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BACKGROUND: Irritable bowel syndrome (IBS) is a functional disorder that leads to abdominal pain; its diagnosis is based on Rome IV criteria (recurrent abdominal pain at least 1 day per week in the last 3 months with more than two of the following: related to defecation, associated with a change in stool frequency and/or with a change in stool appearance). OBJECTIVE: To characterize an outpatient population diagnosed with IBS in Colombia during 2017-2018. METHODS: A cross-sectional study based on a review of clinical records of patients with a primary diagnosis of IBS. A representative sample of 380 individuals was recruited from a population of 38,182 people with a new diagnosis of IBS from a drug-claim database. Sociodemographic, clinical (symptoms, type of IBS, alarm features, etc.), treatment (pharmacological or not), and follow-up variables (for those with additional medical care at 3-12 months) were analyzed. The diagnosis and treatment used in the consultation were compared with clinical guidelines. RESULTS: Most of the 380 patients were women (n = 238; 62.6%), and the mean age was 40.1 ± 15.0 years. None of the physicians recorded the Rome IV criteria in the medical records. Unclassified IBS was the most prevalent subtype (n = 311; 81.8%), and the main symptom was abdominal pain (n = 327; 86.1%). Only 73 patients (19.2%) had follow-up data. The most frequently used drugs were aluminum hydroxide (n = 203; 53.4%) and hyoscine N-butyl bromide (n = 200; 52.6%). Regarding drugs included in the clinical practice guidelines, 19 people received loperamide (5.0%), 3 received trimebutine (0.8%), and 1 received sertraline (0.3%). CONCLUSIONS: The patients were diagnosed without clearly established criteria, and they were treated symptomatically with little follow-up.
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La epilepsia es uno de los trastornos neurológicos más frecuentes a nivel mundial y afecta a más de 70 millones de personas en todo el mundo, las quemaduras son eventos traumáticos que representan un importante problema de salud pública. Método: Se realizó un estudio descriptivo de corte transversal, se incluyeron pacientes con quemaduras secundarias a eventos convulsivos, en un hospital de Bogotá, Colombia entre agosto de 2019 y diciembre de 2020, con el objetivo de describir la frecuencia y características de las quemaduras secundarias a un evento convulsivo en esta población. Resultados: La mayoría de los casos se presentó en mujeres solteras (65%) con una edad promedio de 44 años provenientes en su mayoría de zona urbana (70%), con ocupación principal ama de casa (45%), el principal desencadenante de la crisis epiléptica fue la mala adherencia al tratamiento (70%), el 95% de los pacientes no tuvo un control previo por neurología y el área corporal más afectada fue las extremidades superiores (brazos) en el 55%, la estancia hospitalaria promedio fue de 20 días en Unidad de Cuidados Intensivos. Conclusión: La epilepsia es una enfermedad prevalente, una baja adherencia a la medicación y un inadecuado seguimiento neurológico pueden llevar a problemas graves como las quemaduras, con la consecuente afectación de la calidad de vida de los pacientes y estancias en UCI prolongadas, así como secuelas importantes que imposibiliten la reincorporación laboral de la persona, convirtiéndose en un problema de salud pública.
Epilepsy is one of the most common neurological disorders worldwide, affecting more than 70 million people worldwide; on the other hand, burns are traumatic events that represent an important public health problem. Considering the relationship that has been documented between epilepsy and burns, a descriptive cross-sectional study was carried out in the burn unit of a tertiary care hospital in the city of Bogotá, Colombia. 78 medical records were reviewed, 20 correspond to patients burned during a convulsive episode, most of the cases occurred in single women (65%) with an average age of 44 years, mostly from urban areas (70%), with main occupation housewife (45%), the main trigger of the epileptic crisis was poor adherence to treatment (70%), 95% of the patients did not have a previous control by neurology and the body area most affected was the upper limbs (arms) in 55%, the average hospital stay was 20 days in the Intensive Care Unit. Epilepsy is a disease with poor adherence to medication and inadequate neurological follow-up that may be related to the presence of convulsive episodes, which can lead to serious problems such as burns, with the consequent impact on the quality of life of patients. as well as important consequences that make it impossible for the person to return to work, becoming a public health problem.
