Related factors to human toxocariasis in a rural community of Argentina

The objective of this study was to evaluate the relationship between toxocariasis frequency and demographic, environmental, sanitary variables, eosinophylia, and other intestinal parasites in a rural population of Argentina. Serological examination of 100 individuals was carried out by using ELISA technique for the detection of antitoxocara antibodies. Eosinophiles in peripheral blood, presence of intestinal parasites, and demographic, environmental, and socio-cultural data were evaluated. Eighty-one feces samples of dogs belonging to the studied people were analyzed to detect eggs of Toxocara canis. Thirty of them were from 30 dogs and 51 were pools from dog feces. Samples of dirt from around the homes (n: 47) and from public park (n: 4) were taken. To determine the associations, the X2 and Fisher tests were used. The seroprevalence was 23%. Eosinophilia in peripheral blood was detected in 86.95% seropositive individuals and in 37.66% seronegative individuals (p < 0.001, OR = 11.03). Of the 23 people with positive serology, 69.56% had at least one intestinal parasite. All individuals with positive serology had dogs in their homes. Among the dog owners there was a significant association between the presence of anti-toxocara antibodies and home flooding. Eggs of T. canis were detected in the feces of 5/81 dogs and three of these dogs belonged to individuals with positive serology. Eggs of Toxocara spp. were found in 41.17% of the dirt samples, eight of which came from the area surrounding the homes of individuals with positive serology (p = 0.032; OR = 4.36). Taking into account all the variables influencing the frequency of toxocariasis in this population, the implementation of Public Health programs specifically focused on anti-parasitic treatment of dogs is recommended

Towards a non-invasive method of appraisal of the regular suction in 0 to 5-months-old lactating infants

Objetivos: Encontrar una técnica alternativa a la de la videodeglución, que permita identificar el comportamiento de succión-deglución normal o compensado, sin necesidad de llegar a la instancia radiológica. Material y métodos: Como instancia preliminar, una vez diseñado y desarrollado el equipo electromédico necesario, se realizaron estudios a fin de investigar si los diagramas manométricos obtenidos presentan alguna correlación con las conclusiones de los estudios videofluoroscópicos, e identificar las posibles variables a tener en cuenta para encontrar dicha correlación. Resultados: Se identificaron las curvas de succión productiva en 139 casos de lactantes de entre 0 y 6 meses de edad, y de allí se determinaron los valores promedio de amplitud en [mmHg] y frecuencia [Succ/seg] para cada caso. Se calcularon las regiones de normalidad para las categorías elegidas por peso y edad respectivamente. Conclusiones: Los resultados permiten predecir que esta podría validarse como una técnica alternativa y complementaria de diagnóstico que pueda indicarse previamente a solicitar el estudio radiológico correspondiente, y que sería conveniente automatizar el cálculo de los parámetros de interés, para facilitar la transferencia del método al sector hospitalario.Objectives To find an alternative technique to videofluoroscopic swallow study, which would allow for the distinction of the regular or facilitated suction-deglutition behavior, with no need for reaching the radiological instance. Material and methods As a preliminary instance, once the electromedical equipment had been designed and developed, studies were carried out in order to investigate if the obtained manometrical diagrams show any correlation with the conclusions derived from the videofluoroscopic studies, and to identify the possible variants to be taken into account so as to achieve such correlation. Results The curves of productive suction have been found in all the 139 cases of lactating infants between 0 and 6 months old, from which the average values of breadth in [mmHg] and frequency [Suct/sec] were determined for each case. The areas of normality for the categories determined in terms of weight and age has been respectively calculated. Conclusions The results allow for the prediction that the technique could be validated as an alternative and complementary one for diagnosis that can be asked for before requesting the corresponding radiologic study, and that it would be convenient automating the calculations of the parameter of interest to enhance the appliance of such method to the hospital sector.Fil: Jury, Silvia. Provincia de Buenos Aires. Ministerio de Salud. Hospital de Niños "Sor Maria Ludovica" de la Plata. Instituto de Desarrollo e Investigaciones Pediatricas; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; ArgentinaFil: Zerbino, Lia Maria. Universidad Nacional de la Plata. Facultad de Ingeniería. Departamento de Ciencias Básicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Centro de Investigaciones Opticas (i); Argentina. Universidad Tecnologica Nacional. Facultad Regional La Plata; ArgentinaFil: Laquidara, Anibal Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Centro de Investigaciones Opticas (i); Argentina. Universidad Nacional de la Plata. Facultad de Ingenieria. Departamento de Electrotecnia; ArgentinaFil: Apezteguía, M. C.. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; Argentin

