Factores asociados a mortalidad en la pandemia de influenza H1N1 2009 en Paraguay

La presencia de condiciones médicas pre-existentes se ha asociado con la mortalidadrelacionada al virus de influenza A (H1N1). El objetivo de este estudio fue determinar losfactores asociados a mortalidad en personas con sospecha de infección con influenza A(H1N1) en Paraguay. Los datos clínicos y epidemiológicos fueron obtenidos a través delsistema de vigilancia para la infección por influenza A(H1N1) establecido en el país por elMinisterio de Salud Pública y Bienestar Social a partir del 28 de abril de 2009. Hasta el 30de enero de 2010, fueron notificados a la Dirección General de Vigilancia de la Salud,8303 casos con sospecha de Influenza A (H1N1). Tanto el análisis bivariado como elmultivariado identificaron los siguientes factores de riesgo de mortalidad: obesidad(p=0,022; OR:13,5), embarazo (p<0,001; OR:11,0), Diabetes mellitus (p= 0,006;OR:5,7), enfermedad cardiovascular (p=0,002; OR: 4,6), sexo masculino (p <0,0001,OR: 3,0), edad mayor a 60 años (p =0,008; OR: 2,9) y no haber sido vacunado contra elvirus de influenza estacional en el periodo 2009 (p<0,023; OR: 2,6). El embarazo comofactor de riesgo de mortalidad ya había sido observado en las otras pandemias; no así laobesidad, la cual recién en la última pandemia, ha sido relacionada, por varios países,con complicaciones graves de infección por el virus A (H1N1). Esta asociación amerita eldesarrollo de investigaciones que permitan un mejor abordaje promocional, preventivo yterapéutico de las personas con obesidad

Bacteriological Water Quality Indicators in Natural Waters

Abstract A number of natural waters were analyzed for the presence of somatic coliphages, total and fecal coliforms (TC and FC), Escherichia coli (Ec), heterotrophic plate count (HPC) and fecal streptococci (FS). Sources sampled include permanent and intermittent streams, irrigation canals, potable water treatment plant influents and sewage treatment plant influents and effluents and receiving waters above and below those effluents. Earlier studies in Puerto Rico have suggested that coliphages are only detected in natural waters contaminated with sewage(1). In this study most sources had coliphages most of the time. Coliphage densities are compared with the bacteriological indicators analyzed. Standard Methods(2) includes formulae for the estimation of total and fecal coliform densities from coliphage results. For this study coefficients of empirical formulae to estimate TC and FC densities from coliphage occurrence are given and extended to E. coli densities. Coliphages have proven to be reliable indicators of the occurrence of TC and FC, though not Ec, in these samples and the ease, reliability and precision of the method suggest that it may with confidence be substituted for other methods for natural water monitoring. Key Words: coliphage, natural water quality. Methods & Materials Samples were collected in clean, sterile polypropylene 0.5 or 1 L bottles. A dechlorinating agent was not used for samples from non-chlorinated sources. All samples were transported immediately to the laboratory and refrigerated. All analyses were completed within thirty hours of sample collection. Analyses for coliphage, total coliform(TC), fecal coliform(FC) and fecal streptococci(FS) were in accordance with Standard Methods(2). Heterotrophic plate counts were made on R2A medium, by spread plate techniques and were incubated in the dark for 168 hours at ambient temperature. All coliphage determinations were made utilizing the host culture, Escherichia coli C, ATCC 13706 and following the technique in Standard Methods. Plaques were counted at 6 hours. Presumptive E. coli, (Ec) determinations were made utilizing MPN methods with media containing MUG. MUG-positive cultures (cultures which fluoresce when exposed to long-wave UV -approximately 340 nm) are presumed positive for the presence of E. coli. Samples were collected from 4 sites on an irrigation canal system (canal samples), 5 sites on Río Guanajibo (river samples), a sewage treatment plant influent and effluent and a potable water treatment plant influent (collected at the plant, piped from a small reservoir). Two of the canal sample sites are the influent and effluent of a large wetland, consisting of approximately 350 acres with an average depth of water of 1.5 -2 feet (1.8 billion gallons, 648,000 m 3 )with an unknown residence time. Statistical analyses were performed utilizing PC software, SPSS and SYSTAT, both from SPSS, Inc, Chicago, IL. Estimates of TC and FC identified as "calculated" (TCcalc, e.g.) were according to formulae 1 and 3 from Standard Methods

