RESUMO
Ataxia-telangiectasia (AT) is a rare genetic disorder leading to neurological defects, telangiectasias, and immunodeficiency. We aimed to study the clinical and immunological features of Latin American patients with AT and analyze factors associated with mortality. Referral centers from 9 Latin American countries participated in this retrospective cohort study, and 218 patients were included. Median (IQR) ages at symptom onset and diagnosis were 1.0 (1.0-2.0) and 5.0 (3.0-8.0) years, respectively. Most patients presented recurrent airway infections, which was significantly associated with IgA deficiency. IgA deficiency was observed in 60.8% of patients and IgG deficiency in 28.6%. T- and B-lymphopenias were also present in most cases. Mean survival was 24.2 years, and Kaplan-Meier 20-year-survival rate was 52.6%, with higher mortality associated with female gender and low IgG levels. These findings suggest that immunologic status should be investigated in all patients with AT.
Assuntos
Ataxia Telangiectasia , Humanos , Feminino , Masculino , América Latina/epidemiologia , Ataxia Telangiectasia/mortalidade , Ataxia Telangiectasia/imunologia , Ataxia Telangiectasia/diagnóstico , Estudos Retrospectivos , Criança , Pré-Escolar , Adulto , Adolescente , Lactente , Síndromes de Imunodeficiência/mortalidade , Síndromes de Imunodeficiência/epidemiologia , Síndromes de Imunodeficiência/imunologia , Adulto JovemRESUMO
Image segmentation and computer vision are becoming more important in computer-aided design. A computer algorithm extracts image borders, colours, and textures. It also depletes resources. Technical knowledge is required to extract information about distinctive features. There is currently no medical picture segmentation or recognition software available. The proposed model has 13 layers and uses dilated convolution and max-pooling to extract small features. Ghost model deletes the duplicated features, makes the process easier, and reduces the complexity. The Convolution Neural Network (CNN) generates a feature vector map and improves the accuracy of area or bounding box proposals. Restructuring is required for healing. As a result, convolutional neural networks segment medical images. It is possible to acquire the beginning region of a segmented medical image. The proposed model gives better results as compared to the traditional models, it gives an accuracy of 96.05, Precision 98.2, and recall 95.78. The first findings are improved by thickening and categorising the image's pixels. Morphological techniques may be used to segment medical images. Experiments demonstrate that the recommended segmentation strategy is effective. This study rethinks medical image segmentation methods.
Assuntos
Aprendizado Profundo , Processamento de Imagem Assistida por Computador , Algoritmos , Processamento de Imagem Assistida por Computador/métodos , Redes Neurais de Computação , SoftwareRESUMO
La hemiagenesia tiroidea representa un trastorno congénito caracterizado por la ausencia de desarrollo de uno de los lóbulos tiroideos, asociado o no a ausencia del istmo. Es más frecuente en las mujeres y por lo general se presenta como falta del lóbulo izquierdo, con hipertrofia compensatoria del lóbulo contralateral. Su diagnóstico es generalmente incidental o por manifestaciones del lóbulo tiroideo presente. Se hizo una revisión bibliografía, en donde no se encontraron casos reportados en Venezuela de hemiagenesia o agenesia tiroidea, describiéndose el siguiente. Presentamos a una paciente de 50 años de edad, conocida con hipotiroidismo desde los 31 años, negando cualquier cirugía en el área de cabeza y cuello. Desde febrero 2019 presentó aumento progresivo de volumen en región anterior de cuello. Al examen físico se observó aumento de volumen en región anterior derecha del cuello, palpándose lóbulo tiroideo derecho aumentado de tamaño, de aspecto nodular, no doloroso. En ecosonograma tiroideo se concluyó como bocio tiroideo derecho de aspecto multinodular, con ausencia del lóbulo izquierdo. Perfil tiroideo dentro de límites normales. Se lleva a mesa operatoria corroborándose ausencia del lóbulo izquierdo y presentado en la biopsia definitiva hiperplasia nodular en el lóbulo derecho. Se discute su frecuencia, la forma de presentación y se hace revisión de la literatura(AU)
