Dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean: a systematic review / Infecciones por dengue, chikungunya y el virus de Zika en América Latina y el Caribe: revisión sistemática / Dengue, zika e chikungunya na América Latina e no Caribe: revisão sistemática

ABSTRACT Objectives. To characterize the distribution profile of dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean and to identify possible factors associated with the risk of dissemination and severity of these arboviruses. Methods. The protocol of this review was registered on the PROSPERO platform. Searches were carried out in the following databases: Virtual Health Library, MEDLINE/PubMed, and Embase. The search terms were: Zika virus, Zika virus infection, dengue, dengue virus, chikungunya virus, chikungunya fever, epidemiology, observational study, Latin America, and Caribbean region. Studies that addressed the distribution of these arboviruses and the risk factors associated with dengue, Zika virus disease, and chikungunya, published between January 2000 and August 2020 in English, Portuguese, and Spanish, were included. Results. Of 95 studies included, 70 identified risk factors, clinical manifestations, and outcomes for arbovirus infections and 25 described complications and/or deaths. The highest frequency of confirmed cases was for dengue. Brazil reported most cases of the three arboviruses in the period analyzed. Environmental and socioeconomic factors facilitated the proliferation and adaptation of vectors, and host-related factors were reported to aggravate dengue. Most deaths were due to chikungunya, Zika virus disease caused most neurological alterations, and dengue resulted in greater morbidity leading to more frequent hospitalization. Conclusions. The review provides a broad view of the three arboviruses and the intrinsic aspects of infections, and highlights the factors that influence the spread of these viruses in the populations studied.

RESUMEN Objetivos. Caracterizar el perfil de distribución de infecciones por dengue, chikungunya y el virus de Zika en América Latina y el Caribe, y determinar posibles factores relacionados con el riesgo de propagación y gravedad de estas arbovirosis. Métodos. Se registró el protocolo de esta revisión en la plataforma PROSPERO. Se realizaron búsquedas en las siguientes bases de datos: Virtual Health Library, MEDLINE/PubMed y Embase. Los términos de búsqueda fueron: "zika virus" [virus del Zika], "zika virus infection" [infección por el virus del Zika], "dengue", "dengue virus" [virus del dengue], "chikungunya virus" [virus del chikunguña], "chikungunya fever" [fiebre de chikunguña], "epidemiology" [epidemiología], "observational study" [estudio observacional], "Latin America" [América Latina] y "Caribbean región" [Caribe]. Se incluyeron estudios que abordaban la distribución de estas arbovirosis y los factores de riesgo asociados con el dengue, la enfermedad por el virus del Zika y el chikunguña, publicados entre enero del 2000 y agosto del 2020 en español, inglés y portugués. Resultados. De los 95 estudios incluidos, 70 establecieron factores de riesgo, manifestaciones clínicas y resultados de las infecciones por arbovirus y 25 describieron complicaciones o muertes. La mayor frecuencia de casos confirmados fue del dengue. Brasil notificó la mayoría de los casos de infección por los tres arbovirus en el período analizado. Los factores ambientales y socioeconómicos facilitaron la proliferación y adaptación de los vectores, y se notificó que los factores relacionados con el huésped agravaban el dengue. El chikunguña causó la mayor parte de las muertes, la enfermedad por el virus del Zika causó la mayor parte de las alteraciones neurológicas y el dengue fue responsable de una mayor morbilidad, lo que llevó a una hospitalización más frecuente. Conclusiones. Esta revisión ofrece un panorama de las tres arbovirosis y de los aspectos intrínsecos de las infecciones, y pone de relieve los factores que influyen en la propagación de estos virus en las poblaciones estudiadas.

RESUMO Objetivos. Descrever a distribuição das arboviroses causadas pelo vírus da dengue, zika e chikungunya na América Latina e no Caribe e identificar possíveis fatores associados ao potencial de disseminação e à gravidade dessas infecções. Métodos. O protocolo desta revisão sistemática foi registado na plataforma PROSPERO. Foram realizadas buscas nas bases de dados Biblioteca Virtual em Saúde, MEDLINE/PubMed e Embase. Os termos de busca foram: vírus zika, infecção pelo vírus zika, dengue, vírus da dengue, vírus chikungunya, febre chikungunya, epidemiologia, estudo observacional, América Latina e região do Caribe. Foram selecionados estudos publicados em inglês, português e espanhol, entre janeiro de 2000 e agosto de 2020, que tratavam da distribuição desses arbovírus e de fatores de risco associados à dengue, à infecção pelo vírus zika e à febre chikungunya. Resultados. Dos 95 estudos selecionados, 70 descreveram fatores de risco, manifestações clínicas e desfechos das arboviroses e 25 destacaram as complicações e/ou mortes. Houve uma maior taxa de casos confirmados de dengue. O Brasil foi o país onde se registrou a maioria dos casos dessas três arboviroses no período analisado. Fatores ambientais e socioeconômicos facilitaram a proliferação e a adaptação dos vetores dos arbovírus e fatores próprios do hospedeiro são determinantes na gravidade da dengue. As mortes ocorreram principalmente nos casos de febre chikungunya, as manifestações neurológicas foram mais comuns na infecção pelo vírus zika e a dengue resultou em maior morbidade e internação hospitalar. Conclusões. Esta revisão sistemática oferece um panorama destas três arboviroses e de suas peculiaridades destacando os fatores que influenciam a disseminação destes arbovírus nas populações estudadas.

Factors Influencing Contribution of Geriatric Persons in the Society: A Glance from a Rural Area of West Bengal

Background: To facilitate healthy aging in India, it is important not only to acknowledge older people’s contribution but also to understand their perception regarding their impact in the society along with society’s attitude toward them. Objectives: This study aims to assess their self‑perceived contribution in the society and the factors related with their contribution. Methods: It was an observational, descriptive, cross‑sectional study, conducted at Amdanga block of North 24 Parganas district, West Bengal, during July 2021–June 2022. A total 0f 384 geriatrics were interviewed by the house‑to‑house survey with the help of a predesigned, pretested and semi‑structured schedule. Potential predictors of contribution were investigated using the multivariate logistic regression model. Results: 78.9% of participants had contribution in the society. 85.9% were taking care of family members when they were sick. 93.2% were sharing their opinion with the family members. 86.5% were participating in various social works. 79.1% were suffering from at least one physical health problem. With increase in the number of health problems, chances of good contribution decreases. In case of self‑perceived contribution in the society family type, employment, physical health and social participation are influencing the most. Conclusion: Elderly people are taking care of not only family members, but even relatives and neighbors also. They are sharing their knowledge and experience with family members and in the society. They are also contributing financially. Employment and proper health‑care infrastructure for geriatric may be helpful to maximize their contribution.