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Introduction: Mutations in the promoter region of telomerase reverse transcriptase occur frequently in meningiomas. Objective: To estimate the prognostic importance of telomerase reverse transcriptase mutations in Colombian patients with grades II and III meningioma. Materials and methods: This was a multicenter retrospective cohort study of patients diagnosed with refractory or recurrent WHO grades II and III meningiomas, recruited between 2011 and 2018, and treated with systemic therapy (sunitinib, everolimus ± octreotide, and bevacizumab). Mutation status of the telomerase reverse transcriptase promoter was established by PCR. Results: Forty patients were included, of which telomerase reverse transcriptase mutations were found in 21 (52.5%), being C228T and C250T the most frequent variants with 87.5 % and 14.3 %, respectively. These were more frequent among patients with anaplastic meningiomas (p=0.18), with more than 2 recurrences (p=0.04); and in patients with parasagittal region and anterior fossa lesions (p=0.05). Subjects characterized as having punctual mutations were more frequently administered with everolimus, sunitinib and bevacizumab drug series (p=0.06). Overall survival was 23.7 months (CI95% 13.1-34.2) and 43.4 months (CI95% 37.5-49.3; p=0.0001) between subjects with and without mutations, respectively. Multivariate analysis showed that the number of recurrences and the presence of telomerase reverse transcriptase mutations were tthe only variables that negatively affected overall survival. Conclusions: Mutations in telomerase reverse transcriptase allows the identification of high-risk patients and could be useful in the selection of the best medical treatment.
Introducción. En los meningiomas, ocurren con frecuencia mutaciones en la región promotora de la transcriptasa inversa de la telomerasa. Objetivo. Estimar la importancia pronóstica de las mutaciones de la transcriptasa inversa de la telomerasa en pacientes colombianos con meningiomas de grados II y III. Materiales y métodos. Es un estudio de cohorte, retrospectivo y multicéntrico, que incluyó pacientes con diagnóstico de meningioma persistente o recidivante, de grados II y III, según la clasificación de la OMS, reclutados entre el 2011 y el 2018, con tratamiento sistémico (sunitinib, everolimus con octreótido o sin él, y bevacizumab). El estado de la mutación del promotor de la transcriptasa inversa de la telomerasa se determinó por medio de la PCR. Resultados. Se incluyeron 40 pacientes, en 21 (52,5 %) de los cuales se encontraron mutaciones en la transcriptasa inversa de la telomerasa, siendo las variantes más frecuentes la C228T (87,5 %) y la C250T (14,3 %). Estas fueron más frecuentes entre los pacientes con meningiomas anaplásicos (p=0,18), en aquellos con más de dos recurrencias (p=0,04), y en los que presentaron lesiones en la región parasagital y la fosa anterior (p=0,05). Los sujetos caracterizados por tener alteraciones puntuales fueron tratados con mayor frecuencia con la serie de medicamentos everolimus, sunitinib y bevacizumab (p=0,06). Tras el inicio del tratamiento médico, la supervivencia global fue de 23,7 meses (IC95% 13,1-34,2) en los pacientes con mutaciones y, de 43,4 meses (IC95% 37,5-49,3), entre aquellos sin mutaciones (p=0,0001). Los resultados del análisis multivariado demostraron que, únicamente, el número de recurrencias y la presencia de mutaciones en el gen de la transcriptasa inversa de la telomerasa, fueron factores que afectaron negativamente la supervivencia global. Conclusiones. Las mutaciones en el gen promotor de la transcriptasa inversa de la telomerasa permiten identificar los pacientes con alto riesgo, cuya detección podría ser de utilidad para seleccionar el mejor esquema terapéutico.