Thyroid hemiagenesis represents a congenital disorder characterized by the absence of development of one of thyroid lobes, associated or not with absence of isthmus. It is more frequent in women and generally presents as absence of the left lobe, with compensatory hypertrophy of the contralateral lobe. Its diagnosis is generally incidental or by manifestations of the present thyroid lobe. A bibliography review was made, where no cases reported in Venezuela of hemiagenesis or thyroid agenesis were found, describing the following. We present a 50-year-old patient, known with hypothyroidism since she was 31, denying any surgery in the head and neck area. Since February 2019, presented a progressive increase in volume in the anterior neck region. On physical examination, an increase in volume was observed in right anterior region of the neck, palpating an enlarged right thyroid lobe, with a nodular appearance and not painful. In a thyroid echo-sonogram, it was concluded as a right thyroid goiter with a multinodular appearance, with the absence of the left lobe. Thyroid profile within normal limits. It is taken to the operating table, confirming the absence of the left lobe and presented in the definitive biopsy nodular hyperplasia in the right lobe. Its frequency, form of presentation, and literature review are discussed(AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Glândula Tireoide/fisiopatologia , Bócio , Hipotireoidismo/cirurgia , Doenças da Glândula Tireoide , Tri-Iodotironina , UltrassonografiaRESUMO
RESUMEN Introducción: la perforación del íleon terminal es una causa de la peritonitis oscura, anunciado por la exacerbación del dolor abdominal asociado con la defensa muscular y la rigidez más pronunciado sobre la fosa ilíaca derecha. Sin embargo, muchos pacientes, en un estado tóxico grave, pueden ser no clásicas sus características clínicas y conllevar a demoras en el diagnóstico y la intervención quirúrgica adecuada Presentación de caso: se presenta el caso de una paciente operada de urgencias en la capital de las Islas Seychelles con diagnóstico de perforación no traumática del íleon terminal. Se realizó resección intestinal con anastomosis término lateral en dos planos con evolución favorable. Discusión: el desbridamiento simple y el cierre primario de la perforación es el procedimiento más comúnmente empleado, pero en casos en los que, además, se encuentra una contaminación importante con íleon terminal friable (causado por una presentación tardía, perforaciones múltiples o por peritonitis fecaloidea), se hace obviamente necesario algo más que el mero cierre de la perforación para reducir la incidencia de complicaciones mortales como la fístula fecaloidea. Conclusiones: los tempranos diagnóstico y tratamiento evitan procederes más complicados, y también están asociados a una menor morbilidad y mortalidad en estos pacientes, y en el paciente quirúrgico en general.
ABSTRACT Introduction: perforation of the terminal ileum is a cause of the dark peritonitis, announced by the exacerbation of the abdominal pain associated with the muscular defense and the more pronounced rigidity on the right iliac fossa. However, many patients, in a severe toxic state, may be non-classical clinical characteristics and lead to delays in diagnosis and appropriate surgical intervention. Case presentation: the case of an emergency operated patient is presented in the capital of the Seychelles Islands with a diagnosis of non-traumatic perforation of the terminal ileum. Intestinal resection was performed with lateral term anastomosis in two planes with favorable evolution. Discussion: simple debridement and primary closure of the perforation is the most commonly used procedure, but in cases in which there is also significant contamination with friable terminal ileum (caused by late presentation, multiple perforations or fecaloid peritonitis). ), something more than the mere closure of the perforation is obviously necessary to reduce the incidence of fatal complications such as the fecaloid fistula. Conclusions: early diagnosis and treatment avoid more complicated procedures, and they are also associated with lower morbidity and mortality in these patients, 3 and in the surgical patient in general.
RESUMO Introdução: a perfuração terminal do íleo é uma causa do peritonitis escuro, anunciada pela exacerbação da dor abdominal associadacom a defesa do músculo e a rigidez mais pronunciada sobre o poço ilíaco direito. Entretanto, muitos pacientes, emum estado tóxico severo, podem ser não-Classicalsuas características clínicas e conduziraos atrasos no diagnóstico e à intervençãocirúrgicaapropriada Apresentação do caso: o exemplo de um paciente emergência-operado no capital das ilhas de Seychelles comum diagnóstico da puncturanão-traumático do drenagem terminal é apresentado. A ressecção intestinal com anastomose de termo lateral foi realizada emdois planos comevoluçãofavorável. Discussão: o desbridamento simples e o fechamento preliminar da perfuraçãosão o procedimento o maisgeralmente usado, mas nos casos onde, além, a contaminação significativa com o drenagem terminal friável é encontrada (causada por umaapresentação atrasada, perfuraçõesmúltiplasou pelo peritonitis restos), torna-se obviamente necessáriomais do que apenas fechando a perfuração para reduzir a incidência de complicaçõesfataistais como a fístula restos. Conclusões: o diagnóstico precoce e o tratamentoevitamaçõesmais complicadas, e tambémestãoassociadoscom menor morbidade e mortalidadenesses pacientes3, e no paciente cirúrgicoemgeral.
