Results and evaluation of the expansion of a model of comprehensive care for Chagas disease within the National Health System: The Bolivian Chagas network

Background: Most people with chronic Chagas disease do not receive specific care and therefore are undiagnosed and do not receive accurate treatment. This manuscript discusses and evaluates a collaborative strategy to improve access to healthcare for patients with Chagas in Bolivia, a country with the highest prevalence of Chagas in the world. Methods: With the aim of reinforcing the Chagas National Programme, the Bolivian Chagas Platform was born in 2009. The first stage of the project was to implement a vertical pilot program in order to introduce and consolidate a consensual protocol-based healthcare, working in seven centers (Chagas Platform Centers). From 2015 on the model was extended to 52 primary healthcare centers, through decentralized, horizontal scaling-up. To evaluate the strategy, we have used the WHO ExpandNet program. Results: The strategy has significantly increased the number of patients cared for, with 181,397 people at risk of having T. cruzi infection tested and 57,871 (31·9%) new diagnostics performed. In those with treatment criteria, 79·2% completed the treatment. The program has also trained a significant number of health personnel through the specific Chagas guidelines (67% of healthcare workers in the intervention area). Conclusions: After being recognized by the Chagas National Programme as a healthcare model aligned with national laws and priorities, the Bolivian platform of Chagas as an innovation, includes attributes that they have made it possible to expand the strategy at the national level and could also be adapted in other countries

MULTI-WAVELENGTH OBSERVATIONS OF THE ENDURING TYPE IIn SUPERNOVAE 2005ip AND 2006jd

We present an observational study of the Type IIn supernovae (SNe IIn) 2005ip and 2006jd. Broad-band UV, optical and near-IR photometry, and visual-wavelength spectroscopy of SN 2005ip complement and extend upon published observations to 6.5 years past discovery. Our observations of SN 2006jd extend from UV to mid-infrared wavelengths, and like SN 2005ip, are compared to reported X-ray measurements to understand the nature of the progenitor. Both objects display a number of similarities with the 1988Z-like subclass of SN IIn including: (i) remarkably similar early- and late-phase optical spectra, (ii) a variety of high ionization coronal lines, (iii) long-duration optical and near-IR emission and, (iv) evidence of cold and warm dust components. However, diversity is apparent including an unprecedented late-time r-band excess in SN 2006jd.The observed differences are attributed to differences between the mass-loss history of the progenitor stars. We conclude that the progenitor of SN 2006jd likely experienced a significant mass-loss event during its pre-SN evolution akin to the great 19th century eruption of \eta Carinae. Contrarily, as advocated by Smith et al. (2009), we find the circumstellar environment of SN 2005ip to be more consistent with a clumpy wind progenitor.Comment: Submitted May 2012 and to appear in ApJ. Manuscript consists of 61 pages, including 19 figures and 11 tables. Comments welcome; referee approves for publicatio

Total enlarged oesophago-gastrectomy for cancer of the cardia. Review of 85 cases.

Authors describe their experience with total enlarged esophago-gastrectomy in the treatment of cancer of the cardia

Improved completion rates and characterization of drug reactions with an intensive Chagas disease treatment program in rural Bolivia.