Measles Outbreak Reveals Measles Susceptibility among Adults in Namibia; 2009 - 2011

BACKGROUND:The World Health Organization; African Region; set the goal of achieving measles elimination by 2020. Namibia was one of seven African countries to implement an accelerated measles control strategy beginning in 1996. Following implementation of this strategy; measles incidence decreased; however; between 2009 and 2011 a major outbreak occurred in Namibia.METHODS:Measles vaccination coverage data were analysed and a descriptive epidemiological analysis of the measles outbreak was conducted using measles case-based surveillance and laboratory data.RESULTS:During 1989 - 2008; MCV1 (the first routine dose of measles vaccine) coverage increased from 56% to 73% and five supplementary immunisation activities were implemented. During the outbreak (August 2009 - February 2011); 4 605 suspected measles cases were reported; of these; 3 256 were confirmed by laboratory testing or epidemiological linkage. Opuwo; a largely rural district in north-western Namibia with nomadic populations; had the highest confirmed measles incidence (16 427 cases per million). Infants aged =11 months had the highest cumulative age-specific incidence (9 252 cases per million) and comprised 22% of all confirmed cases; however; cases occurred across a wide age range; including adults aged =30 years. Among confirmed cases; 85% were unvaccinated or had unknown vaccination history. The predominantly detected measles virus genotype was B3; circulating in concurrent outbreaks in southern Africa; and B2; previously detected in Angola.CONCLUSION:A large-scale measles outbreak with sustained transmission over 18 months occurred in Namibia; probably caused by importation. The wide age distribution of cases indicated measles-susceptible individuals accumulated over several decades prior to the start of the outbreak

Aportes del Código Deontológico Profesional a la disciplina de enfermería / Contributions of the Professional Ethics Code to the discipline of nursing / Contribuições do Código de Conduta dos Profissionais a disciplina de enfermagem

La Ley 266 de 1996 (enero 25) "por la cual se reglamenta la profesión de enfermería en Colombia y se \r\ndictan otras disposiciones" creó el Tribunal Nacional \r\nÉtico\r\n de Enfermería, "con autoridad para conocer \r\nde los procesos disciplinarios, ético-profesionales que se presenten en la práctica de quienes ejercen la \r\nenfermería en Colombia" (1). Para el cumplimiento de las anteriores competencias toma como referencia \r\nlo planteado en el Código de Ética de Enfermería\r\n,\r\n en el ordenamiento legal que se incluye en dicha ley y \r\nsus reglamentaciones, en concordancia con las normas constitucionales y legales sobre la materia. Esta \r\nrazón dio lugar a la Ley 911 de 2004 (octubre 5) "Por la cual se dictan disposiciones en materia de \r\nresponsabilidad deontológica para el ejercicio de la profesión de Enfermería en Colombia; se establece el \r\nrégimen disciplinario correspondiente y se dictan otras disposiciones" (2).\r\nLa sanción de dicha ley es el reconocimiento que hace el Estado de la madurez, autonomía y capacidad \r\nde regularse que tiene la profesión de enfermería en Colombia. También es una respuesta a la confianza \r\nque tiene la sociedad en la idoneidad y competencia del profesional. Una década después, los aportes de \r\nsu aplicación en el desarrollo de la profesión, el mejoramiento de la calidad de cuidado y la prestación de \r\nla atención en salud en general pueden sintetizarse en los siguientes planteamientos:\r\n1. \r\nEstimula el estudio, reflexión y análisis de la naturaleza del acto del cuidado de enfermería y de \r\nlos principios y valores éticos que fundamentan las responsabilidades del profesional de enfermería \r\ncon los sujetos de cuidado, colegas y trabajadores de la salud, con el desarrollo de la profesión y la \r\ninstitución en la que trabaja y con la investigación y la docencia.\r\n2. \r\nHa incentivado el análisis de la toma de decisiones éticas, la necesidad de obtener el consentimiento \r\ninformado en enfermería y la aplicación del derecho a hacer uso de la objeción de conciencia. Este \r\núltimo \r\nes un tema objeto de debate y preocupación porque, aunque es un derecho constitucional \r\ny la Ley 911 (Art\r\ní\r\nculo 9) establece con claridad que el profesional de enfermería puede hacer uso \r\nde ella, sin que por esto se le pueda menoscabar sus derechos o imponérsele sanciones, "ha habido \r\ncasos de maltrato laboral a las enfermeras cuando la hacen" (3).\r\n3. \r\nSe ha fortalecido la autonomía profesional, el ejercicio idóneo del profesional de enfermería en \r\nbeneficio de los sujetos de cuidado y de la sociedad en general y el reconocimiento por parte de \r\nempleadores y otros profesionales de la enfermería como una profesión liberal e independiente. 4. \r\nHa contribuido a hacer evidentes los derechos del profesional de enfermería ante la sociedad, a \r\nhacer visible su verdadera imagen y sus funciones. Este aporte de la Ley 911 plantea a los profe\r\n-\r\nsionales el reto de demostrar en sus actuaciones la calidad ética, científica y técnica en las que se \r\nfundamenta la disciplina.\r\n5. \r\nSe ha convertido en uno de los sustentos ético-legales para fundamentar propuestas de cambio en \r\nlas instituciones de salud, orientadas a asegurar la calidad del cuidado de enfermería. Al respecto, el \r\nArtículo 5 aclara las condiciones para el ejercicio de la enfermería, entendidas como "los requisitos \r\nbásicos indispensables de personal, infraestructura física, dotación, procedimientos técnico-admi\r\n-\r\nnistrativos, registros para el sistema de información, transporte, comunicaciones, auditoría de \r\nservicios y medidas de seguridad que le permitan al profesional de enfermería actuar con auto\r\n-\r\nnomía, calidad e independencia".\r\n6. \r\nHa permitido identificar los eventos adversos que se presentan con mayor frecuencia al proporcionar \r\ncuidado de enfermería, sus causas y consecuencias. Estos han sido referentes para las actividades \r\ndocentes e investigativas que desarrollan los Tribunales Éticos de Enfermería (nacional y departa\r\n-\r\nmentales) y para elaborar las Páginas de Ética Profesional.