RESUMO
RESUMEN Se presenta el caso de un paciente masculino de 9 años, ingresado en los servicios de pediatría y cirugía del Hospital General Peltier de la República de Djibouti, con diagnóstico de tumor abdominal gigante, el cual es intervenido quirúrgicamente y se realiza escisión completa del tumor quístico. El estudio anatomopatológico mostró quiste del mesenterio. Se revisa la literatura y se ofrecen consideraciones.
ABSTRACT We present the case of a 9-year-old male patient, admitted to the pediatrics and surgery departments of the Peltier General Hospital of the Republic of Djibouti, with a diagnosis of a giant abdominal tumor, which is operated on and a complete excision of the cystic tumor is performed. The anatomopathological study showed cyst of the mesentery. The literature is reviewed and considerations are offered.
RESUMO Apresentamos o caso de um paciente do sexo masculino, 9 anos, internado nos departamentos de pediatria e cirurgia do Hospital Geral de Peltier, República de Djibuti, com diagnóstico de tumor abdominal gigante, que é operado e completa excisão do tumor cístico. . O estudo anatomopatológico mostrou cisto do mesentério. A literatura é revisada e considerações são oferecidas.
RESUMO
BACKGROUND: Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting. METHODS: We conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment. RESULTS: Of 1701 participants treated for tuberculosis, 136 (8.0%) died during tuberculosis treatment. HIV-positive patients constituted 11.0% of the cohort and contributed to 34.6% of all deaths. HIV-positive patients were significantly more likely to die (25.1 vs. 5.9%, P < 0.001) and less likely to be cured (28.3 vs. 39.4%, P = 0.003). On multivariate analysis, positive HIV status (hazard ratio [HR] = 6.06; 95% confidence interval [CI], 3.96-9.27), unemployment (HR = 2.24; 95% CI, 1.55-3.25), and sputum acid-fast bacilli smear positivity (HR = 1.91; 95% CI, 1.10-3.31) were significantly associated with a higher hazard of death. CONCLUSIONS: We demonstrate that positive HIV status was a strong predictor of mortality among patients treated for tuberculosis in the early years after Peru started providing free antiretroviral therapy. As HIV diagnosis and antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational research should document the changing profile of HIV-associated tuberculosis mortality.
Assuntos
Infecções por HIV/complicações , Tuberculose/mortalidade , Adulto , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Peru/epidemiologia , Prevalência , Modelos de Riscos Proporcionais , Estudos Prospectivos , Tuberculose/epidemiologia , Tuberculose/etiologia , Adulto JovemRESUMO
BACKGROUND: Lost, delayed or incorrect laboratory results are associated with delays in initiating treatment. Delays in treatment for Multi-Drug Resistant Tuberculosis (MDR-TB) can worsen patient outcomes and increase transmission. The objective of this study was to evaluate the impact of a laboratory information system in reducing delays and the time for MDR-TB patients to culture convert (stop transmitting). SETTING: 78 primary Health Centers (HCs) in Lima, Peru. Participants lived within the catchment area of participating HCs and had at least one MDR-TB risk factor. The study design was a cluster randomized controlled trial with baseline data. The intervention was the e-Chasqui web-based laboratory information system. Main outcome measures were: times to communicate a result; to start or change a patient's treatment; and for that patient to culture convert. RESULTS: 1671 patients were enrolled. Intervention HCs took significantly less time to receive drug susceptibility test (DST) (median 11 vs. 17 days, Hazard Ratio 0.67 [0.62-0.72]) and culture (5 vs. 8 days, 0.68 [0.65-0.72]) results. The time to treatment was not significantly different, but patients in intervention HCs took 16 days (20%) less time to culture convert (pâ=â0.047). CONCLUSIONS: The eChasqui system reduced the time to communicate results between laboratories and HCs and time to culture conversion. It is now used in over 259 HCs covering 4.1 million people. This is the first randomized controlled trial of a laboratory information system in a developing country for any disease and the only study worldwide to show clinical impact of such a system. TRIAL REGISTRATION: ClinicalTrials.gov NCT01201941.
