Intestinal Parasitic Infections among Pregnant Women in Venezuela

Introduction. Intestinal parasitic infections, especially due to helminths, increase anemia in pregnant women. The results of this are low pregnancy weight gain and IUGR, followed by LBW, with its associated greater risks of infection and higher perinatal mortality rates. For these reasons, in the setting of no large previous studies in Venezuela about this problem, a national multicentric study was conducted. Methods. Pregnant women from nine states were studied, a prenatal evaluation with a coproparasitological study. Univariated and multivariated analyses were made to determine risk factors for intestinal parasitosis and related anemia. Results. During 19 months, 1038 pregnant women were included and evaluated. Intestinal parasitosis was evidenced in 73.9%: A lumbricoides 57.0%, T trichiura 36.0%, G lamblia 14.1%, E hystolitica 12.0%, N americanus 8.1%, E vermicularis 6.3%, S stercoralis 3.3%. Relative risk for anemia in those women with intestinal parasitosis was 2.56 (P < .01). Discussion. Intestinal parasitoses could be associated with conditions for development of anemia at pregnancy. These features reflect the need of routine coproparasitological study among pregnant women in rural and endemic zones for intestinal parasites. Further therapeutic and prophylactic protocols are needed. Additional research on pregnant intestinal parasitic infection impact on newborn health is also considered

Clinical Study Intestinal Parasitic Infections Among Pregnant Women in Venezuela

Introduction. Intestinal parasitic infections, especially due to helminths, increase anemia in pregnant women. The results of this are low pregnancy weight gain and IUGR, followed by LBW, with its associated greater risks of infection and higher perinatal mortality rates. For these reasons, in the setting of no large previous studies in Venezuela about this problem, a national multicentric study was conducted. Methods. Pregnant women from nine states were studied, a prenatal evaluation with a coproparasitological study. Univariated and multivariated analyses were made to determine risk factors for intestinal parasitosis and related anemia. Results. During 19 months, 1038 pregnant women were included and evaluated. Intestinal parasitosis was evidenced in 73.9%: A lumbricoides 57.0%, T trichiura 36.0%, G lamblia 14.1%, E hystolitica 12.0%, N americanus 8.1%, E vermicularis 6.3%, S stercoralis 3.3%. Relative risk for anemia in those women with intestinal parasitosis was 2.56 (P &lt; .01). Discussion. Intestinal parasitoses could be associated with conditions for development of anemia at pregnancy. These features reflect the need of routine coproparasitological study among pregnant women in rural and endemic zones for intestinal parasites. Further therapeutic and prophylactic protocols are needed. Additional research on pregnant intestinal parasitic infection impact on newborn health is also considered. INTRODUCTION The soil-transmitted helminthiases are ancient diseases that continue to cause misery and disability in poor populations. The numbers affected are staggering. About 2 billion harbor these infections worldwide, of whom 300 million suffer associated severe morbidity. Of the total number infected, an estimated 400 millions are school-age children. In 1999, World Health Organization (WHO) estimated that schistosomiasis and soil-transmitted helminthiasis represented more than 40% of the disease burden due to all tropical diseases, excluding malaria Tropical diseases such as malaria, schistosomiasis, intestinal helminths, and filariasis have a dramatic impact on reproductive health. Many cases of unexplained pregnancy loss are due to undiagnosed tropical diseases. Malnutrition or anemia caused by intestinal worms may be worsened by pregnancy and make the pregnancy difficult In the developing world, young women, pregnant women, and their infants and children frequently experience a 2 Infectious Diseases in Obstetrics and Gynecology cycle, where undernutrition (macronutrient and micronutrient) and repeated infection, including parasitic infections, lead to adverse consequences that can continue from one generation to the next. Among parasitic infections, malaria and intestinal helminths coexist widely with micronutrient deficiencies and contribute importantly to anemia and this cycle of retarded growth and development. In somewhat more limited or focal geographic settings, other parasitic diseases (eg, schistosomiasis, filariasis) contribute similarly to this cycle. It is undoubtedly much better to enter a pregnancy free of infection and nutritionally replete than the various alternatives Intestinal parasitic infections, especially due to the helminths, increase anemia in pregnant women For these reasons, in the setting of no large previous studies in Venezuela about this problem, a national multicentric study was conducted with the objectives to describe preliminarily the epidemiological importance of intestinal parasitosis in pregnant women and its possible impacts. METHODS The study was a transversal analysis of pregnant women attending to prenatal control outpatient health care centers in Venezuela. Pregnant women from fifteen centers located in semi-urban and rural areas of nine states in the country were studied during the period January 2003-July 2004. All women accepted to be studied and included in this study. Women with previous diagnosis of infectious diseases as HIV/AIDS, HBV infection, syphilis, or toxoplasmosis were not enrolled. Evaluation of those women included, as a part of their routine prenatal control, an initial interrogation, physical examination, and laboratory studies: count of blood cells (CBC) (including thick and thin films, stained with Giemsa), serological screening studies for HIV-1 and -2 (ELISA), HBV (HbsAg and IgM anti-HBc), VDRL, and FTA-ABS, and toxoplasmosis (antibody titers by DAT). For this study, we considered as normal levels of Hb in women those between 12-16 g/dL, and between 37-48% for the hematocrit. An eosinophils proportion up to 4% was considered normal. All women were asked for a fresh stool sample each for coproparasitological study. The stool samples were masked, coded, and processed for parasitological examination. All stool samples were processed within 2 hours of collection. Isolation of enteric bacterial and viral pathogens was not studied in these samples. Different stool examinations were used for efficacy in detecting parasites. These were direct wet-mount, formaldehyde-ether sedimentation method and modified acid-fast staining techniques RESULTS One thousand thirty eight pregnant women were enrolled in this study. The mean age of this population was 25.5 ± 6.5 years old. The mean gestational age at enrollment moment was 28.5 ± 4.0 weeks (60% was on the 3rd trimester). At clinical evaluations, no apparent significant obstetrical alterations were observed. All women were asymptomatic. All serological studies were negative in all women (HIV, HBV, VDRL, Toxoplasmosis). Hematological evaluation showed that 65.1% of women presented anemia. The mean hemoglobin levels were 10.3 ± 0.4 g/dL, mean hematocrit was 30.6 ± 1.8%. Eosinophils relative mean proportion was 5.1 ± 4.2%. Eosinophilia was seen in 22.3% women. No other alterations were seen in these women. Intestinal parasitosis was seen in 767 women (73.9%). From this total, 360 (46.9 %) presented infections due to two simultaneous intestinal parasite species, 84 (10.9 %) with three intestinal parasite species, and only 2 women presented infections due to more than three intestinal parasite species (0.3 %). In this studied group of women, ten different species of intestinal parasites were found, 2 nonpathogenic protozoans, 3 pathogenic protozoans, and 5 helminths species Univariated and multivariated analyses made to assess risk factors for intestinal parasitosis and related anemia only found significance for the presence of intestinal parasitosis as a risk to have anemia during pregnancy, relative risk (RR) was 2.56 (95% CI 2.13-3.08)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Conocimientos de los padres de familia sobre hábitos alimenticios saludables de niños escolares de Bucaramanga