Act 266 of 1996 (January 25), "by which the nursing profession is regulated in Colombia and other \r\nprovisions are dictated" created the National Nursing Court of Ethics "with authority on ethical and \r\nprofessional disciplinary processes created within the practice of nursing practitioners in Colombia" (1), \r\nand for the fulfillment of the above powers referencing issues raised in the Nursing Code of Ethics, in \r\nthe legal system that is included in this Act and its regulations, and in accordance with constitutional \r\nand legal provisions on the subject. This justification resulted in Act 911 of 2004 (October 5), "by which \r\nprovisions are established regarding ethical responsibility for the exercise of nursing in Colombia; the \r\ncorresponding disciplinary system is established and other provisions are dictated" (2).\r\nThe passage of this law indicates state recognition of the maturity, autonomy, and capacity for self-regu\r\n-\r\nlation of the nursing profession. It is also considered a response to the trust of society in the suitability \r\nand competence of the professionals. A decade after the application of this law, the contributions of its \r\nimplementation to the development of the nursing profession, the improvement of the quality of care, and \r\nthe provision of health care in general may be summarized in the following statements:\r\n1. \r\nIt stimulated the study, reflection and analysis of the nature of nursing care and ethical princi\r\n-\r\nples, and the values that support the responsibilities of professional nursing care with individuals, \r\ncolleagues and health workers, along with the development of the profession's working institutions, \r\nresearch and teaching.\r\n2. \r\nIt has encouraged the analysis of ethical decision-making, the need for an informed consent in \r\nnursing and the implementation of the right to conscientious objection. This remains a matter of \r\ndiscussion and concern, because "there have been cases of labor abuse when the nurses use this \r\nright" (3), although it is a constitutional right and Law 911 (Article 9) makes clear that the profes\r\n-\r\nsional nurses may use it without undermining their rights or inviting sanctions.\r\n3. \r\nIt has strengthened the professional autonomy, the ideal practice of professional nursing for the \r\nbenefit of patients and society in general and the recognition of employers and other nurses as a \r\nliberal and independent profession.\r\n4. \r\nIt has helped to make clear the rights of the nursing professional in society and to make visible the \r\ntrue image and role of the nurse. This application of Law 911 challenges professionals to demons\r\n-\r\ntrate through their actions the ethical, scientific and technical excellence on which the discipline of \r\nnursing is based.\r\n5. \r\nIt has become one of the ethical-legal proposals to support change in health institutions, aimed \r\nat ensuring the quality of nursing care livelihoods. In this sense, Article 5 makes clear the condi\r\n-\r\ntions for the nursing practice to be understood as "the essential basic requirements for personnel, \r\nphysical infrastructure, staffing, technical and administrative procedures, records for information \r\nsystems, transport, communications, audit services and security measures that allow the nurse to \r\nact with autonomy, quality and independence".\r\n6. \r\nIt has identified adverse events that occur more frequently when providing nursing care, including \r\ntheir causes and consequences. These are related to the teaching and research activities developed \r\nby the Courts of Nursing Ethics (national and department), and to the development of the Pages of \r\nProfessional Ethics.

A Lei 266 de 1996 (25 de janeiro) "por que a profissão de enfermagem na Colômbia é regulada e as outras \r\nprovisões são ditadas" criou o Tribunal Nacional de Ética em Enfermagem, "com autoridade para admi\r\n-\r\nnistrar os éticos e disciplinares profissionais apresentado na prática da enfermagem em Colômbia" (1); \r\npara o cumprimento das poderes acima será usado como referência a o que foi afirmado no Código de \r\nÉtica de Enfermagem, no sistema judicial que está incluído em este lei e seus regulamentos, de acordo com \r\nas disposições constitucionais e legais sobre o assunto. Por este razão resulto a Lei 911 de 2004 (05 de \r\noutubro), "criando regras relativas à responsabilidade ética para o exercício do profissão de enfermagem \r\nem Colômbia; a sistema disciplinar correspondente é estabelecida e outras provisões são ditadas" (2).\r\nA aprovação da Lei é o reconhecimento a maturidade, autonomia e capacidade do profissão de enfermagem \r\nna Colômbia para se-regular. Também é considerado como uma reação à confiança que a sociedade tem \r\nna competência profissional. Depois de uma década de aplicação da presente lei, as contribuições dadas \r\npela implementação no desenvolvimento da profissão de enfermagem, melhorando a qualidade do atendi\r\n-\r\nmento e na prestação de cuidados de saúde, em geral pode ser resumidas nas seguintes afirmações:\r\n1. \r\nEstimula estudo, reflexão e análise da forma do ato dos cuidados de enfermagem e os princípios \r\ne os valores que sustentam as responsabilidades dos cuidados de enfermagem profissional com \r\nindivíduos, colegas e profissionais de saúde, com o desenvolvimento do profissão e a instituições de \r\ntrabalho e também com pesquisa e ensino.\r\n2. \r\nEncorajou a análise das decisões éticas, a necessidade de obter o consentimento informado em \r\nenfermagem e aplicando o direito para objetar conscienciosamente. Isso é uma questão que e causa \r\nde debate e preocupação, porque apesar de ser um direito constitucional, a Lei 911 (Artigo 9) \r\nafirma claramente que o enfermeiro pode fazer uso disso, sem debilitar seus direitos e impostas de \r\nsanções, "já houve casos de abuso de trabalho quando as enfermeiras fazem" (3).\r\n3. \r\nA Lei aumentou a autonomia profissional, a prática ideal do profissão de enfermagem para o bene\r\n-\r\nfício dos pacientes e da sociedade geral e o reconhecimento por parte dos empregadores e os outros \r\nprofissionais da que a enfermagem seja uma profissão liberal e independente.\r\n4. \r\nTambém a Lei ajudou realizar os direitos das enfermeiras na sociedade e aumentou a imagem \r\nverdadeira da enfermagem e suas funções. Este contribuição dos profissionais da Lei 911 coloca o \r\ndesafio de demonstrar, com as suas ações, a ética, excelência científica e técnica na disciplina de \r\nque a enfermagem é baseada.\r\n5. \r\nEste Lei virou uma das propostas éticos para apoiar a mudança nas instituições de saúde, com o \r\nobjetivo de garantir a qualidade da subsistência dos cuidados de enfermagem. Nesse sentido, o \r\nArtigo 5 deixa clara as condições para a prática de enfermagem, entendida como "os requisitos \r\nessenciais para o pessoal, infraestrutura física, processos técnicos e administrativos, registros para \r\na sistema de informação, transportes, comunicações, auditoria medidas de serviço e da segurança \r\nque permite a enfermeira para agir com autonomia, qualidade e independência".\r\n6. \r\nIdentificou os eventos adversos que ocorrem com mais frequência para prestar cuidados de enfer\r\n-\r\nmagem, suas causas e consequências. Estes eventos têm sido relacionados com o ensino e a pesquisas \r\ndesenvolvidas pelos Tribunais de Ética de Enfermagem (nacional e departamental) e realizou o \r\ndesenvolvimento das Páginas de Ética.

Investigación de blastocystis spp, giardia spp y cryptosporidium spp en aguas de consumo en una comunidad de Caracas- Venezuela: Reporte preliminar / Surveillance of blastocystis spp, giardia spp and cryptosporidium spp in human consumption water in a community of Caracas- Venezuela

Uno de los mecanismos de transmisión de protozoarios intestinales, es el consumo de agua contaminada con quistes y ooquistes, cuya eliminación por cloración o filtración no resulta eficaz. En una comunidad de Caracas, se evaluó la posible contaminación del agua de consumo, con Blastocystis spp, Giardia spp y Cryptosporidium spp. El sedimento obtenido mediante filtración y separación inmunomagnética de 15 muestras de agua, se examinó microscópicamente al fresco, con coloraciones, inmunofluorescencia y cultivo en medio de Boeck- Drbohlav modificado (BDM). Se recopiló información sobre las condiciones de suministro, almacenamiento y consumo del agua, además del procedimiento utilizado para el lavado de frutas y vegetales. El único parásito observado fue Blastocystis spp (60%), mediante examen directo/cultivo (33%). Se observó un mayor consumo de agua filtrada que hervida (p= 0,001). Predominó el uso del agua de chorro para el lavado de vegetales y frutas, más que con agua y vinagre (p= 0,011). Se observó una mayor proporción de averías en los sistemas de recolección de aguas servidas (78,6%), más que en los sistemas de aguas blancas (28,6%, p= 0,011). El hallazgo de Blastocystis spp en el agua, se correlaciona con la prevalencia del parásito en habitantes de este sector. Destaca el papel del agua en la transmisión de Blastocystis spp, por lo cual se recomienda filtrarla y hervirla para prevenir la infección con este parásito.