Assuntos
Sistemas de Informação em Laboratório Clínico/organização & administração , Comunicação , Erros Médicos/prevenção & controle , Qualidade da Assistência à Saúde , Tuberculose/diagnóstico , Tuberculose/terapia , Adolescente , Adulto , Antituberculosos/uso terapêutico , Bases de Dados Factuais , Países em Desenvolvimento , Feminino , Humanos , Laboratórios/organização & administração , Masculino , Testes de Sensibilidade Microbiana/normas , Pessoa de Meia-Idade , Peru , Pobreza , Modelos de Riscos Proporcionais , Estudos Prospectivos , Melhoria de Qualidade , Projetos de Pesquisa , Resultado do Tratamento , Tuberculose/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto JovemRESUMO
El micro carcinoma papilar de la glándula tiroidea son lesiones de 1 cm o menos, siendo su incidencia hasta en un 35% en series de autopsias en población general, y comúnmente son de buen pronóstico. Las metástasis distantes en el carcinoma diferenciado de tiroides son bien infrecuentes y su prevalencia puede variar entre un 5% al 23% de los casos, pero son extremadamente inusuales en el micro carcinoma tiroideo. Se relata un caso clínico de una paciente de 38 años de edad; quien consultó por insuficiencia respiratoria aguda realizando el diagnóstico de micro carcinoma papilar con metástasis pulmonares y se describe su manejo, encontrándose actualmente eutiroidea, controlada su enfermedad, con tratamiento hormonal supresivo y con niveles de tiroglobulinas y anticuerpos antitiroglobulinas normales
The papillary micro carcinoma thyroid gland is injuries of 1 cm or less, with incidence until 35% in series of autopsies in general population, and is commonly considered as a good prognosis. The distant metastases in the differentiated thyroid carcinoma are infrequent and its prevalence varies from 5% to 23% of all cases, but is extremely unusual in the thyroid micro carcinoma. We describe a clinical case of a female patient of 38 years old; who consulted us by acute respiratory failure, we are making the diagnosis of a papillary micro carcinoma with lung metastases and describes its handling, and finding currently normal thyroid hormone value and controlled her disease, the suppression hormonal treatment, tyro globulin and anti- tyro globulins antibody normal levels
Assuntos
Feminino , Carcinoma Papilar/complicações , Carcinoma Papilar/diagnóstico , Metástase Neoplásica/diagnóstico , Neoplasias da Glândula Tireoide , Insuficiência Respiratória/patologia , OncologiaRESUMO
Actualmente, la invención de materiales sintéticos ha mejorado los tubos para traqueostomía y han reducido la tasa de complicaciones del procedimiento de traqueostomía. La prolongada incubación de este proceso de insolvencia en nuestro país, ha producido una escases importante de insumos médicos quirúrgicos, lo que trae como consecuencia, ciertas improvisaciones con el fin de aliviar la carga al enfermo y así contribuir con una mejor calidad de vida para este. En este trabajo, describimos y proponemos y tipo de traqueostomo casero, con lo cual hemos ayudado a algunos pacientes a resolver el déficit de los mismos en el mercado interno nacional
Currently, the invention of synthetic materials has improved the tracheotomy tubes and it has reduced the rate of the complications from the procedure of tracheotomy. The prolonged incubation process of the insolvency in our country, has produced a major severe surgical and medical supplies, which comes as a result and certain improvisations in reducing the burden to the sick, and thus contribute to a better quality of life for the patient. In this paper, we describe and propose a type of made home tracheostom, which we have helped some of patients to resolve the deficit of the same national domestic market
Assuntos
Humanos , Masculino , Feminino , Estenose Traqueal/terapia , Traqueostomia/métodos , SeringasRESUMO
OBJECTIVES: To evaluate the costs of three methods for the diagnosis of drug susceptibility in tuberculosis, and to compare the cost per case of Multidrug-resistant tuberculosis (MDR TB) diagnosed with these (MODS, GRIESS and Genotype MTBDR plus®) in 4 epidemiologic groups in Peru. MATERIALS AND METHODS: In the basis of programmatic figures, we divided the population in 4 groups: new cases from Lima/Callao, new cases from other provinces, previously treated patients from Lima/Callao and previously treated from other provinces. We calculated the costs of each test with the standard methodology of the Ministry of Health, from the perspective of the health system. Finally, we calculated the cost per patient diagnosed with MDR TB for each epidemiologic group. RESULTS: The estimated costs per test for MODS, GRIESS, and Genotype MTBDR plus® were 14.83. 15.51 and 176.41 nuevos soles respectively (the local currency, 1 nuevos sol=0.36 US dollars for August, 2011). The cost per patient diagnosed with GRIESS and MODS was lower than 200 nuevos soles in 3 out of the 4 groups. The costs per diagnosed MDR TB were higher than 2,000 nuevos soles with Genotype MTBDR plus® in the two groups of new patients, and lower than 1,000 nuevos soles in the group of previously treated patients. CONCLUSIONS: In high-prevalence groups, like the previously treated patients, the costs per diagnosis of MDR TB with the 3 evaluated tests were low, nevertheless, the costs with the molecular test in the low- prevalence groups were high. The use of the molecular tests must be optimized in high prevalence areas.
