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BACKGROUND: Chagas disease (CD) treatment is commonly associated with a high incidence of adverse effects. It is crucial to study and update these adverse effects to improve the existing knowledge of which drugs to use and to clarify the information presented to patients. METHODS: We analyzed the adverse effects of benznidazole in two cohorts of patients: a large retrospective study and a small prospective study. RESULTS: This large retrospective study described the most and least common adverse effects in our area and characterized our Chagas disease population. This prospective study, along with a close follow-up of the treatment, detected more adverse effects and enhanced the patients' perception of the disease and treatment. CONCLUSIONS: This information is important for preventing non-medical-related withdrawals and for removing baseless fears. Better knowledge of patients could help us provide better care.
Assuntos
Doença de Chagas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Nitroimidazóis , Tripanossomicidas , Trypanosoma cruzi , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Doença Crônica , Tripanossomicidas/efeitos adversos , Doença de Chagas/tratamento farmacológico , Doença de Chagas/epidemiologia , Nitroimidazóis/efeitos adversosRESUMO
ABSTRACT Background: Chagas disease (CD) treatment is commonly associated with a high incidence of adverse effects. It is crucial to study and update these adverse effects to improve the existing knowledge of which drugs to use and to clarify the information presented to patients. Methods: We analyzed the adverse effects of benznidazole in two cohorts of patients: a large retrospective study and a small prospective study. Results: This large retrospective study described the most and least common adverse effects in our area and characterized our Chagas disease population. This prospective study, along with a close follow-up of the treatment, detected more adverse effects and enhanced the patients' perception of the disease and treatment. Conclusions: This information is important for preventing non-medical-related withdrawals and for removing baseless fears. Better knowledge of patients could help us provide better care.
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A novel manufacturing approach was used to fabricate metallic scaffolds. A calibration of the laser cutting process was performed using the kerf width compensation in the calculations of the tool trajectory. Welding defects were studied through X-ray microtomography. Penetration depth and width resulted in relative errors of 9.4%, 1.0%, respectively. Microhardness was also measured, and the microstructure was studied in the base material. The microhardness values obtained were 400 HV, 237 HV, and 215 HV for the base material, HAZ, and fusion zone, respectively. No significant difference was found between the microhardness measurement along with different height positions of the scaffold. The scaffolds' dimensions and porosity were measured, their internal architecture was observed with micro-computed tomography. The results indicated that geometries with dimensions under 500 µm with different shapes resulted in relative errors of ~2.7%. The fabricated scaffolds presented an average compressive modulus ~13.15 GPa, which is close to cortical bone properties. The proposed methodology showed a promising future in bone tissue engineering applications.
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Laparoscopic surgery demands highly skilled surgeons. Traditionally, a surgeon's knowledge is acquired by operating under a mentor-trainee method. In recent years, laparoscopic simulators have gained ground as tools in skill acquisition. Despite the wide range of laparoscopic simulators available, few provide objective feedback to the trainee. Those systems with quantitative feedback tend to be high-end solutions with limited availability due to cost. A modular smart trainer was developed, combining tool-tracking and force-using employing commercially available sensors. Additionally, a force training system based on polydimethylsiloxane (PDMS) phantoms for sample stiffness differentiation is presented. This prototype was tested with 39 subjects, between novices (13), intermediates (13), and experts (13), evaluating execution differences among groups in training exercises. The estimated cost is USD $200 (components only), not including laparoscopic instruments. The motion system was tested for noise reduction and position validation with a mean error of 0.94 mm. Grasping force approximation showed a correlation of 0.9975. Furthermore, differences in phantoms stiffness effectively reflected user manipulation. Subject groups showed significant differences in execution time, accumulated distance, and mean and maximum applied grasping force. Accurate information was obtained regarding motion and force. The developed force-sensing tool can easily be transferred to a clinical setting. Further work will consist on a validation of the simulator on a wider range of tasks and a larger sample of volunteers.