Many intestinal protozoa are transmitted by contaminated water with cysts and oocysts and methods for their elimination as filtration or chlorination are not completely effective. We evaluated a possible consumption water contamination with Blastocystis spp, Giardia spp and Cryptosporidium spp in a community located in Caracas, Venezuela. The pellet obtained by immunomagnetic separation filtration of 15 water samples were examined by microscopic observation (direct examination), stain techniques, immunofluorescence and culture in Drbohlav Boeck-modified medium (BDM). We also collected information about consuming habits, water supply, storage and washing procedures of vegetables and fruits at assessed homes. The only parasite detected was Blastocystis spp (60%), by direct examination/culture (33%). A higher consumption of boiled filtered water (p = 0.001) was observed. The use of tub water for washing vegetables and fruits was predominant, instead of using water and vinegar (p = 0.011). We observed a higher proportion of nonfunctioning sewage collection (78.6%), rather than white water systems (28.6%, p = 0.011). Finding Blastocystis spp in water samples correlates with prevalence of this parasite in residents of this sector. The role of water in Blastocystis spp transmission is significant, so we recommend filtering and boiling it to prevent infection with this parasite.

Síndrome de sommer asociado con amioplasia exclusiva de miembros superiores: A propósito de un caso / Sommer syndrome associated with upper limb exclusive amyoplasia: Apropos of a case

Introducción: El Síndrome cráneofacial sordera mano (deafness-hand .CDHS) también conocido como síndrome de Sommer, es una condición patológica poco frecuente caracterizada por una mutación en el gen PAX3 (Asn 47 lys).Se presenta un caso de un lactante mayor de 13 meses de edad con alteraciones craneofaciales, hipoacusia neurosensorial y anormalidades en las manos, que presenta además amioplasia simétrica de los miembros superiores con limitación funcional de la cintura escapular. Discusión: Con apoyo de la base de datos de la Universidad de Oxford se discute el diagnóstico de síndrome de Sommer y se realiza correlación clínica-fenotípica con el síndrome de Waanderburg (tipo I,y III),Artrogriposis distal tipo IV, Amioplasia Congénita, síndrome de CODAS; síndrome sordera, cataratas, microstomía, alteraciones craneofaciales y retardo mental; Síndrome de Braegger, Síndrome de Saethre Chotzen y Síndrome de Lambotte. Conclusión: Se presenta la asociación de Síndrome de Sommer y amioplasia simétrica exclusiva de miembros superiores, con compromiso codo- hombro, condición no reportada hasta ahora.

Introduction: The Cranialfacial Deafness-Hand Syndrome (CDHS) also known as Sommer syndrome, is a rare pathological condition characterized by a mutation in PAX3 (Asn 47 lys) gene. A case of one infant older than 13 months with cranialfacial disorders, neurosensory hearing loss, abnormalities in the hands, and symmetrical amyoplasia of the upper limbs with functional limitation of the scapular waist is here presented. Discussion: Standing on the University of Oxford database, the diagnosis of a Sommer syndrome is discussed and a clinical-phenotypical correlation with Waanderburg syndrome (type I and III), distal Arthrogryposis syndrome type IV, Amyoplasia congenita, CODAS syndrome; syndrome deafness, cataracts, microstomia, cranialfacial abnormalities and mental retardation; Braegger syndrome, Saethre chotzen syndrome and Lambotte syndrome is performed. Conclusion: The Association with the syndrome of Sommer is confirmed with a unique symmetrical amyoplasia of the upper limbs, compromising the elbow-shoulder: a condition that has not been reported so far in the literature.

Clozapine-induced severe eosinophilia: report of a case with good outcome / Eosinofilia induzida por clozapina: relato de um caso de bom desfecho

INTRODUCTION: Clozapine is the antipsychotic of choice in the treatment of refractory schizophrenia. However, its side effects, such as eosinophilia, may preclude its use. METHODS: Case report and literature review. RESULTS: Young woman, 19 years old, diagnosed with hebefrenic schizophrenia, admitted at Unicamp's psychiatry ward after psychotic symptoms relapse. Clozapine was started after unsuccessful attempts with risperidon and olanzapine. By the fourth week of clozapine use, eosinophils began to increase. Drug titration was stopped, but eosinophils counts continued to rise up, reaching the mark of 5200/mm³. Due to severity of psychotic symptoms and to the good response obtained with clozapine, we decided to investigate organs involvement before withdrawing the medication. As the patient had no organs involvement, clozapine was maintained and one month after eosinophils peak, it was already normalized. CONCLUSION: Eosinophilia should not necessarily lead to clozapine's withdrawal. Patients who present eosinophilia must be at rigorous observation for organs involvement, and if there is no such involvement, clozapine might be maintained, considering the possible benign and transitory nature of the eosinophils count elevation.

INTRODUÇÃO: Clozapina é o antipsicótico de escolha no tratamento de esquizofrenia refratária. No entanto, ela apresenta uma série de efeitos colaterais, como a eosinofilia, os quais podem inviabilizar sua continuação. MÉTODOS: Relato de caso e revisão da literatura. RESULTADOS: Jovem de 19 anos, com diagnóstico de esquizofrenia hebefrênica, internada na enfermaria de psiquiatra do HC-Unicamp por reagudização de sintomas psicóticos. Durante internação, após tentativas frustradas de uso de antipsicóticos como risperidona e olanzapina, iniciou-se clozapina. Na quarta semana após introdução, iniciou-se aumento de eosinófilos. Tendo em vista a gravidade do quadro e a ótima resposta obtida com relação aos sintomas psicóticos, o aumento de dose de clozapina foi interrompido, mas a medicação foi mantida. Mesmo com a dose estabilizada, a eosinofilia continuou a aumentar, chegando a 5.200/mm³. A paciente foi investigada para lesões de órgãos pela possível inflamação, mas nada foi encontrado. Assim, clozapina foi mantida e, um mês após seu pico, eosinófilos normalizaram-se. CONCLUSÃO: Eosinofilia não necessariamente impõe a interrupção de clozapina. O paciente deve ser mantido em observação rigorosa em busca de lesões de órgãos. Caso não haja indício de lesões, é justificável manter a clozapina, tendo em vista o possível caráter benigno e transitório da eosinofilia.