Assuntos
Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/economia , Técnicas Bacteriológicas/economia , Técnicas Bacteriológicas/métodos , Custos e Análise de Custo , Humanos , Peru/epidemiologia , Fatores de Tempo , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologiaRESUMO
Objetivos. Evaluar los costos de tres métodos diagnósticos para susceptibilidad a drogas antituberculosas y comparar el costo por caso de tuberculosis multidrogorresistente (TB MDR) diagnosticado con estos (MODS; GRIESS y Genotype MTBDR plus ® en cuatro grupos epidemiológicos en el Perú. Materiales y métodos. En base a cifras programáticas, se dividió a la población en cuatro grupos: pacientes nuevos de Lima/Callao; nuevos de otras provincias; los antes tratados de Lima/Callao y de otras provincias. Se calcularon los costos de cada prueba en base a la metodología estándar utilizada por el Ministerio de Salud, desde la perspectiva de los servicios de salud. Basado en ello, se calculó el costo por paciente TB MDR diagnosticado para cada grupo epidemiológico. Resultados. Los costos estimados por prueba para MODS, GRIESS, y Genotype MTBDR plus ® fueron de 14,83; 15,51 y 176,41 nuevos soles, respectivamente. El costo por paciente TB MDR diagnosticado con GRIESS y MODS fue menor a los 200 nuevos soles en tres de los cuatro grupos. El costo por TB MDR diagnosticado fue de más de 2000 nuevos soles con el Genotype MTBDR plus ® en los dos grupos de pacientes nuevos y, menores a 1000 nuevos soles en los grupos de pacientes antes tratados. Conclusiones. En grupos de alta prevalencia, como son los pacientes antes tratados, los costos por caso diagnosticado de TB MDR con las tres pruebas evaluadas fueron bajos, sin embargo, con la prueba molecular en los grupos de baja prevalencia, fueron elevados. El uso de las pruebas moleculares debe optimizarse en grupos de altas prevalencias.
Objectives.To evaluate the costs of three methods for the diagnosis of drug susceptibility in tuberculosis, and to compare the cost per case of Multidrug-resistant tuberculosis (MDR TB) diagnosed with these (MODS, GRIESS and Genotype MTBDR plus ® in 4 epidemiologic groups in Peru. Materials and methods.In the basis of programmatic figures, we divided the population in 4 groups: new cases from Lima/Callao, new cases from other provinces, previously treated patients from Lima/Callao and previously treated from other provinces. We calculated the costs of each test with the standard methodology of the Ministry of Health, from the perspective of the health system. Finally, we calculated the cost per patient diagnosed with MDR TB for each epidemiologic group. Results. The estimated costs per test for MODS, GRIESS, and Genotype MTBDR plus® were 14.83. 15.51 and 176.41 nuevos soles respectively (the local currency, 1 nuevos sol=0.36 US dollars for August, 2011). The cost per patient diagnosed with GRIESS and MODS was lower than 200 nuevos soles in 3 out of the 4 groups. The costs per diagnosed MDR TB were higher than 2,000 nuevos soles with Genotype MTBDR plus ® in the two groups of new patients, and lower than 1,000 nuevos soles in the group of previously treated patients. Conclusions. In high-prevalence groups, like the previously treated patients, the costs per diagnosis of MDR TB with the 3 evaluated tests were low, nevertheless, the costs with the molecular test in the low- prevalence groups were high. The use of the molecular tests must be optimized in high prevalence areas.
Assuntos
Humanos , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/economia , Técnicas Bacteriológicas/economia , Técnicas Bacteriológicas/métodos , Custos e Análise de Custo , Peru/epidemiologia , Fatores de Tempo , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologiaRESUMO
Los quistes óseos aneurismáticos del área de cabeza y cuello representan menos del 5% de todos los tumores óseos. Son lesiones benignas, que comúnmente afectan las metáfisis de los huesos largos y las vértebras como en el caso que se describe a continuación, simulando una lesión de la rinofaringe. Se describe su manejo y tratamiento.
The aneurismal of bone cyst of the head and neck localization, represent less than the 5% of the all bone tumors. They are benign lesions, and commonly affecting the metaphysis of the long bones and vertebrae, like in the case we described below, it simulating the rhino pharynx lesion. We describe the management and treatment.