Sistema de vigilancia epidemiológica comunitaria “Bonis”. Estado actual y proyecciones futuras

El sistema actual de vigilancia epidemiológica en la zona del Centro de Ayuda Mutua y Salud para Todos (CAMSAT) del Bañado Sur, de Asunción, se basa en la búsqueda rutinaria de posibles casos febriles mediante visitas domiciliarias, realizadas por las agentes comunitarias adscritas a la Unidad de Salud Familiar (USF). Cada una de las diezagentes comunitarias de CAMSAT tiene asignada 150 hogares, y los resultados de sus visitas domiciliarias quedan recogidos en planillas que se reportan mediante medios tradicionales (papel, correo interno, fax, etc.) a la DGVS del Ministerio de Salud. La consecuencia de este modo de trabajo es que muchas veces las acciones de bloqueo de latransmisión llegan tarde con el coste social y económico que ello significa. El sistema Bonis introduce la telefonía móvil como elemento catalizador para transformar la búsqueda rutinaria de posibles casos febriles en una acción proactiva, y también la utilización de tecnologías web y bases de datos para el registro de pacientes y su correspondiente seguimiento por el personal sanitario. La utilización de estas tecnologías de la información y comunicación (TICs) transforman el sistema de vigilancia epidemiológica en un caso de estudio de e-Salud en Paraguay. Se describe el estado actual y proyecciones futuras del sistema de vigilancia epidemiológica comunitaria “Bonis”,que utiliza las TICs para prevenir, alertar, supervisar y controlar la expansión de síndromes febriles en un área de influencia del Hospital Barrio Obrero (HBO), en la Unidad de Atención Primaria en Salud del Centro de Ayuda Mutua y Salud para Todos, Asunción, Paraguay

ADEPT - Abnormal Doppler Enteral Prescription Trial

<p>Abstract</p> <p>Background</p> <p>Pregnancies complicated by abnormal umbilical artery Doppler blood flow patterns often result in the baby being born both preterm and growth-restricted. These babies are at high risk of milk intolerance and necrotising enterocolitis, as well as post-natal growth failure, and there is no clinical consensus about how best to feed them. Policies of both early milk feeding and late milk feeding are widely used. This randomised controlled trial aims to determine whether a policy of early initiation of milk feeds is beneficial compared with late initiation. Optimising neonatal feeding for this group of babies may have long-term health implications and if either of these policies is shown to be beneficial it can be immediately adopted into clinical practice.</p> <p>Methods and Design</p> <p>Babies with gestational age below 35 weeks, and with birth weight below 10th centile for gestational age, will be randomly allocated to an "early" or "late" enteral feeding regimen, commencing milk feeds on day 2 and day 6 after birth, respectively. Feeds will be gradually increased over 9-13 days (depending on gestational age) using a schedule derived from those used in hospitals in the Eastern and South Western Regions of England, based on surveys of feeding practice. Primary outcome measures are time to establish full enteral feeding and necrotising enterocolitis; secondary outcomes include sepsis and growth. The target sample size is 400 babies. This sample size is large enough to detect a clinically meaningful difference of 3 days in time to establish full enteral feeds between the two feeding policies, with 90% power and a 5% 2-sided significance level. Initial recruitment period was 24 months, subsequently extended to 38 months.</p> <p>Discussion</p> <p>There is limited evidence from randomised controlled trials on which to base decisions regarding feeding policy in high risk preterm infants. This multicentre trial will help to guide clinical practice and may also provide pointers for future research.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN: 87351483</p

Towards precision medicine: defining and characterizing adipose tissue dysfunction to identify early immunometabolic risk in symptom-free adults from the GEMM family study