Protozoarios y helmintos intestinales en adultos asintomáticos del estado Zulia, Venezuela / Intestinal protozoa and helminths in asymptomatic adults in the Zulia state, Venezuela

Los estudios de prevalencia de enteroparásitos generalmente se efectúan en población infantil, por ser la más susceptible a estas infecciones; sin embargo, para evaluar la situación en adultos se realizó la presente investigación. Se efectuó el examen coproparasitológico a 95 personas asintomáticas mayores de 18 años, provenientes de 3 diferentes localidades del estado Zulia, Venezuela. Las muestras fecales se sometieron al examen microscópico con SSF-Lugol y método de concentración con formol-éter. 64 individuos (67,36%) presentaron una o varias especies de parásitos intestinales y de éstos, el 81,25% presentaba al menos un parásito patógeno para los humanos. 31 individuos presentaron más de una especie parasitaria (poliparasitismo), con un máximo de 3 especies por hospedador. Se identificaron 7 especies de protozoarios intestinales incluyendo patógenos y comensales, así como 2 especies de helmintos. Predominaron los casos de protozoosis (93) sobre las helmintiasis (10). La mayor frecuencia correspondió a Blastocystis sp. entre los protozoarios y Ascaris lumbricoides entre los helmintos, así mismo, existió un predominio de A. lumbricoides y Trichuris trichiura en la comunidad Los Pescadores, al comparar las tres comunidades estudiadas. La asociación parasitaria más frecuente fue Blastocystis sp. con varias amibas. Este estudio detectó una elevada prevalencia de protozoarios intestinales y particularmente de Blastocystis sp.

Prevalence studies for intestinal parasites are usually performed on children, since they are the most susceptible to these infections; however, this research was conducted to assess the situation in adults. Stool examination was performed on 95 asymptomatic persons over 18 years old, from three different locations in the state of Zulia, Venezuela. Fecal samples were submitted to microscopic examination with SSF-Lugol and the concentration method with formalin ether. Sixty-four individuals (67.36%) had one or more species of intestinal parasites and of these, 81.25% had at least one parasite pathogenic for humans. Thirty-one individuals had more than one parasite species (polyparasitism), with a maximum of three species per host. Seven intestinal protozoa species were identified, including pathogens and commensals, as well as 2 species of helminths. Protozoosis cases predominated (93) over helminths (10). The greatest frequencies corresponded to Blastocystis sp. among protozoa and Ascaris lumbricoides among helminths; also, there was a predominance of A. lumbricoides and Trichuris trichiura in the community Los Pescadores, when comparing the three communities studied. The most frequent parasitic association was Blastocystis sp. with several amoebas. This study found a high prevalence of intestinal protozoa and particularly Blastocystis sp.

Hallazgo de acanthamoeba spp en biopsia cerebral de un paciente con adenocarcinoma metastásico / Acanthamoeba spp found in a cerebral biopsy from a patient with metastasic adenocarcinoma

Las amibas de vida libre (AVL) del género Acanthamoeba son parásitos facultativos ampliamente distribuidos en el ambiente, por lo cual el contacto del humano con ellos es frecuente, sin embargo, los reportes de enfermedades producidas por AVL son escasos. La gravedad de éstas justifica su búsqueda, sobre todo cuando la infección es del sistema nervioso central (SNC) y cuando hay compromiso in munológico. En este trabajo se reporta el hallazgo de Acanthamoeba spp en una biopsia cerebral, tomada a un paciente de 44 años de edad con adenocarcinoma. Se exa minó la muestra bajo el protocolo del Laboratorio de Amibiasis, de la Cátedra de Parasitología, Escuela de Bioanálisis, Facultad de Medicina, Universidad Central de Venezuela, para la investigación de AVL y Entamoeba histolytica. Se realizó examen directo y coloraciones especiales, inducción de la flagelación y cultivos a diferentes temperaturas. Se observó crecimiento de Acanthamoeba spp en el medio de Page modificado por Chinchilla y col. (1979), incubado a 37 °C a las 96 horas. La descripción morfológica coincide con la morfología del grupo 3 de Acanthamoeba, según Visvesvara (1991). Se destaca la importancia de la realización del cultivo para el crecimiento e identificación de estos organismos en aquellos laboratorios donde los métodos basados en biología molecular aun no se hayan implementado como parte del diagnóstico y así aplicar el tratamiento oportuno y específico al paciente.

Free-living amoebas (FLA) of genus Acanthamoeba are parasitic facultative organisms whose are widely distributed in the environment, thus the human contact with them is frequent; nevertheless, there are few reports of diseases produced by FLA. The severity of these diseases justifies its re search, mainly when the infection is at central nervous system (CNS) and when there is an immunocompromised host. This work reports the finding of Acanthamoeba spp in a cerebral biopsy from a 44 year-old patient with adenocarcinoma. We followed the protocol established by the Amibiasis Laboratory, Parasitology Chair, School of Bioanalisis, Medicine Faculty, Central University of Venezuela, for the investigation of FLA and Entamoeba histolytica. It wasmade by direct examination of the sample and special stains, flagellation induction and cultures incubated at different temperatures. We observed Acanthamoeba spp growth in biphasic Page media modified by Chinchilla and col. (1979), incubated for 96 hours at 37 °C. The morphologic des cription agrees with the morphology of group 3 of Acanthamoeba, according to Visvesvara (1991). We emphasize the importance of using growth culture for isolation and identification of these organisms in those laboratories where molecular methods has not been implemented yet as part of the diagnosis scheme and thus for applying the opportune and specific treatment to the patient.

Reporte de cinco casos de cyclosporiosis en un centro penitenciario en Venezuela / Cyclosporiosis five cases report in Venezuelan penitentiery center

Cyclospora cayetanensis, es un protozoario intestinal humano, productor de diarrea en individuos inmunocompetentes e inmunocomprometidos. La transmisión ocurre por ingestión de ooquistes que han esporulado en el ambiente. La transmisión del parásito ocurre a través de un vehículo ambiental. En los países en vías de desarrollo, la ciclosporiosis se ha relacionado con el agua y los alimentos contaminados, contacto con la tierra o animales, y variables asociadas con bajas condiciones socioeconómicas. En junio de 2004 se realizó un estudio parasitológico en un centro pe nitenciario en Venezuela, donde se presentaron varios casos con diarrea. A 7 personas del sexo masculino, con edades entre 19-39 años y con diarrea de 2 a 10 días de du ración, se les realizó examen de heces con S.S. 0,85%, lugol, Quesel, Sudán III, ziehl Neelsen, Micrometría y Esporulación en K2Cr2O4 2,5%. Se encontró ooquistes de C. cayetanensis en 5 (71, 42%) y huevos de Ancylos tomídeos en 1 (14,3%). El número de casos, en los cuales se observó C. cayetanensis, en individuos con diarrea, en este centro penitenciario en Venezuela, resulta muy llamativo en virtud de ser este un microorganismo de baja prevalencia a escala mundial y nacional. No obstante, las condiciones de hacinamiento y probablemente medidas higiénicas inadecuadas, tanto en las áreas físicas como en la conservación y manipulación del agua y alimentos, favorecen la transmisión de parásitos que ocasionan diarrea. Lo cual demuestra, la necesidad de establecer medidas de control y educación sanitaria a los manipuladores de alimentos, para evitar la transmisión y aparición de diarrea por diversos agentes infecciosos entre estas poblaciones.