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Competência Clínica , Laparoscopia , Simulação por Computador , Retroalimentação , Humanos , Fenômenos Mecânicos , Interface Usuário-ComputadorRESUMO
In this paper, we characterized an assortment of photopolymers and stereolithography processes to produce 3D-printed molds and polydimethylsiloxane (PDMS) castings of micromixing devices. Once materials and processes were screened, the validation of the soft tooling approach in microfluidic devices was carried out through a case study. An asymmetric split-and-recombine device with different cross-sections was manufactured and tested under different regime conditions (10 < Re < 70). Mixing performances between 3% and 96% were obtained depending on the flow regime and the pitch-to-depth ratio. The study shows that 3D-printed soft tooling can provide other benefits such as multiple cross-sections and other potential layouts on a single mold.
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In recent decades and because of migration, Chagas disease has become a global public health problem. A significant focus has been placed on pregnant women who can transmit the disease to their offspring. Here, we report four cases of women who did not know that they were pregnant while they were being treated with benznidazole. A diagnosis was established according to serology and Trypanosoma cruzi polymerase chain reaction (PCR)-standardized tests. Treatment was discontinued when pregnancy was confirmed, and a thorough follow-up was carried out. Although each case was different, none of the mothers developed health problems during pregnancy, and their newborns were delivered without any teratogenic effects.
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Doença de Chagas/complicações , Nitroimidazóis/uso terapêutico , Complicações Parasitárias na Gravidez/tratamento farmacológico , Tripanossomicidas/uso terapêutico , Adolescente , Adulto , Bolívia , Doença de Chagas/congênito , Doença de Chagas/tratamento farmacológico , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/tratamento farmacológico , Doenças do Recém-Nascido/parasitologia , Nitroimidazóis/efeitos adversos , Gravidez , Tripanossomicidas/efeitos adversos , Trypanosoma cruziRESUMO
Recently, ultrasonic molding (USM) has emerged as a promising replication technique for low and medium volume production of miniature and micro-scale parts. In a relatively short time cycle, ultrasonic molding can process a wide variety of polymeric materials without any noticeable thermal degradation into cost-effective molded parts. This research work reviews recent breakthroughs of the ultrasonic injection molding and ultrasonic compression molding process regarding the equipment and tooling development, materials processing and potential applications in the medical industry. The discussion is centered on the challenges of industrializing this technology, pointing out the need for improvement of the current process's robustness and repeatability. Among the most important research areas that were identified are the processing of novel engineered and nanomaterials, the understanding and control of the ultrasonic plasticization process and the tooling and equipment development.
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Introducción: Nuestro objetivo es evaluar el impacto de la participación activa del especialista en Patología Infecciosa en el pronóstico de los enfermos con bacteriemia/candidemia. Pacientes y métodos: Estudio observacional, longitudinal y prospectivo de una cohorte de pacientes con bacteriemia/candidemia en un hospital de tercer nivel (2010-2011). Se analizaron los factores asociados con fracaso terapéutico (persistencia de la bacteriemia/candidemia o muerte relacionada) mediante análisis bivariante y multivariante. Resultados: Se valoraron un total de 324 episodios de bacteriemia/candidemia significativa, de los que en 252 pacientes (78%) el Servicio de Medicina Interna Infecciosas aplicó un sistema de participación activa (recomendación sobre el tratamiento antibiótico). La adquisición de la bacteriemia se consideró nosocomial o relacionada con cuidados sanitarios en 154 pacientes (47,5%) y comunitaria en 170 (52,5%). Los focos de infección más frecuentemente identificados fueron: urinario (31%), catéter vascular (14%), intraabdominal (12%) y desconocido (15%). El 31,6% era portador de sonda vesical y el 35,4%, de catéter venoso central. El 24% de los pacientes no presentaban fiebre (>38 °C) en el momento de cursar los hemocultivos. La bacteriemia fue persistente en 35 pacientes (11%). La mortalidad global fue del 17,4% y del 15% relacionada ("fracaso" terapéutico, 20%). Se asociaron a un mayor fracaso terapéutico el índice de Pitt ≥ 3 (OR 7,94), McCabe III (OR 3,11), uso previo de antibióticos (OR 2,93) y la ausencia de participación activa de los especialistas clínicos en Patología Infecciosa (OR 2,44). Conclusiones: En la cohorte de pacientes con bacteriemia/candidemia estudiada, la gravedad de la enfermedad de base, la gravedad al inicio, el uso previo de antibióticos y la ausencia de participación activa de los especialistas clínicos en Patología Infecciosa se asociaron a fracaso terapéutico.
