Stillbirth rates in 20 countries of Latin America: an ecological study

Objective: To describe country-level stillbirth rates and their change over time in Latin America, and to measure the association of stillbirth rates with socio-economic and health coverage indicators in the region. Design: Ecological study. Setting: 20 countries of Latin America. Population or Sample: Aggregated data from pregnant women with countries as units of analysis. Methods: We used stillbirth estimates, and socio-economic and healthcare coverage indicators reported from 2006 to 2016 from UNICEF, United Nations Development Programme and World Bank datasets. We calculated Spearman's correlation coefficients between stillbirths rates and socioeconomic and health coverage indicators. Main outcome measures: National estimates of stillbirth rates in each country. Results: The estimated stillbirth rate for Latin America for 2015 was 8.1 per 1000 births (range 3.1–24.9). Seven Latin America countries had rates higher than 10 stillbirths per 1000 births. The average annual reduction rate for the region was 2% (range 0.1–3.8%), with the majority of Latin America countries ranging between 1.5 and 2.5%. National stillbirth rates were correlated to: women's schooling (rS = −0.7910), gross domestic product per capita (rS = −0.8226), fertility rate (rS = 0.6055), urban population (rS = −0.6316), and deliveries at health facilities (rS = −0.6454). Conclusions: Country-level estimated stillbirth rates in Latin America varied widely in 2015. The trend and magnitude of reduction in stillbirth rates between 2000 and 2015 was similar to the world average. Socio-economic and health coverage indicators were correlated to stillbirth rates in Latin America. Tweetable abstract: Stillbirth rates decreased in Latin America but remain relatively high, with wide variations among countries.Fil: Pingray, María Verónica. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Vazquez, Paula. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Correa, Malena. Instituto de Efectividad Clínica y Sanitaria; Argentina. University of Tulane; Estados UnidosFil: Pajuelo, Mónica. University Johns Hopkins; Estados UnidosFil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentin

Stillbirth rates in 20 countries of Latin America: an ecological study

Objective: To describe country-level stillbirth rates and their change over time in Latin America, and to measure the association of stillbirth rates with socio-economic and health coverage indicators in the region. Design: Ecological study. Setting: 20 countries of Latin America. Population or Sample: Aggregated data from pregnant women with countries as units of analysis. Methods: We used stillbirth estimates, and socio-economic and healthcare coverage indicators reported from 2006 to 2016 from UNICEF, United Nations Development Programme and World Bank datasets. We calculated Spearman's correlation coefficients between stillbirths rates and socioeconomic and health coverage indicators. Main outcome measures: National estimates of stillbirth rates in each country. Results: The estimated stillbirth rate for Latin America for 2015 was 8.1 per 1000 births (range 3.1–24.9). Seven Latin America countries had rates higher than 10 stillbirths per 1000 births. The average annual reduction rate for the region was 2% (range 0.1–3.8%), with the majority of Latin America countries ranging between 1.5 and 2.5%. National stillbirth rates were correlated to: women's schooling (rS = −0.7910), gross domestic product per capita (rS = −0.8226), fertility rate (rS = 0.6055), urban population (rS = −0.6316), and deliveries at health facilities (rS = −0.6454). Conclusions: Country-level estimated stillbirth rates in Latin America varied widely in 2015. The trend and magnitude of reduction in stillbirth rates between 2000 and 2015 was similar to the world average. Socio-economic and health coverage indicators were correlated to stillbirth rates in Latin America. Tweetable abstract: Stillbirth rates decreased in Latin America but remain relatively high, with wide variations among countries.Fil: Pingray, María Verónica. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Vazquez, Paula. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Correa, Malena. Instituto de Efectividad Clínica y Sanitaria; Argentina. University of Tulane; Estados UnidosFil: Pajuelo, Mónica. University Johns Hopkins; Estados UnidosFil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentin

Pustulosis exantematosa generalizada aguda

Acute generalized exanthematic pustulosis (PEGA) is a rare dermatological pathology characterized by the sudden and generalized appearance of multiple, sterile, non-follicular, punctate pustules on an erythematous and edematous base. It is frequently triggered by drugs, among which antibiotics stand out. We present the case of a 40-year-old male patient who was admitted to the emergency room due to abdominal pain síndrome, to rule out intra-abdominal tumor pathology, initially indicating ceftriaxone and metronidazole. The next day, he was re-admitted to the emergency room, finding, after emergency surgery, acute appendicitis complicated with intestinal perforation, for which they rotated the antibiotic therapy to imipenem-cilastatin + metronidazole. At the next 48 hours, he presents generalized erythema and some small pustules and microvesicles in the thoracic region, upper extremities and neck. Likewise, it is shown in laboratory tests, neutrophilic leukocytosis and hypoalbuminemia. In the biopsy, subcorneal and intraepidermal neutrophilic pustules are found, with edematous papillary dermis and perivascular inflammatory infiltrate with the presence of neutrophils and few eosinophils. With everything described above, we reached the conclusion of a PEGA, triggered by received antibiotics, ceftriaxone or imipenemcilastatin. After 6 days of the suspension of imipenem-cilastatin, the patient shows improvement of dermal lesions, with mild erythema and scant fine scaling.La pustulosis exantematosa generalizada aguda (PEGA) es una patología dermatológica poco frecuente, caracterizada por la aparición brusca y generalizada de múltiples pústulas puntiformes, estériles, no foliculares, sobre una base eritematosa y edematosa. Es desencadenada frecuentemente por fármacos, entre los cuales resaltan los antibióticos. Presentamos el caso de un paciente varón de 40 años, que ingresó a emergencia por síndrome doloroso abdominal a descartar patología tumoral intraabdominal, indicándole inicialmente ceftriaxona y metronidazol. Al día siguiente, reingresó a emergencia encontrando, tras la cirugía de emergencia, una apendicitis aguda complicada con perforación intestinal, por lo cual rotan la antibioticoterapia a imipenem-cilastatina + metronidazol. A las siguientes 48 horas, presentó eritema generalizado y algunas pústulas pequeñas y microvesículas en región torácica, extremidades superiores y cuello. Asimismo, se observó en los exámenes de laboratorio, leucocitosis neutrofílica e hipoalbuminemia. En la biopsia, se encontró pústulas neutrofílicas subcorneales e intraepidérmicas, con dermis papilar edematosa e infiltrado inflamatorio perivascular con presencia de neutrófilos y escasos eosinófilos. Con todo lo descrito anteriormente, llegamos a la conclusión de una PEGA, desencadenado por los antibióticos recibidos, ceftriaxona o imipenem-cilastatina. Tras 6 días de la suspensión de imipenem-cilastatina, paciente mostró mejoría de lesiones dérmicas, con leve eritema y escasa descamación fina

Cisteínoproteasas catepsinas L de Taenia solium: rol biológico en la infección y potencial uso para el inmunodiagnóstico de la neurocisticercosis

Taenia solium is a plane helminth responsible for taeniasis and human cysticercosis, the latter being the result of the consumption of infective eggs. Cysticerci can develop in different human tissues, often in the central nervous system, causing neurocysticercosis (NCC). For the diagnosis of NCC, an adequate interpretation of clinical data, neuroimaging results and serological tests are required. However, serological tests could be improved by developing candidate antigens able to increase their sensibility and specificity. In the last years, a series of surface and secretory proteins of T. solium essential for the parasite-host interaction have been described. One of these families is cathepsin L cysteine proteases, which have a predominant role in the development and survival of the parasite. They take part in the tissue invasion, immune response evasion, excystation and encystment of cysticercus. They are considered potential antigens for the immunodiagnosis of neurocysticercosis.Taenia solium es un helminto aplanado responsable de la teniosis y de la cisticercosis humana, siendo esta última producida por el consumo de huevos infectivos. Los cisticercos pueden desarrollarse en diferentes tejidos del hombre, frecuentemente en el sistema nervioso central causando la neurocisticercosis (NCC). Para el diagnóstico de la NCC se requiere de una adecuada interpretación de datos clínicos, resultados de neuroimagen y pruebas serológicas. Sin embargo, las pruebas serológicas podrían mejorarse con el desarrollo de antígenos candidatos capaces de incrementar su sensibilidad y especificidad. En los últimos años se han descrito una serie de proteínas de superficie y de secreción de T. solium esenciales para la interacción parásito-hospedero. Una de estas familias son las cisteínoproteasas catepsinas L, las cuales cumplen un rol preponderante para el desarrollo y supervivencia del parásito, participando en la invasión tisular, la evasión de la respuesta inmune, el desenquistamiento y enquistamiento del cisticerco. Son consideradas como antígenos potenciales para el inmunodiagnóstico de la neurocisticercosis

Enzimas antioxidantes en cerebro de cobayos nativos de las grandes alturas

We have determined antiaxidant enzyme activities of: Superoxide Dismutase (SOD), Glutatione Peroxidase (GPx) and Catalase (CAT); levels of malondialdehyde (MDA) and hydroperoxids as lipoperoxidation indicators, and phospholilpase activity as mediator of the lipoperoxidation in cerebral tissue of guinea pigs born and bred in Cerro de Pasco at 4 300 m (ALT), with respect to guinea pigs at sea level (NM), in order to detect real differences between both groups. With respect to activity of antioxidant enzymes, we have not found significant differences between both groups. In the study group (ALT) we have found significant differences in the activity of phospholipase and level of hydroperoxides (p < 0.01 Y P < 0.001. respectively) as compared to sea level group. Also, we have found that level of MDA is significantly less in the study group (p < 0.01).Thus, observed data would lead us to say that altitude does not influence activity of antioxidant enzymes in cerebral tissue of guinea pigs, but it probably influences level of lipoperoxidation, due to a major activity of phospholipase and level of hydroperoxides; nevertheless, a minor level of MDA would indicate the participation of other antioxidant mechanisms.Se ha determinado la actividad de las enzimas antioxidantes Superóxido Dismutasa (SOD), Glutation Peroxidasa (GPx) y Catalasa (CAT), la concentración de malondialdehído (MDA) e hidroperóxidos como indicadores de peroxidación lipídica, y la actividad de fosfolipasa A, como mediador de la lipoperoxidación, en tejido cerebral de cobayos nacidos y criados en Cerro de Pasco a 4 300 m, en comparación con cobayos del nivel del mar (NM), con la finalidad de estimar las diferencias entre ambos grupos. En la actividad de las enzimas antioxidantes no se hallaron diferencias significativas entre ambos grupos. En el grupo de estudio (ALT) se halló la actividad de fosfolipasa A y la concentración de hidroperóxidos significativamente mayores que en el grupo control (p < 0.01 Y P < 0.001, respectivamente). Asimismo, se encontró que la concentración de MDA es significativamente menor en el grupo de ALT (p < 0.01). Por tanto, los datos observados presentan evidencia de que la altura no influiría en la actividad de las enzimas antioxidantes en tejido cerebral de cobayos, pero probablemente sí en el grado de lipoperoxidación, por una mayor actividad de fosfolipasa A y concentración de hidroperóxidos; sin embargo una menor concentración de MDA indicaría la participación de otros mecanismos antioxidantes