Cyclospora cayetanensis is a human intestinal protozoan, causing diarrhea in immunocompetent and immunocompromised individuals. Transmission occurs by ingestion of oocysts that have sporulated in the environment. In developing countries, ciclosporosis has been associated with contaminated food and water, contact with soil or animals and low socioeconomic conditions. In June 2004, a parasitological survey in a venezuelan prison in, where several diarrhea cases appeared. All seven (7) people were male, age ranging 19-39 year-old with diarrhea during between 2 and 10 days; they were evaluated by stool examination with ss 0,85%, iodine, quensel, sudan III, ziehl Neelsen stain/mi - crometry and sporulation in K2Cr2O4 2,5%. C. cayetanensis oocysts were found in 5 (71,42%) and hookworm eggs in one (14,3%). The number of diarrhea cases at this prison in Venezuela in which C. cayetanensis was observed, is very striking, knowing the premise for this microorganism to be global and regional low prevalent protozoan. However, overcrowding and poor hygienic measures, probably both, in the physical areas and in the storage and food/water handling, contribute to diarrhea-causing parasites transmission. This shows the need to implement control measures and health education for food handlers to prevent transmission and diarrhea outbreaks caused by infectious agents among this population.

A saúde e estresse ocupacional em médicos / The health and occupational stress in physicians

Introdução: A prática da Medicina sofreu alterações relevantes nas últimas décadas e está atualmente associadaa condições desgastantes de trabalho, como carga horária excessiva, perda de autonomia, redução de salários e exposição a situações estressantes, que aumentam a vulnerabilidade desses profissionais para adoecimento,depressão, abuso de substâncias e suicídio. Objetivos: Identificar e analisar publicações sobre o estresse ocupacional e a saúde do médico. Métodos: Os artigos foram identificados nas bases de dados MedLine, LILACS e SciElo. Foram utilizadas as palavras-chave: saúde, médicos, estresse, trabalho. O período pesquisado foi de 1999 a 2009. Resultados: As publicações identificadas associam o trabalho médico com situações geradoras de ansiedade e estresse, que podem aumentar a vulnerabilidade para a Síndrome de Burnout, principalmente em profissionais que atuam em situações de emergência, cuidados intensivos, psiquiatria e oncologia. Abordam também a relação entre estresse e saúde, destacando a adoção de estratégias de enfrentamento inadequadas como a automedicação, abuso do álcool ou outras substâncias e tabagismo. Discussão: A alta demanda emocional e física do trabalho médico está associada a altos níveis de estresse e baixa freqüência hábitos saudáveis, como alimentação adequada, prática regular de atividade física, tempo para lazer e para a convivência com a família, o que afeta não só a saúde física e mental do médico, mas a qualidade dos serviços por ele prestados. Conclusão: Pesquisas sobre estratégias de enfrentamento para o estresse em médicos brasileiros ainda são importantes e o desenvolvimento de modelos de prevenção e intervenção é necessário para diminuir a vulnerabilidade desses profissionais ao adoecimento.

Introduction: In the last decades, Medicine practice has had great changes, and this is currently associatedwith bad working conditions such as wok overload, loss of autonomy, low salary and stress situations that expose physicians to sickness, depression, substance addiction and suicide. Background: To identify and evaluate publications about occupational stress and health of physicians. Methods: The papers were selected from Medline, SciELO and LILACS, using the keywords health, physicians, stress and work. The research comprised related papers of the the period from 1999 to 2009. Results: In these papers, the physician´s work was associated with conditions resulting stress situations which can increase the risk of Burnout Syndrome in professionals who work with Emergency, Intensive Care, Psychiatry and Oncology. They also reported the relationship between stress and health, pointing out the use of inadequate coping strategies such as selfmedication, alcohol or drug addiction and smoking habits. Discussion: The physicians´ high emotional and physical working overload creates stress and can produce low frequency of healthy habits such as adequate nutrition, physical exercises, spare time and familial contact. This can affect the physicians´ physical and mental health and also damage their service quality. Conclusion: Further research on strategies coping stress addressing Brazilian physicians are still important, and models of stress prevention and intervention are needed to reduce the vulnerability of these professionals to illness.

Complicaciones clínicas de un electrodo Sprint Fidelis / Clinical complications with the Sprint Fidelis electrode

Se presenta el caso de un paciente que ingresa a nuestro servicio presentando terapias inapropiadas e infección del bolsillo, posterior al implante de un desfibrilador automático implantable con un electrodo Sprint Fidelis 6949 en estado de alerta del fabricante...

A case of a patient who was admitted to our department with inappropriate therapies and infection of the pocket, after implantation of an implantable defibrillator with a Sprint Fidelis 6949 electrode on alert of the manufacturer...

Espinaca fresca, supercongelada y en conserva: contenido de vitamina C pre y post cocción / Fresh, frozen and canned spinach: vitamin C content before and after cooking

Vitamin C stability, new variables of cultivation, management and post harvest conservation of vegetables and culinary treatments before consumption can produce modifications in the content of this vitamin. To obtain actualized information of vitamin C content in fresh and processed food, this nutrient was determined in spinach in the fresh state and after subjected to current methods of conservation. Vitamin C determination by HPLC included ascorbic and dehydroascorbic acid. Mean values of vitamin C (mean +SD) in spinach were: fresh, 44.0 +/- 8,74 mg/100g; quick frozen, 24,2+14.81 mg/100g; and canned, 25.0 +/-1.9 mg/100g. This variability depends of genotypic factors and conservation conditions. Microwave and steam cooking generated the most retention of the nutrient, while boiling generated great losses of both vitamin forms.

La labilidad de la vitamina C, las nuevas variables de cultivo, manejo y conservación postcosecha de los vegetales y los tratamientos culinarios previos a su consumo pueden provocar modificaciones en el contenido de este nutriente. Para contar con información actualizada y propia del contenido de vitamina C en alimentos frescos y procesados, se determinó este nutriente en espinacas frescas y sometidas a los métodos de conservación actuales considerando también, la influencia de los sitios de expendio y la aplicación de los tratamientos culinarios más comunes. La determinación de vitamina C, constituida por ácido ascórbico y dehidroascórbico, se realizó empleando HPLC. Los valores medios de vitamina en espinacas sin procesar y su desvío estándar son 44.0 y 8,74 mg/100g, en productos supercongelados 24,2 y 14,81 mg/100g y en conservas de 25.0 y 1.9 mg/100g. Esta variabilidad depende de factores genotípicos y condiciones de conservación. La cocción por microondas y vapor generaron las mayores retenciones del nutriente, mientras que el hervor provocó grandes pérdidas de ambas formas vitamínicas.