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Neoplasias Meníngeas , Meningioma , Humanos , Meningioma/genética , Bevacizumab , Sunitinibe , Everolimo , Estudos Retrospectivos , Neoplasias Meníngeas/genéticaRESUMO
Introducción. En los meningiomas, ocurren con frecuencia mutaciones en la región promotora de la transcriptasa inversa de la telomerasa. Objetivo. Estimar la importancia pronóstica de las mutaciones de la transcriptasa inversa de la telomerasa en pacientes colombianos con meningiomas de grados II y III. Materiales y métodos. Es un estudio de cohorte, retrospectivo y multicéntrico, que incluyó pacientes con diagnóstico de meningioma persistente o recidivante, de grados II y III, según la clasificación de la OMS, reclutados entre el 2011 y el 2018, con tratamiento sistémico (sunitinib, everolimus con octreótido o sin él, y bevacizumab). El estado de la mutación del promotor de la transcriptasa inversa de la telomerasa se determinó por medio de la PCR. Resultados. Se incluyeron 40 pacientes, en 21 (52,5 %) de los cuales se encontraron mutaciones en la transcriptasa inversa de la telomerasa, siendo las variantes más frecuentes la C228T (87,5 %) y la C250T (14,3 %). Estas fueron más frecuentes entre los pacientes con meningiomas anaplásicos (p=0,18), en aquellos con más de dos recurrencias (p=0,04), y en los que presentaron lesiones en la región parasagital y la fosa anterior (p=0,05). Los sujetos caracterizados por tener alteraciones puntuales fueron tratados con mayor frecuencia con la serie de medicamentos everolimus, sunitinib y bevacizumab (p=0,06). Tras el inicio del tratamiento médico, la supervivencia global fue de 23,7 meses (IC95% 13,1-34,2) en los pacientes con mutaciones y, de 43,4 meses (IC95% 37,5-49,3), entre aquellos sin mutaciones (p=0,0001). Los resultados del análisis multivariado demostraron que, únicamente, el número de recurrencias y la presencia de mutaciones en el gen de la transcriptasa inversa de la telomerasa, fueron factores que afectaron negativamente la supervivencia global. Conclusiones. Las mutaciones en el gen promotor de la transcriptasa inversa de la telomerasa permiten identificar los pacientes con alto riesgo, cuya detección podría ser de utilidad para seleccionar el mejor esquema terapéutico.
Introduction: Mutations in the promoter region of telomerase reverse transcriptase occur frequently in meningiomas. Objective: To estimate the prognostic importance of telomerase reverse transcriptase mutations in Colombian patients with grades II and III meningioma. Materials and methods: This was a multicenter retrospective cohort study of patients diagnosed with refractory or recurrent WHO grades II and III meningiomas, recruited between 2011 and 2018, and treated with systemic therapy (sunitinib, everolimus ± octreotide, and bevacizumab). Mutation status of the telomerase reverse transcriptase promoter was established by PCR. Results: Forty patients were included, of which telomerase reverse transcriptase mutations were found in 21 (52.5%), being C228T and C250T the most frequent variants with 87.5 % and 14.3 %, respectively. These were more frequent among patients with anaplastic meningiomas (p=0.18), with more than 2 recurrences (p=0.04); and in patients with parasagittal region and anterior fossa lesions (p=0.05). Subjects characterized as having punctual mutations were more frequently administered with everolimus, sunitinib and bevacizumab drug series (p=0.06). Overall survival was 23.7 months (CI95% 13.1-34.2) and 43.4 months (CI95% 37.5-49.3; p=0.0001) between subjects with and without mutations, respectively. Multivariate analysis showed that the number of recurrences and the presence of telomerase reverse transcriptase mutations were the only variables that negatively affected overall survival. Conclusions: Mutations in telomerase reverse transcriptase allows the identification of high-risk patients and could be useful in the selection of the best medical treatment.
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Meningioma , Telomerase , Mutação com Ganho de FunçãoRESUMO
BACKGROUND: Normal pressure hydrocephalus (NPH) is a common neurodegenerative syndrome among the elderly characterized by ventriculomegaly and the classic triad of symmetric gait disturbance, cognitive decline and urinary incontinence. To date, the only effective treatment is a cerebrospinal fluid shunting procedure that can either be ventriculo-atrial, ventriculo-peritoneal, or lumbo-peritoneal shunt. The conventional ventriculo-atrial shunt uses venodissection, whereas the peel-away is a percutaneous ultrasound (US)-guided technique that shows some advantages over conventional technique. We sought to compare perioperative complication rates, mean operating time and clinical outcomes for both techniques in NPH patients at our institution. METHODS: A retrospective cohort-type analytical study was conducted, using clinical record data of patients diagnosed with NPH and treated at our center from January 2009 to September 2019. Parameters to be compared include: Perioperative complication rates, intraoperative bleeding, mortality, and mean operating time. Perioperative complication rates are those device-related such as shunt infection, dysfunction, and those associated with the procedure. Complications are further classified in immediate (occurring during the first inpatient stay), early (within the first 30 days of surgery), and late (after day 30 of surgery). RESULTS: A total of 123 patients underwent ventriculo-atrial shunt. Eighty-two patients (67%) underwent conventional venodissection technique and 41 patients (33%) underwent a peel-away technique. Immediate complications were 3 (3.6%) and 0 for conventional and peel-away groups, respectively. Early complications were 0 and 1 (2.4%) for conventional and peel-away groups, respectively. Late complications were 5 (6.1%) and 2 (4.9%) for conventional and peel-away groups, respectively. Mean operating time was lower in the peel-away group (P = 0.0000) and mortality was 0 for both groups. CONCLUSION: Ventriculo-atrial shunt is an effective procedure for patients with NPH. When comparing the conventional venodissection technique with a percutaneous US-guided peel-away technique, the latter offers advantages such as shorter operating time and lower perioperative complication rates.