Integración y aplicaciones de los estudios de farmacoeconomía e investigación de resultados en salud en los diferentes niveles asistenciales

Integración y aplicaciones de los estudios de farmacoeconomía e investigación de resultados en salud en los diferentes niveles asistenciales

Delays in seeking and receiving health care services for pneumonia in children under five in the Peruvian Amazon: a mixed-methods study on caregivers’ perceptions

Abstract Background Delays in receiving adequate care for children suffering from pneumonia can be life threatening and have been described associated with parents’ limited education and their difficulties in recognizing the severity of the illness. The “three delays” was a model originally proposed to describe the most common determinants of maternal mortality, but has been adapted to describe delays in the health seeking process for caregivers of children under five. This study aims to explore the caregivers’ perceived barriers for seeking and receiving health care services in children under five years old admitted to a referral hospital for community-acquired pneumonia in the Peruvian Amazon Region using the three-delays model framework. Methods There were two parts to this mixed-method, cross-sectional, hospital-based study. First, medical charts of 61 children (1 to 60 months old) admitted for pneumonia were reviewed, and clinical characteristics were noted. Second, to examine health care-seeking decisions and actions, as well as associated delays in the process of obtaining health care services, we interviewed 10 of the children’s caregivers. Results Half of the children in our study were 9 months old or less. Main reasons for seeking care at the hospital were cough (93%) and fever (92%). Difficulty breathing and fast breathing were also reported in more than 60% of cases. In the interviews, caregivers reported delays of 1 to 14 days to go to the closest health facility. Factors perceived as causes for delays in deciding to seek care were apparent lack of skills to recognize signs and symptoms and of confidence in the health system, and practicing self-medication. No delays in reaching a health facility were reported. Once the caregivers reached a health facility, they perceived lack of competence of medical staff and inadequate treatment provided by the primary care physicians. Conclusion According to caregivers, the main delays to get health care services for pneumonia among young children were identified in the initial decision of caregivers to seek healthcare and in the health system to provide it. Specific interventions targeted to main barriers may be useful for reducing delays in providing appropriate health care for children with pneumonia

Genetic variability of <i>Taenia solium</i> cysticerci recovered from experimentally infected pigs and from naturally infected pigs using microsatellite markers

<div><p>The adult <i>Taenia solium</i>, the pork tapeworm, usually lives as a single worm in the small intestine of humans, its only known definitive host. Mechanisms of genetic variation in <i>T</i>. <i>solium</i> are poorly understood. Using three microsatellite markers previously reported [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006087#pntd.0006087.ref001" target="_blank">1</a>], this study explored the genetic variability of <i>T</i>. <i>solium</i> from cysts recovered from experimentally infected pigs. It then explored the genetic epidemiology and transmission in naturally infected pigs and adult tapeworms recovered from human carriers from an endemic rural community in Peru. In an initial study on experimental infection, two groups of three piglets were each infected with proglottids from one of two genetically different tapeworms for each of the microsatellites. After 7 weeks, pigs were slaughtered and necropsy performed. Thirty-six (92.3%) out of 39 cysts originated from one tapeworm, and 27 (100%) out of 27 cysts from the other had exactly the same genotype as the parental tapeworm. This suggests that the microsatellite markers may be a useful tool for studying the transmission of <i>T</i>. <i>solium</i>. In the second study, we analyzed the genetic variation of <i>T</i>. <i>solium</i> in cysts recovered from eight naturally infected pigs, and from adult tapeworms recovered from four human carriers; they showed genetic variability. Four pigs had cysts with only one genotype, and four pigs had cysts with two different genotypes, suggesting that multiple infections of genetically distinct parental tapeworms are possible. Six pigs harbored cysts with a genotype corresponding to one of the identified tapeworms from the human carriers. In the dendrogram, cysts appeared to cluster within the corresponding pigs as well as with the geographical origin, but this association was not statistically significant. We conclude that genotyping of microsatellite size polymorphisms is a potentially important tool to trace the spread of infection and pinpoint sources of infection as pigs spread cysts with a shared parental genotype.</p></div