Ansiedad dental en adultos chilenos que concurren a un servicio de salud primaria / Dental anxiety in Chilean adults who attend a primary care health service

El objetivo fue identificar el nivel de ansiedad dental en una muestra de adultos chilenos que concurren a un servicio de atención de salud primaria. Se realizó un estudio transversal, obteniendo una muestra de 174 adultos, con edades entre los 20 y 70 años, pertenecientes al área urbana de Santiago de Chile, y que acudían en calidad de acompañantes de niños(as) que asistían a atención dental. Se registraron datos socio-demográficos y fecha de último control dental. Se aplicó la escala de ansiedad dental de Corah. Se realizaron estadísticos descriptivos, prueba t, prueba U de Mann Whitney y prueba de Spearman. Se trabajó con un error de significancia del 5 %. Un 37,9% de la muestra presentó ansiedad dental, en sus niveles moderado (16,1 %), severo (13,2 %) y fobia dental (8,6 %). A nivel educacional, los sujetos con educación básica completa presentaron la mayor frecuencia (57,1 %) de ansiedad, mientras que los de educación superior incompleta presentaron la menor frecuencia (25 %). No se observaron asociaciones entre ansiedad dental y edad, sexo, nivel educacional, índice per cápita y último control dental. La muestra de adultos encuestados de Santiago de Chile presentó altos niveles de ansiedad dental en comparación con países desarrollados. Se recomienda realizar más estudios en dicha población para determinar las variables que explican el problema de la ansiedad dental en la población chilena.

The objective of this study is to identify the level of dental anxiety in a sample of Chilean adults who attend a service of primary health care. A cross-sectional study was carried out. The sample consisted of 174 caregivers of pediatric dental patients, aged between 20 and 70 years, belonging to the urban area of Santiago de Chile. A questionnaire that included socio-demographic information (sex, age, educational level, income per capita index and last dental visit) were registered. Corah's Dental Anxiety Scale was applied. Descriptive statistics and t-test, U-Mann Whitney test and Spearman test was used. An error of significance of 5% was applied. 37.9 % of thesample shows dental anxiety in their moderate levels (16.1 %), severe (13.2 %) and dental phobia (8.6 %). Of the subjects who had dental anxiety, the majority had moderate anxiety (42.4 %). In an educational level, subjects with complete basic education have the highest rate (57.1 %) of anxiety, while incomplete higher education had the lowest rate (25 %). Adults between 50 and 59 years reported greater presence of dental anxiety. There were not significant associations between dental anxiety and age, sex, educational level, per capita rate and last dental visit. The sample of adults surveyed in Santiago de Chile presented high levels of dental anxiety compared to other developed countries. We recommend further studies in this population to determine the variables that explain the problem of dental anxiety in the Chilean population.

Evaluación de una prueba rápida para el diagnóstico de la infección por Trypanosoma cruzi en suero / Evaluation of a rapid diagnosis test for trypanosoma cruzi infection in serum sample

Con el fin de evaluar la utilidad práctica, y la sensibilidad y especificidad del test rápido Dipstick test Trypanosoma cruzi Detect, (Inbios, Seattle, WA) se estudiaron 284 sueros humanos de los cuales 145 correspondieron a casos probados de infección chagásica y 139 a individuos sanos de zonas no endémicas. Todos ellos analizados previamente con las Técnicas de ELISA y de Inmunofluorescencia Indirecta para la detección de anticuerpos IgG anti T. cruzi. Además se estudiaron 56 muestras serologicamente negativas para enfermedad de Chagas pero que presentan otras patologías parasitarias y no parasitarias. El "test" rápido de INBIOS demostró una especificidad de 99,3 por ciento al igual que la sensibilidad. Y una concordancia con La ELISA y la RIFI de de 98,2 por ciento. De acuerdo a estos resultados y a la facilidad de su ejecución, Dipstick test T. cruzi Detect (INBIOS) resulta ideal como tamiz para la vigilancia y los programas de intervención de la enfermedad de Chagas.