Assuntos
Humanos , Masculino , Adolescente , Nasofaringe/anatomia & histologia , Nasofaringe/lesões , Cistos Ósseos Aneurismáticos/patologia , Cistos Ósseos Aneurismáticos/radioterapia , Diagnóstico por Imagem/métodos , Granuloma Eosinófilo/diagnósticoRESUMO
The Peruvian National Tuberculosis Control Program issued guidelines in 2006 specifying criteria for culture and drug-susceptibility testing (DST), including district-level rapid DST. All patients referred for culture and DST in 2 districts of Lima, Peru, during January 2005-November 2008 were monitored prospectively. Of 1,846 patients, 1,241 (67.2%) had complete DST results for isoniazid and rifampin; 419 (33.8%) patients had multidrug-resistant (MDR) TB at the time of referral. Among patients with new smear-positive TB, household contact and suspected category I failure were associated with MDR TB, compared with concurrent regional surveillance data. Among previously treated patients with smear-positive TB, adult household contact, suspected category II failure, early relapse after category I, and multiple previous TB treatments were associated with MDR TB, compared with concurrent regional surveillance data. The proportion of MDR TB detected by using guidelines was higher than that detected by a concurrent national drug-resistance survey, indicating that the strategy effectively identified patients for DST.
Assuntos
Antituberculosos/farmacologia , Farmacorresistência Bacteriana Múltipla , Programas de Rastreamento/métodos , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Humanos , Isoniazida/farmacologia , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/isolamento & purificação , Peru/epidemiologia , Vigilância da População/métodos , Guias de Prática Clínica como Assunto , Prevalência , Rifampina/farmacologia , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologiaRESUMO
OBJECTIVE: To evaluate the time to communicate laboratory results to health centers (HCs) between the e-Chasqui web-based information system and the pre-existing paper-based system. METHODS: Cluster randomized controlled trial in 78 HCs in Peru. In the intervention group, 12 HCs had web access to results via e-Chasqui (point-of-care HCs) and forwarded results to 17 peripheral HCs. In the control group, 22 point-of-care HCs received paper results directly and forwarded them to 27 peripheral HCs. Baseline data were collected for 15 months. Post-randomization data were collected for at least 2 years. Comparisons were made between intervention and control groups, stratified by point-of-care versus peripheral HCs. RESULTS: For point-of-care HCs, the intervention group took less time to receive drug susceptibility tests (DSTs) (median 9 vs 16 days, p<0.001) and culture results (4 vs 8 days, p<0.001) and had a lower proportion of 'late' DSTs taking >60 days to arrive (p<0.001) than the control. For peripheral HCs, the intervention group had similar communication times for DST (median 22 vs 19 days, p=0.30) and culture (10 vs 9 days, p=0.10) results, as well as proportion of 'late' DSTs (p=0.57) compared with the control. CONCLUSIONS: Only point-of-care HCs with direct access to the e-Chasqui information system had reduced communication times and fewer results with delays of >2 months. Peripheral HCs had no benefits from the system. This suggests that health establishments should have point-of-care access to reap the benefits of electronic laboratory reporting.
Assuntos
Sistemas de Informação em Laboratório Clínico/organização & administração , Eficiência Organizacional , Disseminação de Informação , Sistemas Multi-Institucionais/organização & administração , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Humanos , Análise de Intenção de Tratamento , Internet , Programas Nacionais de Saúde/organização & administração , Peru , Fatores de Tempo , Tuberculose/diagnósticoRESUMO
Demostrar que la cirugía de intervalo constituye una opción terapéutica efectiva en el aumento de la resecabilidad tumoral, mejorando la sobrevida de aquellas pacientes con tumores epiteliales de ovario clasificados como estadio III y catalogados como "no resecables". Estudio retrospectivo y descriptivo de las pacientes pertenecientes al servicio de ginecología del Hospital Oncológico "Padre Machado" con el diagnóstico de tumor epitelial de ovario clasificados como estadio III, incluidos en un protocolo de cirugía de intervalo, en el período septiembre 2002- septiembre 2007. Fueron identificadas 13 pacientes. El esquema de quimioterapia utilizado en todos los casos fue el de paclitaxel a dosis de 175mg/m² y carboblatino 5ABC, con una media de 4,46 ciclos. Se estableció una respuesta posterior a la quimioterapia primaria mayor al 50 por ciento 76,92 por ciento de los pacientes. La cirugía de intervalo aumenta el porcentaje de resecabilidad y disminuye el porcentaje de complicaciones posoperatorias, no evidenciándose beneficios estadísticamente significativos en términos de aumento de la sobrevida libre de enfermedad.