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Salomón Hakim (1922-2011) was a Colombian neurosurgeon and brain scientist This biography examines the social and cultural background through which he emerged as an inquisitive and multi-dimensional surgeon-scientist, and his lifelong contributions to the specialty of neurosurgery. With empirical knowledge in applied medical physics, electronics, electricity and chemistry, he understood the paradoxical phenomenon of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. This ultimately led Hakim to describe in exquisite detail the physics of the cranial cavity and brain hydrodynamics. His name is intertwined with the identification of the entity of a syndrome which had not previously been addressed in the medical literature: Normal Pressure Hydrocephalus (Hakim's syndrome). Additionally, he designed and built various models of valved shunting devices to treat the condition (eg the Hakim programmable valve). Through his selflessness and cogent work, Hakim left a legacy and intellectual heritage that has allowed many colleagues worldwide to save thousands of lives who would be otherwise condemned to oblivion.
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BACKGROUND: Amplification of EGFR and its active mutant EGFRvIII are common in glioblastoma (GB). While EGFR and EGFRvIII play critical roles in pathogenesis, targeted therapy with EGFR-tyrosine kinase inhibitors or antibodies has shown limited efficacy. To improve the likelihood of effectiveness, we targeted adult patients with recurrent GB enriched for simultaneous EGFR amplification and EGFRvIII mutation, with osimertinib/bevacizumab at doses described for non-small cell lung cancer. METHODS: We retrospectively explored whether previously described EGFRvIII mutation in association with EGFR gene amplification could predict response to osimertinib/bevacizumab combination in a subset of 15 patients treated at recurrence. The resistance pattern in a subgroup of subjects is described using a commercial next-generation sequencing panel in liquid biopsy. RESULTS: There were ten males (66.7%), and the median patient's age was 56 years (range 38-70 years). After their initial diagnosis, 12 patients underwent partial (26.7%) or total resection (53.3%). Subsequently, all cases received IMRT and concurrent and adjuvant temozolomide (TMZ; the median number of cycles 9, range 6-12). The median follow-up after recurrence was 17.1 months (95% CI 12.3-22.6). All patients received osimertinib/bevacizumab as a second-line intervention with a median progression-free survival (PFS) of 5.1 months (95% CI 2.8-7.3) and overall survival of 9.0 months (95% CI 3.9-14.0). The PFS6 was 46.7%, and the overall response rate was 13.3%. After exposure to the osimertinib/bevacizumab combination, the main secondary alterations were MET amplification, STAT3, IGF1R, PTEN, and PDGFR. CONCLUSIONS: While the osimertinib/bevacizumab combination was marginally effective in most GB patients with simultaneous EGFR amplification plus EGFRvIII mutation, a subgroup experienced a long-lasting meaningful benefit. The findings of this brief cohort justify the continuation of the research in a clinical trial. The pattern of resistance after exposure to osimertinib/bevacizumab includes known mechanisms in the regulation of EGFR, findings that contribute to the understanding and targeting in a stepwise rational this pathway.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Glioblastoma , Acrilamidas , Adulto , Idoso , Compostos de Anilina , Bevacizumab/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas , Receptores ErbB/genética , Feminino , Glioblastoma/tratamento farmacológico , Glioblastoma/genética , Humanos , Neoplasias Pulmonares , Masculino , Pessoa de Meia-Idade , Mutação , Recidiva Local de Neoplasia , Inibidores de Proteínas Quinases , Estudos RetrospectivosRESUMO