We tested a Rapid Diagnostic Test (RDT) to detect Trypanosoma cruzi infection using a total of 284 human sera, some of them from provedcases ofChagas disease (n = 145) and healthy individuals from non-endemic areas (n = 139). Another group included was non chagasic serum samples of individuals of other parasitic and non parasitic disease (n = 56), all of them with known serological test results. The RDT had a specificity of 99,3 percent and a sensitivity of 99,3 percent. The agreement with ELISA and IFAT was 98,2 percent. According to the results and the feasibility of the RDT should be an ideal tool for screening purposes in disease surveillance and intervention programs ofChagas disease.

Aspectos parasitológicos y epidemiológicos de los donantes de sangre seropositivos para Trypanosoma cruzi, en un hospital universitario / Parasitological and epidemiological aspects of Trypanosoma cruzi seropositive blood donors

Background: After the interruption of the transmission of Chagas disease via vector insects in Chile, there is little available epidemiological information about this parasitosis in blood banks. Aim To update the rates of T cruzi positive blood donors. To measure parasitological and epidemiological parameters in blood donors with anti T cruzi antibodies. Material and Methods: An ELISA-T cruzi test was carried out in 30,309 blood donors between 2000 and 2004. In 75 blood donors with an ELISA-T cruzi positive test and 79 donors with negative ELISA (controls), a survey about personal or parental history of biting by a kissing bug (Triatomine), was performed. A blood sample was also obtained to perform Polymerase Chain Reaction (PCR) for T cruzi and a xenodiagnostic test. Results: Annual frequency of positive ELISA for T cruzi serum antibodies in blood donors varied from 0.31 percent to 0.45 percent. Twenty eight percent of subjects with positive and 6 percent of subjects with negative specific antibodies answered the survey about biting. PCR and xenodiagnostic test were positive in 52 (69 percent) and 16 (21 percent) of positive ELISA-T cruzi test blood donors, respectively. Xenodiagnostic was also positive in 5 individuals who had a negative PCR. Conclusions: Seroprevalence of T cruzi antibodies decreased from 3 percent in 1968 to 0.3 percent in 2004.

Seroprevalencia de hidatidosis humana en la Región de Coquimbo. Chile / Human hydatidic seroprevalence in Coquimbo Region, Chile

Estudio previos de seroprevalencia de hidatidosis en Chile, realizados en sectores urbanos y rurales encontraron una tasa de 135 x 105, con una estimación probable de 17.002 personas infectadas. En los últimos años la prevalencia humana y animal ha tendido a disminuir en todas las regiones del país, excepto en la IV, VI y IX. Entre ellas destaca la IV Región por mostrar las mayores alzas, tanto en el ganado ovino como en el caprino. Con el objeto de contribuir al conocimiento actual de la hidatidosis humana, se estudió la prevalencia serológica en comunidades rurales ganaderas de la IV Región de Coquimbo con el fin de que dichos resultados sirvan de base para la aplicación de programas de control en la zona. Se estudiaron 4.632 muestras de habitantes de las provincias de Elqui, Limarí y Choapa. La selección del grupo se efectuó por muestreo aleatorio sistemático representativo de la región, según localidades y equivalentes al 3 por ciento de la población rural total de la IV Región. Las muestras de sangre obtenidas del pulpejo del dedo medio, fueron colectadas en papel filtro, según las normas bioéticas, estando supeditado al consentimiento de las personas. A cada eluído se les efectuó ELISA IgG. En forma paralela en dos laboratorios de rutina de inmunodiagnóstico parasitológico. Como antígeno se usó líquido hidatídico hepático ovino, aislado en forma estéril, centrifugado a 12.000 g en un laboratorio y en el otro el antígeno estuvo constituido por la fracción B o antígeno de Oriol. La seroprevalencia de la hidatidosis encontrada en comunidades rurales ganaderas de la IV Región de Coquimbo, alcanzó a un 2,5 por ciento. La tasa global encontrada en la IV Región equivale a una prevalencia estimada de 2.500 x 105, cifra notablemente superior a la tasa de 1,65 x 105 a nivel nacional y de 6,73 x 105 para la Región de Coquimbo notificadas en el 2004. Las prevalencias encontradas para las provincias de Limarí y Choapa, fueron superiores, en forma significativa, al n.