BACKGROUND: Chagas disease treatment is limited by drug availability, adverse side effect profiles of available medications, and poor adherence. METHODS: Adult Chagas disease patients initiating 60-days of benznidazole were randomized to weekly or twice-weekly evaluations of medication adherence and screening for adverse drug events (ADEs). Mid-week evaluations employed phone-based evaluations. Adherence was measured by self-report, pill counts with intentional over-distribution, and Medication Event Monitoring Systems (MEMS). Prospective data were compared to historical controls treated with benznidazole at the same hospital. RESULTS: 162 prospective patients were compared to 172 historical patients. Pill counts correlated well with MEMS data (R = 0.498 for 7-day intervals, R = 0.872 for intervals >7 days). Treatment completion rates were higher among prospective than historical patients (82.1% vs. 65.1%), primarily due to lower abandonment rates. Rates of ADEs were lower among prospective than historical patients (56.8% vs. 66.9%). Twice-weekly evaluations increased identification of mild ADEs, prompting higher suspension rates than weekly evaluations. While twice-weekly evaluations identified ADEs earlier, they did not reduce incidence of moderate or severe ADEs. Many dermatologic ADEs were moderately severe upon presentation (35.6%), were not reduced by use of antihistamines, occurred among adult patients of all ages, and occurred throughout treatment, rather than the first few weeks alone. CONCLUSIONS: Intensive management improved completion and identified more ADEs, but did not reduce moderate or severe ADEs. Risk of dermatologic ADEs cannot be reduced by selecting younger adults or monitoring only during the first few weeks of treatment. Pill counts and phone-based encounters are reliable tools for treatment programming in rural Bolivia

Endocrine tumours of the pancreas. Twenty-one cases review

Gli autori descrivono l'esperienza maturata dal gruppo nel campo del trattamento dei tumori pancreatici di origine neuroendicrina

Orthotopic liver transplantation (OLT) in malignant tumors of the liver

Gli autori descrivono l'esperienza del gruppo nel trattamento dei tumori maligni del fegato attraverso il trapianto di fegat

Weak lensing analysis of the galaxy clusterRX J1117.4+0743 ([VMF 98] 097)

We present a weak lensing analysis of the galaxy clusterRX J1117.4+0743 ([VMF 98] 097) at z=0.485, based on data collectedwith Gemini South Telescope. The cluster was formerly analyzed byCarrasco et al. (2007, ApJ, 664, 777), and they found a large discrep-ancy between the mass estimated from Xray observations and lensingestimates, exceeding the X-ray mass by more than a factor three. Ourresult for the mass from the weak lensing analysis is lower than the massobtained by Carrasco et al. and closer to the X-ray mass.Presentamos el analisis de lente debil del cumulo de galaxias RX J1117.4+0743 ([VMF 98] 097) situado enz= 0.485, utilizando observaciones obtendias por el Telescopio Gemini Sur. El cumulo fue anteriormente analizado por Carrasco et al. (2007, ApJ, 664, 777), quienes encontraron una gran discrepancia entre la masa estimada a partir de observaciones en rayos X y la obtenida a partir del analisis de lente debil,siendo la masa de lentes mas de tres veces mayor. La masa que obtuvimos a partir del analisis de lente debil es menor que la obtenida por Carrasco et al. y mas cercana a la masa obtenida en X.Fil: Gonzalez, Elizabeth Johana. Universidad Nacional de Córdoba. Facultad de Matemática, Astronomía y Física; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Astronomia Teórica y Experimental. Universidad Nacional de Córdoba. Observatorio Astronómico de Córdoba. Instituto de Astronomia Teórica y Experimental; ArgentinaFil: Dominguez Romero, Mariano Javier de Leon. Universidad Nacional de Córdoba. Facultad de Matemática, Astronomía y Física; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Astronomia Teórica y Experimental. Universidad Nacional de Córdoba. Observatorio Astronómico de Córdoba. Instituto de Astronomia Teórica y Experimental; Argentina. Universidad Nacional de Cordoba. Observatorio Astronomico de Cordoba; ArgentinaFil: Garcia Lambas, Diego Rodolfo. Universidad Nacional de Cordoba. Observatorio Astronomico de Cordoba; Argentina. Universidad Nacional de Córdoba. Facultad de Matemática, Astronomía y Física; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Astronomia Teórica y Experimental. Universidad Nacional de Córdoba. Observatorio Astronómico de Córdoba. Instituto de Astronomia Teórica y Experimental; ArgentinaFil: Moreschi, Osvaldo Mario. Universidad Nacional de Córdoba. Facultad de Matemática, Astronomía y Física; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Física Enrique Gaviola. Universidad Nacional de Córdoba. Instituto de Física Enrique Gaviola; ArgentinaFil: Foëx, Gael. Pontificia Universidad Católica de Valparaíso; ChileFil: Nilo Castellon, Jose Luis Emilio. Universidad de la Serena; ChileFil: Alonso, Maria Victoria. Universidad Nacional de Cordoba. Observatorio Astronomico de Cordoba; Argentina. Universidad Nacional de Córdoba. Facultad de Matemática, Astronomía y Física; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Astronomia Teórica y Experimental. Universidad Nacional de Córdoba. Observatorio Astronómico de Córdoba. Instituto de Astronomia Teórica y Experimental; Argentin