To demonstrate that interval debulking surgery constitutes an effective therapeutic option in the increase of the tumor like resected, improving the over life of those patients with epithelial tumors of ovary classified III stage, catalogued like none resected. Retrospective and descriptive study of the patients that assisted the service of gynecology of the Oncology Hospital Padre Machado with the diagnosis of epithelial tumor of ovary III stage, included in protocol interval debulking surgery, during the period September 2002-September 2007. 13 patients were identified. The scheme of chemotherapy used in all the cases was paclitaxel at dose of 175mg/m² and carboblatin 5ABC, with a media of 4.46 cycles. An answer greater than 50 % was settled down subsequent to the primary chemotherapy in a 76.92 % of the patients. The interval debulking surgery increases the percentage of respectability and diminishes the percentage of postoperative complications, not demonstrating itself significant benefits in terms of increase in the free disease period.
Assuntos
Humanos , Adulto , Feminino , Pessoa de Meia-Idade , Neoplasias Ovarianas/cirurgia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/tratamento farmacológico , Paclitaxel/administração & dosagem , Carcinoma/patologia , Oncologia , Paclitaxel/farmacologiaRESUMO
El objetivo del presente trabajo fue el de establecer la diferencia estadística, con relación a sobrevida global e intervalo libre de enfermedad en pacientes con carcinoma endometrial clasificadas como estadio II-B, tratadas en el servicio de ginecología del Hospital Padre Machado unas con radioterapia preoperatoria más cirugía y otras que fueron tratadas con cirugía más radioterapia posoperatoria. Se incluyen 23 pacientes con carcinoma endometrial clasificadas como estadio II-B, vistas y tratadas entre 1990-2001; a 15 de las pacientes, se les practicó cirugía más radioterapia posoperatoria, y a 8 de las pacientes radioterapia externa más braquiterapia preoperatoria y luego cirugía. El tratamiento quirúrgico para ambos grupos fue el denominado protocolo de endometrio. La edad promedio fue 60 años. La dosis promedio de radioterapia externa fue 50 Gy para el grupo con radioterapia posoperatoria y de 70 Gy para aquellas con radioterapia preoperatoria. La tasa de recurrencia y sobrevida global fue del 20 por ciento y 86,67 por ciento respectivamente, en pacientes con tratamiento quirúrgico primario, en comparación con el 12,5 por ciento y 87,5 por ciento, de aquellas tratadas con radioterapia preoperatoria. No hubo diferencia estadísticamente significativa entre ambos grupos, con relación a sobrevida global e intervalo libre de enfermedad.
The objective of these work was the evaluated of the statistics difference between global survive and interval free disease in patients with endometrial carcinoma classified how stage II B, treated in the gynecological service of the Padre Machado Hospital, one of the patients treated with radiotherapy before surgery and the other treated with radiotherapy after the surgery. We included 23 patients with endometrial carcinoma stage IIB seen and treated between 1990- 2001, to 15 of the patients were tried with surgery plus external radiotherapy and 8 of the patients with radiotherapy and brachytherapy before the surgery. The surgical procedures performed for the two groups were the nominated endometrial protocol. The common age was 60 years. The group with radiotherapy postoperative received a promedial dose of 50 Gy, and the group with preoperative radiotherapy received a dose of 70 Gy. The tease of recurrence and global survive was of 20 % and 86.67 % respectively in patients with surgery as primary treatment, in compare with 12.5% and 87.5 % of the patients with radiotherapy preoperative. There is not any significant statistic in relation to interval free disease survival and to the global survival between the both groups.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Braquiterapia/métodos , Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/radioterapia , Radioterapia/métodos , Adenocarcinoma/cirurgia , Adenocarcinoma/radioterapia , Prontuários Médicos , OncologiaRESUMO
13% of all drug susceptibility tests (DSTs) performed at a public laboratory in Peru were duplicate. To determine reasons for duplicate requests an online survey was implemented in the e-Chasqui laboratory information system. Results showed that 59.6% of tests were ordered because clinical staff was unaware of ordering guidelines or of a previous result. This shows a benefit of using a web-based system and the lack of laboratory information available to clinical staff in Peru.