Integración entre el Servicio de Atención Médica y el Servicio de Alimentación-Nutrición, para los escolares en la renovación carismática Católica: Zona Sur, La Paz - Bolivia año 2001 / Integration between the Service of Medical care and the Service of Feeding - Nutrition, for the scholars in the Catholic charismatic renovation: South area, La Paz - Bolivia year 2001

La Iglesia Católica en todo el mundo tiene obra social. La Renovación Carismática Católica con 27 años de antiguedad en Bolivia que siguienndo la directrices del Papa Juan Pablo II, presta servicios a la comunidad, no solamente evangelizando, sino ofrecienndo alimento, cobijo y servicio médico a personas de bajos recursos económicos, incluidos menores en riesgo social. Bajo este perfil se realiza este proyecto de intervención en el año 2001 para mejorar el servicio ofrecido. Con una población de 120 niños y niñas de bajos recursos económicos de 7 a 12 años de edad, asistentes a la obra social de la Renovación Carismática Católica de la zona sur, La Paz - Bolivia. Este proyecto de intervención, tiene el diseño de antes y después, planificado para un año, con el objetivo de la integración de los Servicios de Alimentación-Nutrición y Atención Médica. El problema fundamental que pretende resolver es las bajas coberturas de atención nédica. Como resultados preliminares al primer mes de implantación, se evidenciaron que el 100 por ciento de la población de estudio no tiene acceso a la Seguridad SOcial. El 20 por ciento asiste a postas sanitarias cercanas a su domicilio, el 70 por ciento no acude a ningún servicio médico, y solamente el 10 por ciento acude al servicio médico de la Renovación Carismática Católica. Demostrando claramente que el acceso a la salud es proporcional a los ingresos económicos, determinando exclusión de la Seguridad Social. Además se logró aumentar las coberturas de un 3.3 por ciento a un 17 por ciento en el primer mes de implantación.

Rendimiento del xenodiagnótico y el PCR para evaluar el tratamiento quimioterápico específico de la enfermedad de Chagas en niños / Yielding of skin diagnosis and PCR for the evaluation of specific chemotherapy of Chagas's disease in children

Amplification by the polymerase chain reaction (PCR) of Trypanosoma cruzi kinetoplastic DNA was used to enhance sentitivity in the detection of the parasite in blood, with the ultimate goal of improving the parasitological diagnosis of Chagas' disease in 0-10 year-old infected children. Twenty eight children were evaluated by using xenodiagnosis (XD) and PCR. Whereas XD detected 75,0 percent of the cases PCR was positive in 96,8 percent. The usefulness of the PCR was further investigated in the 28 children who have received specific treatment with nifurtimox. Negativetion of XD after three and six months post treatment respectively. These observations suggest that PCR is the most sensitive and quick technique available for direct detection of T. cruzi in chagasic children and that it can be a very useful tool for the follow-up of infected subjects after specific chemotherapeutical treatment

Inmunodiagnóstico en 647 casos clínicos sospechosos de toxoplasmosis / Immunodiagnosis in 647 clinical cases of toxoplasmosis suspected

Though Toxoplasma gondii can cause severe pathology in human, in most of the cases it asymptomatic infection. So, it is important to dispose some methods capables to discriminate and chronic infections. An indirect hemagglutination test (IHAT), dye test (DT) and complement fixation test (CFT) were performed in 647 sera from patients suspected of having toxoplasmosis infection. IHAT and DT titer > the same as 4 and CFT > the same as 5 were considered positive. Titers were classified as follows: low (4-16), median (64-512) and high (> the same as 1000) for IHAT and DT. The pathologies for demanding these serological tests were: adenopathies (58), nephropathies (72), neuropathies (30), obstetrical problems (65), opthalmopathies (147), AIDS (237) and miscellaneous (37). Global positvity of 49.5 percent and 4.5 percent for IHAT/DT and CFT respectively were found. The positvity for the different groups were: adenopathies (48.3 percent and 13.8 percent), nephropathies (43.1 percent and 1.4 percent), neuropathies ,(26.7 percent and 3.3 percent), obstetrical problems (40.0 percent and 0.0 percent), ophthalmopathies (59.9 percent and 8.2 percent), AIDS (52. 1 percent and 2.5 percent) and miscellancous (40.5 percent and 2.7 percent) for IHAT/DT and CFT respectively. Low and median titers for IHAT/DT were found in 81.3 percent of cases. A high agreement in frequency of concordant and discordant titers of IHAT/DT and CFT, indicating a recent or acute infection was observed. This fact was more relevant in adenopathies, ophthalmopathies (uveitis) and AIDS groups