Outcome of mechanically ventilated patients who require a tracheostomy

OBJECTIVE: To estimate the prevalence of, the risk factors associated with, and the outcome of tracheostomy in a heterogeneous population of mechanically ventilated patients. DESIGN: Prospective, observational cohort study. SETTING: A total of 361 intensive care units from 12 countries. PATIENTS: A cohort of 5,081 patients mechanically ventilated for >12 hrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 546 patients (10.7%) had a tracheostomy during their stay in the intensive care unit. Tracheostomy was performed at a median time of 12 days (interquartile range, 7-17) from the beginning of mechanical ventilation. Variables associated with the performance of tracheostomy were duration of mechanical ventilation, need for reintubation, and neurologic disease as the primary reason of mechanical ventilation. The intensive care unit stay of patients with or without tracheostomy was a median of 21 days (interquartile range, 12-32) vs. 7 days (interquartile range, 4-12; p < .001), respectively, and the hospital stay was a median 36 days (interquartile range, 23-53) vs. 15 days (interquartile range, 8-26; p < .001), respectively. Adjusting by other variables, tracheostomy was independently related with survival in the intensive care unit (odds ratio, 2.22; 95% confidence interval, 1.72-2.86). Mortality in the hospital was similar in both groups (39% vs. 40%, p = .65). CONCLUSIONS: Tracheostomy is a common surgical procedure in the intensive care unit that is associated with a lower mortality in the unit but with a longer stay and a similar mortality in the hospital than in patients without tracheostom

Management and outcome of mechanically ventilated patients after cardiac arrest

Introduction: The aim of this study was to describe and compare the changes in ventilator management and complications over time, as well as variables associated with 28-day hospital mortality in patients receiving mechanical ventilation (MV) after cardiac arrest. Methods: We performed a secondary analysis of three prospective, observational multicenter studies conducted in 1998, 2004 and 2010 in 927 ICUs from 40 countries. We screened 18,302 patients receiving MV for more than 12 hours during a one-month-period. We included 812 patients receiving MV after cardiac arrest. We collected data on demographics, daily ventilator settings, complications during ventilation and outcomes. Multivariate logistic regression analysis was performed to calculate odds ratios, determining which variables within 24 hours of hospital admission were associated with 28-day hospital mortality and occurrence of acute respiratory distress syndrome (ARDS) and pneumonia acquired during ICU stay at 48 hours after admission. Results: Among 812 patients, 100 were included from 1998, 239 from 2004 and 473 from 2010. Ventilatory management changed over time, with decreased tidal volumes (V T ) (1998: mean 8.9 (standard deviation (SD) 2) ml/kg actual body weight (ABW), 2010: 6.7 (SD 2) ml/kg ABW; 2004: 9 (SD 2.3) ml/kg predicted body weight (PBW), 2010: 7.95 (SD 1.7) ml/kg PBW) and increased positive end-expiratory pressure (PEEP) (1998: mean 3.5 (SD 3), 2010: 6.5 (SD 3); P <0.001). Patients included from 2010 had more sepsis, cardiovascular dysfunction and neurological failure, but 28-day hospital mortality was similar over time (52% in 1998, 57% in 2004 and 52% in 2010). Variables independently associated with 28-day hospital mortality were: older age, PaO 2 <60 mmHg, cardiovascular dysfunction and less use of sedative agents. Higher V T , and plateau pressure with lower PEEP were associated with occurrence of ARDS and pneumonia acquired during ICU stay. Conclusions: Protective mechanical ventilation with lower V T and higher PEEP is more commonly used after cardiac arrest. The incidence of pulmonary complications decreased, while other non-respiratory organ failures increased with time. The application of protective mechanical ventilation and the prevention of single and multiple organ failure may be considered to improve outcome in patients after cardiac arrest