BACKGROUND: Tap test improves symptoms of idiopathic normal pressure hydrocephalus (iNPH); hence, it is widely used as a diagnostic procedure. However, it has a low sensitivity and there is no consensus on the parameters that should be used nor the volume to be extracted. We propose draining cerebrospinal fluid (CSF) during tap test until a closing pressure of 0 cm H2O is reached as a standard practice. We use this method with all our patients at our clinic. METHODS: This is a descriptive cross-sectional study where all patients with presumptive diagnosis of iNPH from January 2014 to December 2019 were included in the study. We used a univariate descriptive analysis and stratified analysis to compare the opening pressure and the volume of CSF extracted during the lumbar puncture, between patients in whom a diagnosis of iNPH was confirmed and those in which it was discarded. RESULTS: A total of 92 patients were included in the study. The mean age at the time of presentation was 79.4 years and 63 patients were male. The diagnosis of iNPH was confirmed in 73.9% patients. The mean opening pressure was 14.4 cm H2O mean volume of CSF extracted was 43.4 mL. CONCLUSION: CSF extraction guided by a closing pressure of 0 cm H2O instead of tap test with a fixed volume of CSF alone may be an effective method of optimizing iNPH symptomatic improvement and diagnosis.
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RESUMEN OBJETIVO: Describir y analizar las características clínicas, funcionales, nutricionales y sociales de pacientes con demencia avanzada (DA), hospitalizados a cargo del servicio de geriatría del Hospital Universitario San Ignacio (HUSI) y su relación con desenlaces hospitalarios, comparando con demencia no avanzada. MÉTODOS: Se realizó un estudio observacional, descriptivo en pacientes ancianos hospitalizados por el servicio de geriatría del HUSI, con revisión retrospectiva de historias clínicas en el perioro de tiempo entre enero del 2016 y diciembre del 2017. La variable dependiente fue DA. Se realizó análisis univariado, bivariado y multivariado. RESULTADOS: De 1091 pacientes con demencia, 606 tenían diagnóstico de DA. La mediana de edad fue de 86 años y la prevalencia de mujeres fue mayor (57,3 %). En los sujetos con DA, comparados con el grupo de demencia, se encontró mayor porcentaje de malnutrición (91,1 %), úlceras por presión (26,2 %), delirium (67,2 %%), polifarmacia (68,3 %%), estancia hospitalaria (5 días), complicaciones (10,6 %%) y mortalidad (16,9 %%). Se encontró una mayor asociación de malnutrición con DA (OR = 2,80, IC = 1,94-4,06, p < 0,00), así mismo con polifarmacia (OR = 1,41, IC = 1,07-1,86, p = 0,012), delirium (OR = 2,24, IC = 1,72-2,92, p < 0,00), úlceras por presión (OR = 3,75, IC = 2,45-5,73, p < 0,00) y mortalidad (OR = 2,21, IC = 1,42-3,44, p < 0,00). DISCUSIÓN: La avanzada edad de nuestros pacientes puede ser determinante en el alto porcentaje de demencia encontrada. La DA condiciona a mayor compromiso en el curso de diferentes desenlaces hospitalarios como malnutrición, polifarmacia, delirium, úlceras y mortalidad. Lo anterior hace necesaria una valoración geriátrica integral del paciente anciano con demencia para mejorar el curso clínico de la hospitalización.
