. Lesion size was also correlated with IFAT titer (P. less than .001). Although time of lesion evolution was highly correlated with all parameters, differences associated with subspecies and disease form were independent of lesion duration (three-way analysis of variance). In contrast with the cutaneous DTH response, the in vitro lymphocyte proliferative response to Leishmania antigen did not correlate with disease form and only weakly with infecting subspecies when time of evolution and subspecies were controlled. The association of mucosal disease presentation with a particular subspecies and the independent correlation of both variables with heightened IFAT titers and cutaneous DTH to Leishmania antigen supports the possibility of immune mechanisms of pathogenesis in human tegumentary leishmaniasis.