Objetivo: Identificar que conocimientos tienen los padres de familia sobre hábitos alimenticios saludables de niños escolares de Bucaramanga durante el periodo 2018. Método: Se realizó un estudio de tipo cuantitativo, descriptivo de dimensión trasversal, que tomo una muestra de 20 padres de familia de niños escolares del área metropolitana de Bucaramanga, que cumplían con los criterios de inclusión, la selección se hizo de manera no probabilística por conveniencia y el instrumento utilizado para el estudio fue la encuesta. Resultado: Los resultados obtenidos fueron favorables en cuanto la parte de concepción de los padres de familia frente a los beneficios de una alimentación saludable, así como sobre los hábitos de las familias en general, en su casa y la frecuencia con la ha consumido una serie de alimentos, obteniendo un porcentaje bueno ya que la mayor parte de la población presentan buenos hábitos de alimentación saludable. Conclusiones: Una alimentación saludable dirigida por los padres de familia ayuda para evitar comorbilidades futuras en el niño.Objective: Identify that knowledge parents have about healthy eating habits of schoolchildren in Bucaramanga during the 2018 period. Method: A study of quantitative descriptive of transverse dimension, which took a sample was conducted 20 parents of school children in the metropolitan area of Bucaramanga, who met the inclusion criteria, the selection was not probabilistically for convenience and the instrument used for the study was the survey. Result: The results were favorable, as part of conception of parents against the benefits of healthy eating, as well as the eating habits of the family in general, at home and often has used a series food, getting a good rate because most of the population have healthy eating habits. Conclusions: A healthy diet directed by parents helps to prevent future morbidities in children.1. Planteamiento problemático -- 2. Justificación -- 3. Objetivos -- 4. Marco referencial -- 5. Diseño metodológico -- 6. Resultados -- 7. Discusión de resultados -- 8. Conclusiones -- 9. Recomendaciones -- 10. Referencias bibliográ[email protected]@campusucc.edu.comaria.moralesar@[email protected]