SUMMARY OBJECTIVE: To describe and analyze the clinical characteristics, functionality, nutritional, and social aspects in patients with Advance Dementia (AD), and to hospitalized in the geriatric unit in the Hospital Universitario San Ignacio (HUSI) and it how it is related with hospital outcomes, compare with no advanced dementia. METHODS: A cross-sectional study was conduct, in patient hospitalized in the geriatric unit in the HUSI, with a retrospective review of electronic medical charts from January of 2016 to December 2017. The dependent variable was AD, a univariate, bivariate and multivariate analysis was made. RESULTS: 1091 patients had dementia, 606 with AD, the median age was 86 years and the women prevalence were (57.3 %) higher than men. In the AD group, compared with those with dementia, had high percentage of malnutrition (91.1 %%), pressure ulcers (26.2 %%), delirium (67.2 %%), polypharmacy (68.3 %%), longer hospital admission (median of 5 days vs 4 days), medical complication (10.6 %%), and mortality (16.9 %%). We found a higher association with malnutrition with AD (OR = 2.80, CI = 1.94-4.06, p < 0.00), polypharmacy (OR = 1.41, CI = 1.07-1.86, p = 0.012), delirium (OR = 2.24, CI = 1.72-2.92, p < 0.00), pressure ulcers (OR = 3.75, CI = 2.455.73, p < 0.00) and mortality (OR = 2.21,CI = 1.42-3.44, p < 0.00). DISCUSSION: The advance aged in our patients, might be a determinant in the high percentage of dementia that we found. AD is an entity that predispose to higher clinical outcomes as malnutrition, polypharmacy, delirium, pressure ulcers and mortality. As previously shown there is a need for a comprenhensive geriatric assessment in elderly with dementia, to improve hospital outcomes.
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Idoso , Mortalidade , Demência , Geriatria , HospitalizaçãoRESUMO
To better understand underlying causes of lower rotavirus vaccine effectiveness in low-middle income countries (LMICs), we measured innate antiviral factors in Nicaraguan mothers' milk and immune response to the first dose of the pentavalent rotavirus vaccine in corresponding infants. No relationship was found between concentrations of innate factors and rotavirus vaccine response.
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Vacina contra Difteria, Tétano e Coqueluche/imunologia , Vacinas Anti-Haemophilus/imunologia , Imunidade Inata/imunologia , Leite Humano/imunologia , Vacina Antipólio de Vírus Inativado/imunologia , Países em Desenvolvimento , Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Feminino , Vacinas Anti-Haemophilus/administração & dosagem , Humanos , Imunogenicidade da Vacina/imunologia , Lactente , Masculino , Nicarágua , Vacina Antipólio de Vírus Inativado/administração & dosagem , Resultado do Tratamento , Vacinas Combinadas/administração & dosagem , Vacinas Combinadas/imunologiaRESUMO
We examined potential risk factors on vaccine virus shedding and antibody seroresponse to human rotavirus vaccine (Rotarix) in Mexican infants. Two doses of Rotarix were administered to infants during the first two visits for their routine childhood immunization (â¼8 and 15weeks of age) in Mexico City. Infant's characteristics and socioeconomic indicators were obtained, including history of long-term feeding practices (exclusively/predominantly breastfed and exclusively/predominantly non-breastfed). Two serum specimens were collected, one during the second rotavirus vaccine visit and one 7weeks later. Stool specimens were collected between days 4-7 after each of the two rotavirus vaccine doses. Rotavirus IgA and IgG titers in serum were determined by enzyme immunoassays (EIA) and rotavirus shedding in stool was assessed by EIA and confirmed by RT-PCR. The overall rotavirus IgA geometric mean titers (GMT) increased significantly post dose 2 from post dose 1 [176 (95%CI: 113-273) to 335 (238-471); p=0.020). Infants who were exclusively/predominantly breastfed were less likely to shed vaccine virus in stool than those who were formula-fed (22% vs. 43%, p=0.016). Infants who were breastfed had lower rotavirus IgA titers than those who were formula-fed after dose 1 [GMT: 145 (84-250) vs. 267 (126-566) p=0.188] and dose 2 [236 (147-378) vs.578 (367-910), p=0.007]. Infants who shed vaccine virus post dose 1 had significantly higher serum IgA GMT than those who did not shed [425 (188-965) vs. 150 (84-266), p=0.038]. Breastfeeding was linked with the reduction of both stool vaccine shedding, and IgA seroresponse. The reduced rotavirus replication in the gut and shedding after dose 1 may explain in part the lower IgA response in serum.