Development of microsatellite markers for identifying Brazilian Coffea arabica varieties

Microsatellite markers, also known as SSRs (Simple Sequence Repeats), have proved to be excellent tools for identifying variety and determining genetic relationships. A set of 127 SSR markers was used to analyze genetic similarity in twenty five Coffea arabica varieties. These were composed of nineteen commercially important Brazilians and six interspecific hybrids of Coffea arabica, Coffea canephora and Coffea liberica. The set used comprised 52 newly developed SSR markers derived from microsatellite enriched libraries, 56 designed on the basis of coffee SSR sequences available from public databases, 6 already published, and 13 universal chloroplast microsatellite markers. Only 22 were polymorphic, these detecting 2-7 alleles per marker, an average of 2.5. Based on the banding patterns generated by polymorphic SSR loci, the set of twenty-five coffee varieties were clustered into two main groups, one composed of only Brazilian varieties, and the other of interspecific hybrids, with a few Brazilians. Color mutants could not be separated. Clustering was in accordance with material genealogy thereby revealing high similarity.

Prevalencia de enteroparasitos, rotavirus y adenovirus en niños aparentemente sanos / Prevalence of enteroparasites, rotavirus and adenovirus in apparently healthy children

Para determinar la prevalencia de parásitos intestinales, rotavirus y adenovirus en niños aparentemente sanos, se realizó el estudio parasitológico de 101 muestras fecales de individuos de uno u otro sexo, con edades comprendidas entre 2 meses y 14 años, así como el estudio virológico en 70 muestras de los niños menores de 5 años. A cada espécimen fecal se le realizó un examen coproparasitológico directo, concentración de Formol-Éter y coloración de Kinyoun. Para determinar Rotavirus y Adenovirus se empleó la técnica de Ensayo Inmunoenzimático (ELISA). Para el análisis estadístico se utilizó el Ji-cuadrado (χ²) y la prueba Z. Se observó un elevado porcentaje de individuos parasitados (85,15 por ciento), los protozoarios más frecuentes fueron: Blastocystis hominis (52,47 por ciento), Giardia lamblia (26,73 por ciento) y Entamoeba coli (20,79 por ciento) y entre los helmintos Trichuris trichiura (50,49 por ciento), Ascaris lumbricoides (48,51 por ciento) y Strongyloides stercoralis (7,92 por ciento). Se observó una frecuencia de Rotavirus del 2,86 por ciento y ausencia de infección por Adenovirus. La elevada prevalencia parasitaria demuestra las condiciones de insalubridad de la comunidad, a pesar de ello, lo contrario ocurrió con los virus estudiados. Para Rotavirus quizás influyó la adquisición de anticuerpos a través de la lactancia materna, mientras que para Adenovirus entéricos, probablemente el desarrollo de anticuerpos a edad temprana

To determine the prevalence of intestinal parasites, rotavirus and adenovirus in apparently healthy children, a parasitological study of 101 fecal samples from persons between 2 months and 14 years from both sexes was performed, as well as a virological study of 70 samples of less than 5 years of age. For each fecal specimen, a direct coproparasitological examination was performed, with Formol - Ether concentration and Modified Zielh-Nielsen tincture techniques was made. To determine the Rotavirus and Adenovirus, the immunoenzymatic assay technique (ELISA) was used. The Ji-square (c2) and the Z test were used for statistical analysis. A high percentage of people with parasites was found (85.15 percent). The most frequent protozoan species were: Blastocystis hominis (52.47 percent), Giardia lamblia (26.73. percent) and Entamoeba coli (20.79 percent); among the helminthes were Trichuris trichiura (50.49 percent), Ascaris lumbricoides (48.51 percent) and Strongyloides stercoralis (7.92 percent). Rotavirus frequency was 2.86 percent, while Adenovirus infection was absent. The high prevalence of parasites demonstrates unhealthy conditions in the community; despite these, the opposite occurred regarding the virus being studied. Perhaps the acquisition of antibodies through maternal lactation influenced the Rotovirus percentages, whereas development of antibodies at an early age probably influenced the enteric Adenovirus

Inmunofenotipificación basal en personas diagnosticadas con VIH-1 en una unidad regional de inmunología (URIC), Venezuela, 2004-2006 / Basal immunephenotyping in HIV-1 diagnosed persons in a regional immunology unit (URIC), Venezuela 2004-2006

En el curso de la infección por el VIH-1, la inmunofenotipificación de los individuos infectados es importante para determinar el estadio inmunológico basal así como para comenzar y monitorear la terapia. Para la inmunofenotipificación basal de individuos recién diagnosticados con infección por el VIH-1 se llevó a cabo un estudio descriptivo y retrospectivo en la URIC de Maracay, Venezuela, de enero 2004 a diciembre 2006. A 238 pacientes (70,6% hombres y 29,4% mujeres) se les determinó el recuento de linfocitos T CD4/CD8 por citometría de flujo. El rango de edad fue de 2 a 74 años y el mayor número de casos (42,0%) se observó entre los 25 y 34 años. Se registraron recuentos de CD4+ menores de 200 cels/mm³ en 39,7% de los individuos; 35,0% presentaron valores entre 200 y 499 cels/mm³ y sólo 25,2% tuvieron valores sobre 500 cels/mm³. Los recuentos de CD8+ en 52,6% de los pacientes fueron mayores de 900 cels/mm³ y en 15,8% menores 500 cels/mm³. El índice CD4/CD8 resultó menor de 1.0 en 94,9% de los individuos, evidenciándose una tendencia creciente a diagnosticar la infección por VIH en una etapa tardía, como indican los recuentos disminuidos de CD4+ encontrados, pero se observó un incremento en el diagnóstico de los casos nuevos en los pacientes menores de 35 años y en las mujeres.

During the course of HIV-1 infection immunephenotyping of infected individuals is important to determine the basal immunological status, as well for initiating and monitoring therapy, for the basal immunephenotyping of recentlyHIV-1 diagnosed individuals we carried out a descriptive and retrospective study at the regional immunology unit (URIC) in Maracay, Venezuela, between January 2004 and December 2006. In the 238 patients included (70.6% men and 29.4% women) we studied CD4/CD8 T lymphocyte numbers through flow cytometry. Age range varied between 2-74 years, and the largest number of cases corresponded to the 25-34 age group. We found CD+ counts under 200 Cells/mm³ in 39.7% individuals; 35.0% had values between 200-499 cells/mm³; and only 25.2% had values over 500 cells/mm³. CD8+ counts in 52.6% of patients were higher than 900 cells/mm³ and 15.8% had counts under 500 cells/mm³. The CD4/CD8 index was lower than 1.0 in 94.9% of the individuals, demonstrating a growing tendency to diagnose HIV infection at a late stage, as shown by the decreased CD4+ counts found. Nevertheless, an increase in the diagnosis of new cases in patients under 35 years and women was also determined.