Seroepidemiology of human toxoplasmosis in Chile

En este trabajo se revisa, se amplia y se analiza en conjunto una crise serie e encuestas seroepidemiologicas sobre toxoplasmosis efectuadas en Chile entre 1982 y 1994, utilizando la reaccion de hemaglutinacion indirecta (RHAI). El estudio incluyo 76.317 personas aparentemente sanas de diferentes edades (0,57 por cento de la problacion total del pais), procedentes de 309 localidades urbanas y rural-periurbanas...

Diagnóstico de la neurocisticercosis humana mediante ELISA-IgG usando un antígeno purificado / Diagnosis of human neurocysticercosis by ELISA-IgG using a purified antigen

An analysis of inmunodiagnosis data for human neurocysticercosis (NC) by ELISA-IgG, complement fixation (CSF) from confirmed cases of different hospitals from the metrolitan area of Santiago, Chile, was performed. The cut-off value was determined by using serum samples from 60 apparently healthy persons, whose absorbance values were the mean plus three standard desviations. The sensitivity of ELISA was 97,0 percent and 100 percent for serum samples and CSF respectively. This assay was considered od statistical significance (p< 0,05) when it was compared with CFT. Specificity was stablished by testing a purified antigen over 109 different helminthiasis serum samples, 185 neurological affections other than NC and 60 control samples. A 98,3 percent of global specificity was found. The use of ELISA-IgG and a purified antigen in the approach of inmune diagnosis of NC is considered a useful assay, particularly if it is perfomed on paired serum/CSF samples.

Epidemiología de la enfermedad de Chagas en Chile: frecuencia de infección humana por trypanosoma cruzi por grupos de edad y por regiones / Epidemiology of Chagas's disease in Chile: frequency of trypanosoma cruzi human infection by age groups and regions

Chagas's disease is endemic in rural-periurban sections of the northern half of Chile which includes the first seven political-administrative regions of the country (18º30'-34º36' South lat.). Data concerning to the results of an indirect hemagglutination test for Chagas's disease performed to 15,418 rural-periurban and 45,119 urban inhabitants from the chagasic endemic regions are presented migrations from rural-periurban to urban areas have contributed to the dissemination of trypanosoma cruzi infection. General rates of infection for rural-periurban (r-p) and urban (u) sections were 16,7 for percent and 1,9 for percent respectively. The higher prevalence rates were detected in region III with 27,2 for percent (r-p) and 3,9 (u) and Region IV with 24,7 for percent (r-p) and 3,5 for percent (u), while the lower prevalence rates corresponded to Region VI with 7,0 for percent (r-p) and 0,8 for percent (u). Serological positivity increased parallelly with age in all regions

Valor diagnóstico de la ELISA-IgG para triquinosis usando antígeno de Melcher / Diagnosis value of ELISA-IgG for human trichinosis by using Melcher's antigen

An enzyme-linked inmunosorbent assay (ELISA) for trichinosis using a Melcher's antigen was developed for the detection of IgG antibodies in 41 serum samples from patients confirmed or suspected to have trichinosis by strong clinical and epidemiological evidences. ELISA-IgG was compared with a precipitin test (PT), a bentonite floculation test (BFT) and an indirect hemagglutination test (IHAT). The cut-off value as determined using serum samples from 67 apparently healthy persons employing two serum dilutions (1:100 and 1:500) with three standard desviations (SD). The sensitivity of ELISA-IgG was 97,6 for percent and 95,2 for percent using serum dilutions of 1:100 and 1:500 respectively, whereas the values for the other tests were: PT (92,7 for percent), BFT (63,4 for percent) and IHAT (85,4 for percent). According to MacNemar test, Elisa-IgG did not present statistical significance (p>0.01). In order to find out the specificity of ELISA-IgG, additional 124 serum samples from individuals with other parasitoses, such as cysticercosis (31), fascioliasis (17), hydatidosis (51) and toxocariasis (25) were also tested. ELISA-IgG presented a specificity of 99,5 for percent with both serum dilutions. The positive predictive values were 97,6 and 97,5 for percent, whereas the negative one were 99,5 and 99,0 for percent for 1:100 and 1:500 serum dilutions respectively. The use of ELISA-IgG and Melcher's antigen in the diagnosis of human trichinosis is discussed