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Anticorpos Antivirais/sangue , Aleitamento Materno , Imunoglobulina A/sangue , Vacinas contra Rotavirus/imunologia , Rotavirus/imunologia , Rotavirus/fisiologia , Eliminação de Partículas Virais , Fezes/virologia , Feminino , Humanos , Imunização , Técnicas Imunoenzimáticas , Imunogenicidade da Vacina , Lactente , Masculino , México , Leite Humano/imunologia , Rotavirus/isolamento & purificação , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Vacinas contra Rotavirus/efeitos adversos , Vacinas Atenuadas/administração & dosagem , Vacinas Atenuadas/efeitos adversos , Vacinas Atenuadas/imunologia , Replicação ViralRESUMO
Much debate exists regarding the need, acceptability, and value of humanitarian medical assistance. We conducted a cross-sectional study on 457 children under 5 years from four remote riverine communities in the Peruvian Amazon and collected anthropometric measures, blood samples (1-4 years), and stool samples. Focus groups and key informant interviews assessed perspectives regarding medical aid delivered by foreigners. The prevalence of stunting, anemia, and intestinal parasites was 20%, 37%, and 62%, respectively. Infection with multiple parasites, usually geohelminths, was detected in 41% of children. The prevalence of intestinal parasites both individual and polyparasitism increased with age. Participants from smaller communities less exposed to foreigners expressed lack of trust and fear of them. However, participants from all communities were positive about foreigners visiting to provide health support. Prevalent health needs such as parasitic infections and anemia may be addressed by short-term medical interventions. There is a perceived openness to and acceptability of medical assistance delivered by foreign personnel.
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Necessidades e Demandas de Serviços de Saúde , Missões Médicas , Aceitação pelo Paciente de Cuidados de Saúde , Fatores Etários , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Coinfecção , Feminino , Nível de Saúde , Humanos , Lactente , Enteropatias Parasitárias/epidemiologia , Malária/epidemiologia , Masculino , Doenças Parasitárias/epidemiologia , Peru/epidemiologia , Rios , População Rural/estatística & dados numéricosRESUMO
BACKGROUND: Human noroviruses are among the most common enteropathogens globally, and are a leading cause of infant diarrhea in developing countries. However, data measuring the impact of norovirus at the community level are sparse. METHODS: We followed a birth cohort of children to estimate norovirus infection and diarrhea incidence in a Peruvian community. Stool samples from diarrheal episodes and randomly selected nondiarrheal samples were tested by polymerase chain reaction for norovirus genogroup and genotype. Excretion duration and rotavirus coinfection were evaluated in a subset of episodes. RESULTS: Two hundred twenty and 189 children were followed to 1 and 2 years of age, respectively. By 1 year, 80% (95% confidence interval [CI], 75%-85%) experienced at least 1 norovirus infection and by 2 years, 71% (95% CI, 65%-77%) had at least 1 episode of norovirus-associated diarrhea. Genogroup II (GII) infections were 3 times more frequent than genogroup 1 (GI) infections. Eighteen genotypes were found; GII genotype 4 accounted for 41%. Median excretion duration was 34.5 days for GII vs 8.5 days for GI infection (P = .0006). Repeat infections by the same genogroup were common, but repeat infections by the same genotype were rare. Mean length-for-age z score at 12 months was lower among children with prior norovirus infection compared to uninfected children (coefficient: -0.33 [95% CI, -.65 to -.01]; P = .04); the effect persisted at 24 months. CONCLUSIONS: Norovirus infection occurs early in life and children experience serial infections with multiple genotypes, suggesting genotype-specific immunity. An effective vaccine would have a substantial impact on morbidity, but may need to target multiple genotypes.
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Infecções por Caliciviridae/epidemiologia , Infecções por Caliciviridae/virologia , Diarreia/epidemiologia , Diarreia/virologia , Norovirus/classificação , Norovirus/isolamento & purificação , Adulto , Pré-Escolar , Estudos de Coortes , Coinfecção/epidemiologia , Coinfecção/virologia , Fezes/virologia , Feminino , Genótipo , Técnicas de Genotipagem , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Norovirus/genética , Peru/epidemiologia , Reação em Cadeia da Polimerase , Gravidez , RNA Viral/genética , RNA Viral/isolamento & purificação , Rotavirus/isolamento & purificação , População SuburbanaRESUMO
We molecularly characterized samples with Giardia, Cryptosporidium, and soil-transmitted helminths from a facility-based surveillance system for diarrhea in Santa Rosa, Guatemala. The DNA sequence analysis determined the presence of Giardia assemblages A (N = 7) and B (N = 12) and, Cryptosporidium hominis (N = 2) and Cryptosporidium parvum (N = 2), suggestive of different transmission cycles. All 41 samples with soil-transmitted helminths did not have the ß-tubulin mutation described for benzimidazole resistance, suggesting potential usefulness in mass drug administration campaigns.