Prevalencia de enteroparásitos en dos comunidades de Santa Rosa de Agua en Maracaibo estado Zulia Venezuela 2006 / Prevalence of enteroparasites in two communities of Santa Rosa de Agua in Maracaibo Zulia Venezuela 2006

Para determinar la prevalencia de enteroparasitos en dos comunidades de Santa Rosa de Agua en el Estado Zulia, se analizaron 216 muestras fecales de individuos de ambos sexos, con edades comprendidas entre 1mes a 73 años. A cada espécimen fecal se le realizó un examen coproparasitológico directo con SSF (0,85 por ciento), coloración temporal de lugol y método de concentración de Formol-Eter; para la búsqueda de coccidios intestinales se aplicó la tinción de Kinyoun. Se observó un elevado porcentaje de individuos parasitados (86,58 por ciento), en donde predominó el poliparasitismo (68,98 por ciento) con asociación entre especies comensales y patógenas. En cuanto al grupo etario, el estrato de los adultos jóvenes (20 a 39 años) resultó mayormente parasitado (20,83 por ciento). A través del Ji (X²) no se observó diferencia significativa entre las enteroparasitosis y sexo; al relacionar los grupos etarios con las infecciones parasitarias, si hubo diferencia entre éstas dos variables. Las especies de protozoarios más prevalentes fueron: Blastocystis hominis (64,07 por ciento), Entamoeba coli (26,73 por ciento), Giardia lamblia (22,45 por ciento). Dentro de los helmintos: Trichuris trichiura (56,68 por ciento), Ascaris lumbricoides (44,09 por ciento), Hymenolepis nana (5,34 por ciento) ocuparon los primeros lugares. Las comunidades estudiadas de Santa Rosa de Agua presentan elevada prevalencia por enteroparásitos, situación similar a la observada en otras comunidades con condiciones socio-sanitarias e higiénicas deficientes.

Linfoma de Hodkin en Chile: Experiencia de 15 años del Programa Nacional de Cáncer del Adulto / Hodgkin lymphoma in Chile: Experience of the national adult cancer program

Background: Hodgkin lymphoma is a highly curable disease. Aim: To evaluate the clinical characteristics and the treatment results of Hodgkin lymphoma patients of the National Cancer Program in Chile. Patients and methods: Prospective assessment of 682 patients treated in 18 adult cancer centers. Progression free survival (PFS) and overall survival (OS) were calculated. Median follow up was 127, 95, 87, 72 and 50 months for C-MOPP, radiotherapy (RT), C-MOPP/ABV, NOVP and ABVD, respectively. Results: Median age was 37 years (15-84). Nodular sclerosis and mixed cellularity were equally expressed. Advanced stages (III & IV) were present at diagnosis in 61 percent of cases. Age over 40 was an adverse prognostic factor (p <0.001). The rate of PFS at 5 and 10 years for early stages was 73 percent and 66 percent with RT, 80 percent and 74 percent with C-MOPP+RT, 73 percent and 71 percent with C-MOPP/ABV, 59 percent and 59 percent with NOVP+RT, and 81 percent with ABVD+RT, at 5 years, being significantly lower for NOVP (p =0.02). The rate of OS at 5 and 10 years for advanced stages was 82 percent and 70 percent with RT, 82 percent and 76 percent with C-MOPP+RT, 82 percent and 80 percent with C-MOPP/ABV, 68 percent and 60 percent with NOVP, and 85 percent with ABVD at 5 years, also significantly lower for NOVP (p =0.04). For advanced stages, the rate of PFS at 5 and 10 years was 49 percent and 43 percent with C-MOPP, 69 percent and 62 percent with C-MOPP/ABVD or C-MOPP/ABV, and 71 percent at 5 years with ABVD, significantly lower for C-MOPP (p =0.01). The rate of OS at 5 and 10 years was 52 percent and 46 percent with C-MOPP, 70 percent and 63 percent with C-MOPP/ABVD or C-MOPP/ABV and 76 percent with ABVD at 5 years, significantly lower for C-MOPP (p =0.0002). Conclusions: Age over 40 years was an adverse prognostic factor. C-MOPP/ABVD, C-MOPP/ABV and ABVD had comparable results and reached a high tumor control and overall survival in both early...

Efectos benéficos de la modificación del estilo de vida en la presión arterial y la calidad de vida en pacientes con hipertensión / The beneficial effects of lifestyle modification on blood pressure and quality of life in patients with hypertension

Este artículo presenta los resultados de un estudio que tuvo como objetivo determinar el impacto de un programa para modificar el estilo de vida en los niveles de presión arterial y la calidad de vida de personas con diagnóstico de Hipertensión Arterial. Se empleó un método cuasi-experimental, con diseño transversal, análisis intragrupo y medidas repetidas (pre y post intervención). La muestra estuvo conformada por 44 personas diagnosticadas con Hipertensión Arterial, adscritas a una Empresa de Servicios de Salud de la ciudad de Cali, Colombia. Se registraron los niveles de presión arterial sistólica (PAS) y diastólica (PAD) pre y post-intervención y se aplicó el SF-36 Health Survey v2 para evaluar calidad de vida. Se encontró una disminución estadísticamente significativa en la PAS, mientras que la PAD no presentó cambios, manteniéndose en niveles controlados. Respecto a la calidad de vida, la modificación del estilo de vida tuvo efectos benéficos en el componente mental, así como en la subescala de Rol Emocional. En cuanto al componente físico, mejoraron significativamente las subescalas de Función Física y Rol Físico. Los resultados en calidad de vida se presentaron con algunas diferencias entre los pacientes con niveles controlados y no-controlados de PAS y PAD.

This paper presents the results of a study which purpose was to determine the impact of a lifestyle modification program to reduce blood pressure levels and to improve the quality of life in Hypertension patients. The method was a quasi-experimental, with transversal design, intragroup analysis and repeated measures (pre-post intervention). The sample was composed of 44 hypertension patients attended at a Health Care Service from Cali, Colombia. Systolic (SBP) and Diastolic (DBP) blood pressure levels were registered, and quality of life was assessed through the SF-36 Health Survey v2. A reduction of SBP was found with statistical significance, while DBP remained the same in controlled levels. With regard to quality of life, the lifestyle modification program had beneficial effects on the mental summary and the Role Emotional scale. In the physical summary, the Physical Function and Role Physical improved significantly. The quality of life results showed some differences between patients with controlled and uncontrolled SBP and DBP levels.

Community Psychiatry Clinics at Sundarban: a clinical and cultural experience.

A series of Community Psychiatric Clinics were conducted in different blocks of Sundarban region of West Bengal. One of the primary objectives of this was to collect clinical epidemiological data on psychiatric morbidity in the region. A total of 26 clinics were conducted in Sagar, Kakdwip, Canning and Gosaba block of the Sundarban region during the period from end 1998 to end 2000. A total of 451 psychiatric cases with diagnostic categories (male 239, female 212) and 215 non-psychiatric cases (male 107 and female 108) were seen in these clinics. Diagnostic Interview Schedules (SCID) and Clinical rating scales like Hamilton Depression Rating Scale and Brief Psychiatric Rating Scales were used to ascertain clinical diagnosis quantitatively. Special emphasis was given on common psychiatric disorders.