Introduction: Our objective is to evaluate the impact of active care by an Infectious Diseases specialist (IDS) on the outcome of patients with bacteraemia/candidemia. Patients and methods: Observational, longitudinal and prospective study of a cohort of patients with bacteraemia/candidemia in a tertiary level hospital (2010-2011). Factors associated with treatment failure (persistent bacteraemia or related death) were analysed (bivariate and multivariate analysis). Results: A total of 324 episodes of bacteraemia were included, of which surveillance by IDS was implemented in 252 cases (78%). Acquisition was considered nosocomial or healthcare-related in 154 patients (47.5%) and community acquired in 170 (52.5%). More frequent sources of bacteraemia were urinary tract (31%), vascular catheter (14%), intra-abdominal (12%); and unknown (15%); 31.6% had a urinary catheter and 35.4% had a central venous catheter. When blood cultures were processed, 24% of patients had no fever (> 38 °C). Bacteraemia was persistent in 35 patients (11%). Overall mortality was 17.4% and 15% related (therapeutic "failure", 20%). Failure was associated with Pitt ≥ 3 (OR 7.94), McCabe III (OR 3.11), previous use of antibiotics (OR 2.93) and no active care by IDS (OR 2.44). Conclusions: In our study cohort, severity at presentation, underlying medical conditions, previous antibiotic use and no active Infectious Diseases specialist care were statistically associated with mortality or microbiological failure.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doenças Transmissíveis , Bacteriemia , Assistência ao Paciente , Infectologia , Candidemia , PatologistasRESUMO
Introducción: La prevalencia de la leishmaniasis visceral (LV), una parasitosis endémica en la cuenca mediterránea, puede verse afectada por movimientos migratorios. Objetivo: El objetivo de este estudio fue analizar los casos de LV valorados en hospitales de la región de Murcia. Material y métodos: Se trata de un estudio retrospectivo multicéntrico de los casos de LV diagnosticados y tratados en los diferentes hospitales de nuestra región, que se agruparon en 2 cohortes: período A (pA), el comprendido entre los años 1997 y 2005, y período B (pB), el transcurrido entre 2006 y 2013. Resultados: Se analizaron 97 casos de LV (75% fueron hombres y la edad media fue de 35 años), 36 en pA y 61 en pB; el 11% de los pacientes procedían de otros países en pA y el 22% en pB (subsaharianos en 10 casos); el 55% tenían algún tipo de inmunosupresión (80% de ellos estaban diagnosticados de infección por VIH). Las manifestaciones más frecuentes fueron: fiebre (85%) y astenia (66%). La duración media de los síntomas antes de la primera consulta fue de 47 días, y el tiempo medio transcurrido entre esta primera consulta y la realización de la prueba diagnóstica, de 13 días. El hallazgo más común en la exploración física fue la esplenomegalia (89%), mientras que la trombocitopenia fue el hallazgo de laboratorio más constante (78%). El diagnóstico se confirmó con la detección de amastigotes y/o PCR del aspirado medular en el 61% de los casos; en el 39% restante el aspirado fue negativo y fue necesario el estudio de otras muestras (biopsia de médula ósea, ganglio linfático, laringe, colon, parótida y amígdala, PCR en sangre, serología o inmunocromatografía en orina). El tratamiento más usado fue anfotericina B liposomal (71%), seguida de glucantime (27%) y anfotericina B complejo lipídico (1%); en un caso no se pudo averiguar el tratamiento administrado. Se objetivaron 16 recidivas, 11 de ellas en pacientes con sida. Conclusiones: Aun a riesgo de sesgos propios de estudios retrospectivos y a pesar del mejor control de la infección VIH, observamos en nuestra región un aumento en la frecuencia de casos de LV, probablemente favorecido por el aumento del número de inmigrantes.