Assuntos
Cryptosporidium/genética , Giardia/genética , Helmintos/genética , Adolescente , Adulto , Idoso , Animais , Anti-Helmínticos/uso terapêutico , Ascaríase/tratamento farmacológico , Ascaríase/parasitologia , Ascaris lumbricoides/genética , Criança , Pré-Escolar , Criptosporidiose/tratamento farmacológico , Criptosporidiose/parasitologia , Cryptosporidium/fisiologia , Cryptosporidium parvum/genética , Cryptosporidium parvum/fisiologia , Resistência a Medicamentos/genética , Giardia/fisiologia , Giardíase/tratamento farmacológico , Giardíase/parasitologia , Guatemala , Helmintos/fisiologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Solo/parasitologia , Tricuríase/tratamento farmacológico , Tricuríase/parasitologia , Trichuris/genética , Trichuris/fisiologia , Adulto JovemRESUMO
The guinea pig (Cavia porcellus) is a natural reservoir for Trypanosoma cruzi but has seldom been used as an experimental infection model. We developed a guinea pig infection model for acute and chronic Chagas disease. Seventy-two guinea pigs were inoculated intradermally with 10(4) trypomastigotes of T. cruzi strain Y (experimental group); 18 guinea pigs were used as control group. Eight animals from the experimental group and two from the control group were sacrificed 5, 15, 20, 25, 40, 55, 115, 165, and 365 days after inoculation. During the acute phase (15 to 55 days), we observed parasitemia (with a peak on day 20) and positive IgM and IgG Western blots with anti-shed acute-phase antigen bands. The cardiac tissue showed vasculitis, necrosis (on days 40 to 55), moderate to severe inflammation, and abundant amastigote nests. Smaller numbers of amastigote nests were also present in kidney, brain, and other organs. In the early chronic phase (115 to 165 days), parasitemia disappeared and anti-T. cruzi IgG antibodies were still detectable. In cardiac tissue, the number of amastigote nests and the grade of inflammation decreased. In the chronic phase (365 days), the cardiac tissue showed vasculitis and fibrosis; detectable parasite DNA was associated with higher grades of inflammation. The experimental T. cruzi infection model in guinea pigs shows kinetics and pathologic changes similar to those of the human disease.
Assuntos
Doença de Chagas/parasitologia , Modelos Animais de Doenças , Fibrose/etiologia , Inflamação/etiologia , Parasitemia/etiologia , Trypanosoma cruzi/patogenicidade , Vasculite/etiologia , Reação de Fase Aguda , Animais , Western Blotting , Doença de Chagas/imunologia , Doença de Chagas/patologia , Doença Crônica , Ensaio de Imunoadsorção Enzimática , Feminino , Fibrose/patologia , Cobaias , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Inflamação/patologia , Parasitemia/patologia , RNA Mensageiro/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Trypanosoma cruzi/imunologia , Vasculite/patologiaRESUMO
OBJECTIVE: Describe the clinical, metabolic and psychosocial characteristics observed among patients with early onset type 2 diabetes (T2DM). METHODS: We included 80 consecutive patients with early onset T2DM. All had a medical record, completed a battery of questionnaires and had blood and urine tests. RESULTS: Mean age was 49 +/- 12 years, 57.5% were women, 76.2% had a family history of diabetes and 68.8% a personal history of obesity. Diabetes was diagnosed at the mean age of 32 +/- 6 years with a mean duration of 17 +/- 11 years. Most patients (66.2%) were on poor glycemic control (Alc > 9.0%) and 30% were depressed. Insulin was commonly needed (80% of the patients) and started on average 9 years after diagnosis Significant diabetes related complications were common (71.3% of patients). A longer diabetes duration was the variable most significantly associated with developing complications (p < 0.00001). CONCLUSIONS: Patients with early onset T2DM constitute 27.8% of the total number of diabetic patients attending our clinic; they are characterized by a stronger family history of diabetes, a personal history of obesity and co-morbidities associated with metabolic syndrome. Longer disease course and poor glycemic control contribute to a high prevalence of diabetes related complications and high rates of mortality.