Interactions between macrophages and adipocytes are early molecular factors influencing adipose tissue (AT) dysfunction, resulting in high leptin, low adiponectin circulating levels and low-grade metaflammation, leading to insulin resistance (IR) with increased cardiovascular risk. We report the characterization of AT dysfunction through measurements of the adiponectin/leptin ratio (ALR), the adipo-insulin resistance index (Adipo-IRi), fasting/postprandial (F/P) immunometabolic phenotyping and direct F/P differential gene expression in AT biopsies obtained from symptom-free adults from the GEMM family study. AT dysfunction was evaluated through associations of the ALR with F/P insulin-glucose axis, lipid-lipoprotein metabolism, and inflammatory markers. A relevant pattern of negative associations between decreased ALR and markers of systemic low-grade metaflammation, HOMA, and postprandial cardiovascular risk hyperinsulinemic, triglyceride and GLP-1 curves was found. We also analysed their plasma non-coding microRNAs and shotgun lipidomics profiles finding trends that may reflect a pattern of adipose tissue dysfunction in the fed and fasted state. Direct gene differential expression data showed initial patterns of AT molecular signatures of key immunometabolic genes involved in AT expansion, angiogenic remodelling and immune cell migration. These data reinforce the central, early role of AT dysfunction at the molecular and systemic level in the pathogenesis of IR and immunometabolic disorders

Bowel management for the treatment of pediatric fecal incontinence

Fecal incontinence is a devastating underestimated problem, affecting a large number of individuals all over the world. Most of the available literature relates to the management of adults. The treatments proposed are not uniformly successful and have little application in the pediatric population. This paper presents the experience of 30 years, implementing a bowel management program, for the treatment of fecal incontinence in over 700 pediatric patients, with a success rate of 95%. The main characteristics of the program include the identification of the characteristics of the colon of each patient; finding the specific type of enema that will clean that colon and the radiological monitoring of the process

Consenso mexicano sobre detección y tratamiento del cáncer gástrico incipiente

El cáncer gástrico representa una de las neoplasias más frecuentes en el aparato digestivo y en la mayoría de los casos es el resultado de la progresión de lesiones premalignas. La detección oportuna de estas lesiones es relevante ya que un tratamiento oportuno brinda la posibilidad de curación. En nuestro país no existía un consenso respecto a la detección temprana del cáncer gástrico, por lo que la Asociación Mexicana de Gastroenterología reunió aun grupo de expertos y realizó el Consenso sobre detección y tratamiento del cáncer gástricoincipiente (CGI) para establecer recomendaciones de utilidad para la comunidad médica. Eneste consenso se utilizó la metodología Delphi y se emitieron 38 recomendaciones al respectodel CGI. El consenso define el CGI como aquel que al momento del diagnóstico se encuentralimitado a la mucosa y a la submucosa, independientemente de metástasis en ganglios linfáticos.En México, como otras partes del mundo, los factores asociados al CGI incluyen la infección porHelicobacter pylori, los antecedentes familiares, el tabaquismo y los factores dietéticos. Para eldiagnóstico se recomienda utilizar cromoendoscopia, magnificación y equipos con luz mejorada.Un diagnóstico histopatológico preciso es invaluable para tomar de decisiones terapéuticas. Eltratamiento endoscópico del CGI, ya sea disección o resección de la mucosa, debe ser preferidoal manejo quirúrgico cuando se puedan obtener resultados semejantes en términos de curaciónoncológica. La vigilancia endoscópica se deberá de individualizar

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The international anorectal physiology working group (IAPWG) recommendations: Standardized testing protocol and the London classification for disorders of anorectal function

BACKGROUND: This manuscript summarizes consensus reached by the International Anorectal Physiology Working Group (IAPWG) for the performance, terminology used, and interpretation of anorectal function testing including anorectal manometry (focused on high-resolution manometry), the rectal sensory test, and the balloon expulsion test. Based on these measurements, a classification system for disorders of anorectal function is proposed. METHODS: Twenty-nine working group members (clinicians/academics in the field of gastroenterology, coloproctology, and gastrointestinal physiology) were invited to six face-to-face and three remote meetings to derive consensus between 2014 and 2018. KEY RECOMMENDATIONS: The IAPWG protocol for the performance of anorectal function testing recommends a standardized sequence of maneuvers to test rectoanal reflexes, anal tone and contractility, rectoanal coordination, and rectal sensation. Major findings not seen in healthy controls defined by the classification are as follows: rectoanal areflexia, anal hypotension and hypocontractility, rectal hyposensitivity, and hypersensitivity. Minor and inconclusive findings that can be present in health and require additional information prior to diagnosis include anal hypertension and dyssynergia. CONCLUSIONS AND INFERENCES: This framework introduces the IAPWG protocol and the London classification for disorders of anorectal function based on objective physiological measurement. The use of a common language to describe results of diagnostic tests, standard operating procedures, and a consensus classification system is designed to bring much-needed standardization to these techniques