Introduction: The prevalence of visceral leishmaniasis (VL), an endemic parasitic infection in the Mediterranean basin, can be affected by migratory movements. Objective: To analyze VL cases evaluated at several hospitals in the Murcia region. Methods: Retrospective, multicentric study of VL cases; patients were grouped into two time periods: period A (pA: 1997-2005) and period B (pB: 2006-2013). Results: A total of 97 VL cases were analyzed (75% men, mean age 35 years), 36 of them in pA and 61 in pB; 11% and 22% of the patients were foreigners in pA and pB, respectively (10 from sub-Saharan Africa); 55% suffered from some type of immunosuppression (80% HIV). The most common clinical manifestations were fever (85%) and asthenia (66%). The mean duration of symptoms before the first medical contact was 47 days and the average time between the first contact and the microbiological confirmation was 13 days. The most common finding on physical examination was splenomegaly (89%), whereas thrombocytopenia was the most frequent laboratory finding (78%). Diagnoses were confirmed by detection of amastigotes and/or PCR of bone marrow aspiration (BMA) in 61%; in the remaining 39% of cases, BMA was negative and additional samples were necessary (bone marrow, lymph node, larynx, colon, parotid and amygdala biopsy, PCR of blood samples, serology or urine antigen detection). The most commonly used treatment was liposomal amphotericin B (71%), followed by glucantime (27%) and amphotericin B lipid complex (1%). A total of 16 recurrent cases (11 in AIDS patients), were bserved. Conclusions: Although this is a retrospective study and despite better control of HIV infection, we have observed an increase in the frequency of VL cases in our region, which is probably related to migratory flows.
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Humanos , Masculino , Feminino , Adulto , Doenças Parasitárias , Doenças Transmissíveis Emergentes , Emigrantes e Imigrantes , Doenças Transmitidas por Vetores , Leishmaniose Visceral , Espanha , Reação em Cadeia da Polimerase , Síndrome da Imunodeficiência Adquirida , Leishmania infantum , Hospitais , Infecções , Linfonodos , AntígenosRESUMO
OBJECTIVE: To analyze the epidemiological and clinical characteristics of Histoplasma capsulatum infection in a group of volunteers who had traveled to Guatemala. METHODS: A review was performed of the clinical records of nine patients who consulted at the Tropical Medicine Outpatient Unit of Hospital Clinic in Barcelona, Spain. RESULTS. All patients were attended for travelers' diarrhea. In addition, one student had also presented with respiratory symptoms and fever while in Guatemala and her chest X-ray showed interstitial infiltrates. The epidemiological history recognized risk factors for histoplasmosis in all patients (all of them had been working in the reconstruction of an old school building). The intradermal histoplasmin test was performed and was positive in all nine patients. None of the students required treatment. CONCLUSIONS: Histoplasmosis should be included in the differential diagnosis of returning travelers' fever. The diagnosis would have been missed in all of our patients if not for a directed clinical history taking. It is important to reinforce prevention measures, e.g. the use of face masks, when working in an environment with a risk for acquiring histoplasmosis.