Assuntos
Sistemas de Informação em Laboratório Clínico/normas , Laboratórios/normas , Testes de Sensibilidade Microbiana/normas , Guias de Prática Clínica como Assunto , Competência Profissional/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Peru , Controle de QualidadeRESUMO
BACKGROUND: The seventh pandemic of Vibrio cholerae unexpectedly reached the coast of Peru in 1991, causing an explosive emergence of infections throughout the American continents. The origin and routes of dissemination are as yet unknown. A new Vibrio epidemic arose in 1997 in South America (northern Chile) when the pandemic clone of Vibrio parahaemolyticus was for the fist time detected outside of Asia. These 2 cases were concurrent with 2 episodes of El Niño. METHODS: We carried out a survey of records of V. parahaemolyticus infection and of strains existing in the Instituto Nacional de Salud of Peru between 1994 and 2005. Association between the El Niño event and the V. parahaemolyticus disease was analyzed through generalized additive models applied to time-series data with negative binomial response, selecting some oceanographic factors distinctive of the movement of the El Niño waters. RESULTS: Epidemiologic data and laboratory investigations of the strains showed that V. parahaemolyticus infections caused by the pandemic clone emerged in the coasts of Peru linked to the 1997 El Niño episode. The epidemic dissemination of this clone matched the expansion and dynamics of the poleward propagation and the receding of the El Niño waters. This pattern was similar to previously reported onset of cholera epidemic in 1991. CONCLUSIONS: These findings identify the El Niño episodes as a reliable vehicle for the introduction and propagation of Vibrio pathogens in South America. The movement of oceanic waters seems to be one of the driving forces of the spread of Vibrio diseases.
Assuntos
Surtos de Doenças , Estações do Ano , Vibrioses/epidemiologia , Vibrio parahaemolyticus , Movimentos da Água , Humanos , Peru/epidemiologia , Risco , Sorotipagem , Vibrioses/etiologia , Vibrio cholerae/isolamento & purificação , Vibrio parahaemolyticus/classificação , Vibrio parahaemolyticus/isolamento & purificação , Tempo (Meteorologia)RESUMO
A score that can accurately determine the risk of major bleeding during anticoagulant therapy may help to make decisions on anticoagulant use. RIETE is an ongoing registry of consecutive patients with acute venous thromboembolism (VTE). We composed a score to predict the risk for major bleeding within three months of anticoagulant therapy. Of 19,274 patients enrolled, 13,057 (67%) were randomly assigned to the derivation sample, 6,572 to the validation sample. In the derivation sample 314 (2.4%) patients bled (fatal bleeding, 105). On multivariate analysis, age >75 years, recent bleeding, cancer, creatinine levels >1.2 mg/dl, anemia, or pulmonary embolism at baseline were independently associated with an increased risk for major bleeding. A score was composed assigning 2 points to recent bleeding, 1.5 to abnormal creatinine levels or anemia, 1 point to the remaining variables. In the derivation sample 2,654 (20%) patients scored 0 points (low risk); 9,645 (74%) 1-4 points (intermediate); 758 (5.8%) >4 points (high risk). The incidences of major bleeding were: 0.3% (95% confidence interval [CI]: 0.1-0.6), 2.6% (95% CI: 2.3-2.9), and 7.3% (95% CI: 5.6-9.3), respectively. The likelihood ratio test was: 0.14 (95% CI: 0.07-0.27) for patients at low risk;2.96 (95% CI: 2.18-4.02) for those at high risk. In the validation sample the incidence of major bleeding was: 0.1%, 2.8%, and 6.2%, respectively. In conclusion, a risk score based on six variables documented at entry can identify VTE patients at low, intermediate, or high risk for major bleeding during the first three months of therapy.
Assuntos
Anticoagulantes/efeitos adversos , Hemorragia/induzido quimicamente , Tromboembolia Venosa/tratamento farmacológico , Doença Aguda , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anemia/complicações , Argentina/epidemiologia , Creatinina/sangue , Europa (Continente)/epidemiologia , Feminino , Hemorragia/sangue , Hemorragia/epidemiologia , Humanos , Incidência , Israel/epidemiologia , Funções Verossimilhança , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Prospectivos , Embolia Pulmonar/complicações , Sistema de Registros , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Tromboembolia Venosa/sangue , Tromboembolia Venosa/epidemiologiaRESUMO
Over the past 10 years, the Peruvian National Tuberculosis (TB) Program, the National Reference Laboratory (NRL), Socios en Salud, and US partners have worked to strengthen the national TB laboratory network to support treatment of multidrug-resistant TB. We review key lessons of this experience. The preparation phase involved establishing criteria for drug susceptibility testing (DST), selecting appropriate DST methods, projecting the quantity of DST and culture to ensure adequate supplies, creating biosafe laboratory facilities for DST, training laboratory personnel on methods, and validating DST methods at the NRL. Implementation involved training providers on DST indications, validating conventional and rapid first-line DST methods at district laboratories, and eliminating additional delays in specimen transport and result reporting. Monitoring included ongoing quality control and quality assurance procedures. Hurdles included logistics, coordinating with policy, competing interests, changing personnel, communications, and evaluation. Operational research guided laboratory scale-up and identified barriers to effective capacity building.