The Prevalence of the Burnout Syndrome and Factors Associated in the Students of Dentistry in Integral Clinic: A Cross-Sectional Study

Background. Burnout syndrome (BS) is composed of three interrelated dimensions (emotional exhaustion, depersonalization, and personal fulfillment), and it has been documented that it affects health professionals from an early age. Aims. Determine the prevalence of BS and associated factors in the integral clinic of the Dentistry Pilot School. Material and Methods. Two instruments were applied: (1) Maslach Burnout Inventory, which measures the degree of professional burnout through 22 items that describe the professional’s attitudes and feelings toward work, as well as symptoms associated with this phenomenon; (2) the second questionnaire determines the possible symptoms of BS and consists of 14 questions that describe tiredness, sleep problems, digestive problems, respiratory problems and headaches, temporomandibular joint (TMJ), neck pain, back pain, and upper and lower extremity pain. The instruments were answered anonymously by a total of 300 students who participated in the study. Results. The emotional exhaustion of the participants was 48.3% at a higher level, the depersonalization was 46.7% at a higher level, and the low perception of personal fulfillment was 73%. In addition, it was shown that BS is significantly related to marital status (p<0.001∗), with single people reporting being more exhausted, with the 6-month level (p=0.011) and with the following symptoms: non-neck pain, head, TMJ, back, waist, upper and lower body pain. Conclusion. It was found that the BS had a prevalence of high levels of exhaustion and depersonalization correlated with the marital status and level of preparation (academic degree) of the person, finding a prevalence of symptoms such as pain in the neck, head, TMJ, and back

[Biliary stenosis in patients treated with liver transplantation. Diagnostic approach]

Between April 1986 and August 1994, 393 orthotopic liver transplantation (OLT) have been performed at "12 de Octubre" Hospital. Among these ones we consider 274 OLT made in 223 adults and in 47 children (4 intraoperative deaths). The reconstruction of the biliary tract was performed with a choledocho-choledochostomy with T tube (CD-CD T) in 131 patients, a choledocho-choledochostomy without T tube or stent (CD-CD) in 75, a Roux-en-y-hepatico-jejunostomy (H-J) in 248, a hepatico-jejunostomy with stent (H-J St) in 13 and a choledocho-cholecisto-jejunostomy (CD-CC-J) in 3 patients. Thirthy six (13.3\%) patients developed biliary complications (30 adults and 6 childrens). Fourteen (18.6\%) occurred in CD-CD reconstruction and 13 (11.4\%) in CD-CD T. The most common complications were leakage and stricture. Thirteen ERCP were performed in 12 patients (1 failed), all adults (CD-CD T: 3; CD-CD: 10). The main indication for ERCP was cholestasis and inability of non invasive methods ultrasound, scintigraphy and computerized tomography in determining the underlying etiology. ERCP was successful in all 12 patients: detecting strictures in 8, strictures + lithiasis in 1, stricture+lekage in 1 and leakage in 2. No complications were encountered after ERCP in our patients. ERCP is the method of choice in diagnosis of biliary complications in CD-CD biliary reconstruction

Flow of participants.

<p>Flow of participants.</p