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Histoplasmose/diagnóstico , Adulto , Feminino , Guatemala , Histoplasmina , Histoplasmose/epidemiologia , Histoplasmose/terapia , Humanos , Masculino , ViagemRESUMO
OBJECTIVE: To understand some of the clinical and demographic features of the epidemic of infection by HIV in El Salvador prior to the availability of antiretroviral therapy in that country. METHODS: We conducted a retrospective review of HIV-infected individuals who were admitted to Hospital Rosales, which is a large public teaching hospital in San Salvador, El Salvador, during the 5-year period of 1994 through 1998. Chart abstraction was done of 194 out of the 208 individuals admitted to the Infectious Diseases Unit at Hospital Rosales (14 charts could not be located). We also carried out a sampling of other HIV-infected adults treated in other parts of the hospital. RESULTS: Of the 250 patients whose records we reviewed, 67% were men and 86% were from an urban area. The mean age at HIV diagnosis was 34 years. In terms of occupation, 50% of the men were day laborers; 76% of the women were housewives, and 8% of the women were commercial sex workers. All the women studied listed only heterosexual contact as their risk behavior. Of the men, 9% of them said they had sex only with men, 17% said with both men and women, and 65% said with female commercial sex workers. In terms of drug use, 2% of the patients reported they had used injection drugs at some point. At their initial medical visit to Hospital Rosales, over half of the 250 patients presented with a respiratory complaint or with diarrhea, 6% had pulmonary tuberculosis (TB), and 5% had extrapulmonary TB. Of the 250 patients, 177 of them (71%) had AIDS at the first medical visit. Of the 250, 138 of them (55%) were lost to follow-up. Of the remaining 112 persons, 81 of them (72%) were known to have died. Of those 81, 38 of them (47%) died of unknown causes and 21 (26%) died of TB. CONCLUSIONS: The HIV-infected adults treated at the Hospital Rosales during the 1994-1998 period were usually infected through heterosexual sex, were symptomatic at the time of presentation, and were often lost to follow-up. Utilizing the results of our study and of other research, efforts to expand early intervention, counseling and testing, and targeted prevention activities should be strengthened.
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Infecções por HIV/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Adulto , Diarreia/epidemiologia , El Salvador/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Ocupações , Fatores de Risco , Trabalho Sexual , Comportamento Sexual , Fatores Socioeconômicos , Tuberculose/epidemiologiaRESUMO
OBJECTIVE: To understand some of the clinical and demographic features of the epidemic of infection by HIV in El Salvador prior to the availability of antiretroviral therapy in that country. METHODS: We conducted a retrospective review of HIV-infected individuals who were admitted to Hospital Rosales, which is a large public teaching hospital in San Salvador, El Salvador, during the 5-year period of 1994 through 1998. Chart abstraction was done of 194 out of the 208 individuals admitted to the Infectious Diseases Unit at Hospital Rosales (14 charts could not be located). We also carried out a sampling of other HIV-infected adults treated in other parts of the hospital. RESULTS: Of the 250 patients whose records we reviewed, 67 percent were men and 86 percent were from an urban area. The mean age at HIV diagnosis was 34 years. In terms of occupation, 50 percent of the men were day laborers; 76 percent of the women were housewives, and 8 percent of the women were commercial sex workers. All the women studied listed only heterosexual contact as their risk behavior. Of the men, 9 percent of them said they had sex only with men, 17 percent said with both men and women, and 65 percent said with female commercial sex workers. In terms of drug use, 2 percent of the patients reported they had used injection drugs at some point. At their initial medical visit to Hospital Rosales, over half of the 250 patients presented with a respiratory complaint or with diarrhea, 6 percent had pulmonary tuberculosis (TB), and 5 percent had extrapulmonary TB. Of the 250 patients, 177 of them (71 percent) had AIDS at the first medical visit. Of the 250, 138 of them (55 percent) were lost to follow-up. Of the remaining 112 persons, 81 of them (72 percent) were known to have died. Of those 81, 38 of them (47 percent) died of unknown causes and 21 (26 percent) died of TB. CONCLUSIONS: The HIV-infected adults treated at the Hospital Rosales during the 1994-1998 period were usually infected through heterosexual sex, were symptomatic at the time of presentation, and were often lost to follow-up. Utilizing the results of our study and of other research, efforts to expand early intervention, counseling and testing, and targeted prevention activities should be strengthened