Abstract A085: A comparison of the recruitment and enrollment of racially and ethnically minoritized patients in two non-interventional genetic testing studies in Florida

Abstract Objectives: To compare participation rates of minority individuals in two non-interventional genetic studies. Background: Enrollment of participants into non-interventional studies is important in understanding cancer development in minority patients. Black, Hispanic, and Latin men and women are diagnosed with aggressive forms of cancer at more advanced stages however, the underlying mechanisms leading to poor outcomes of disease is still not well understood. To understand disease development, two studies were launched. Study 1 focused on the recruitment of mutation carriers not yet diagnosed with cancer. Participants of this study were of any race and consented to the collection of fresh tissue. Participants were physician-referred and approached by the study team on the day of surgery. The patients received an explanation of the objectives and conditions of participation. Study 2 was focused on recruiting minority participants in clinic with a confirmed diagnosis of breast or prostate cancer. Participants consented to the collection of archival tissue and participants were called prior to their clinic visit and explained the objectives and conditions of participation. We compared the rates of enrollment of minority patients into these non-interventional genetic studies. Methods: Participants were Black, Hispanic/Latino(a), or White, Non-Hispanic who were mutation carriers without cancer or had an active diagnosis of ovarian, breast, or prostate cancer. The study team was composed of Latin, South, and Central American Spanish-speakers and African American Caribbeans Haitian-Creole speakers. All study materials were available in English, Haitian Creole, and Spanish. Matched recruitment was completed between the patient population and study team members who spoke English, Haitian Creole, and Spanish. The studies were assessed and compared for their methods of recruitment, participation rates, and demographics of their enrolled patient populations between December 2022 and May 2023.  Results: A total of 121 men and women are included in this data analysis. 81.8% of patients approached for both studies consented to participate. 92.9% of those who consented were minorities. In Study 1, 68.6% eligible patients agreed to participate (24/35). Of the 24 patients enrolled, 41.7% (10/24) were White Hispanic/Latina, 20.8% (5/24) were Black Hispanic and non-Hispanic, 29.2% (7/24) were White non-Hispanic, and 2.7% (2/36) declined race. Of those who rejected participation, 63.6% were Black non-Hispanic. In Study 2, 87.2% (75/86) of the 86 eligible patients consented to the study. 72% (54/75) were female and 28% (21/75) were male. Of the female participants, 31.5% (17/54) were Black non-Hispanic and 68.5% (37/54) were White Hispanic/Latino. Of the male participants, 47.6% (10/21) were Black and 52.3% (11/21) were Hispanic/Latino. 63.6% of those who rejected participation were White Hispanic. Conclusions: Our results indicate that study acceptance by racially and ethnically minoritized individuals is dependent on recruitment approach and current health status. Citation Format: Destiny B. Burnett, Sandy St-Hilaire, Melissa N. Castillo, Daniela M. Zuniga Carlier, Osmaray Morales Casanova, Ashlee J. Sealy, Alex P. Sanchez, Matthew P. Schulmbrecht, Camille Ragin, Sophia George, Judith Hurley, Janaki Sharma, Alejandra Perez. A comparison of the recruitment and enrollment of racially and ethnically minoritized patients in two non-interventional genetic testing studies in Florida [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A085

Acculturation, Behavioral Factors, and Family History of Breast Cancer among Mexican and Mexican-American Women

BACKGROUND: Incidence rates for breast cancer are higher among Mexican-American (MA) women in the United States than women living in Mexico. Studies have shown higher prevalence of breast cancer risk factors in more acculturated than less acculturated Hispanic/Latinas in the United States. We compared the prevalence of behavioral risk factors and family history of breast cancer by level of acculturation and country of residence in women of Mexican descent. METHODS: Data were collected from 1,201 newly diagnosed breast cancer patients living in Mexico (n = 581) and MAs in the United States (n = 620). MA participants were categorized into three acculturation groups (Spanish dominant, bilingual, and English dominant); women living in Mexico were used as the referent group. The prevalence of behavioral risk factors and family history of breast cancer were assessed according to acculturation level, adjusting for age at diagnosis and education. RESULTS: In the adjusted models, bilingual and English-dominant MAs were significantly more likely to have a body mass index of 30 kg/m(2) or greater, consume more than one alcoholic beverage a week, and report having a family history of breast cancer than women living in Mexico. All three U.S. acculturation groups were significantly more likely to have lower total energy expenditure (≤533 kcal/d) than women in Mexico. English-dominant women were significantly less likely to ever smoke cigarettes than the Mexican group. CONCLUSIONS: Our findings add to the limited scientific literature on the relationships among acculturation, health behavior, and family history of breast cancer in Mexican and MA women