Evaluación de la ELISA IgG, usando un antígeno purificado en el diagnóstico de la hidatidosis humana / Evaluation of ELISA IgG test using a purified antigen in the human hydatidosis diagnosis

An enzyme-linked immunosorbent assay (ELISA) was developed for the detection of IgG antibodies to purified sheep hydatic cyst fluid antigen in 56 sera of confirmed cases of hydatidosis. The cut-off value was determined using serum samples from 80 healthy persons, employing two serum dilutions (1:100 and 1:500) with two and three standard desviations (SD). This assay was compared with the indirect hemaglutination test (IHAT). The sensitivity of ELISA-IgG was 94,3 for percent, for hepatic cysts and 92,9 for percent, for pulmonary cysts, whereas the values for IHAT were 77,1 and 64,3 for percent, respcetively. According to Mac Nemar test, both thod presented statistical significance (p < 0,05). In order to find out the specificity, additional 70 serum samples from individuals with other parasitoses, such as cysticercosis (30), trichinosis (26) and fascioliasis (14) were also tested, IHAT presented a specificity of 92,7 for percent and for ELISA-IgG the specificity using a cut-off of average + 3 SD was 99,3 and 100,0 por percent with sera dilution of 1:100 and 1:500 respectively when a cut-off of average +2 SD was considered, we found a specificity of 91,3 and 97,3 por percent, for 1:100 and 1:500 dilutions. The use of ELISA-IgG and purified antigen in the diagnosis of human hydatidosis is discussed

Comparación de la frecuencia de alteraciones electrocardiográficas en grupos de personas aparentemente sanas con serología positiva para enfermedad de Chagas, para toxoplasmosis o para ambas parasitosis / Comparison of the frequence of electrocardiographical alterations in groups of apparently healthy persons with positive serology for Chagas'disease, for toxoplasmosis or for both parasitoses

Comparison of the frequence of electrocardiographical alterations in groups of apparently helathy persons with positive serology for Chagas disease, for toxoplasmosis or for both parasitoses

Resultados de las reacciones serológicas en pacientes con diagnóstico presuntivo de toxoplasmosis / Results of serological reactions in patients with presumptive diagnosis of toxoplasmosis

Eventhough Toxoplasma gondii is an ubiquitous parasite that can affect most of human estructures and organs, not all clinical manifestations suggestive of being produced by it are caused by this protozoon. For these reasons sera samples of patients suspected of having toxoplasmosis are sent to the laboratory for detecting specific antibodies which would facilitate the differential diagnosis. Thus, 716 sera from suspected patients, mainly from the Metropolitan Region of Chile, were sent to the Parasitology Laboratory of Chile University in order to carry out in them, specific serological tests for toxoplasmosis: indirect hemagglutination test (IHAT), Sabin Feldman reaction (SFT) and complement fixation test (CFT). Were considered positive: IHAR and/or SFT with titers * 1 : 16 and CFT with titer * 1 5. The pathologies for demanding these serological tests were: obstetrical probelmas 210 (29,3%), congenital problems 193(27,0%), ophthalmopathies 81(11.3%), adenopathies 77(10.8%), AIDS 67(9.4%), miocardiopathies 46(6.4%) and miscellaneous 42(5.9%). The positivity found in these sera was higher in ophthalmopathies (61.7%), followed by obtetrical problems, miscellaneous problems, miocardiopathies and AIDS (50.7-52.4%), less frequent was the positivity in adenopathies (35.1%) and congenital problems (23.1%). In general, the 43.7% of positivity for toxoplasmosis found in these patients is higher than the 37.0% found in the general population. High titers of IHAT and SFT plus positive CFT was found in 13-fold higher proportion than in the general population

Epidemiología de la toxoplasmosis en Chile: VI prevalencia de la infección humana, investigada por medio de la reacción de hemaglutinación indirecta, en las regiones VII, VIII y IX / Epidemiology of toxoplasmosis in Chile: VI. Prevalence of human infection, investigated by means of an indirected hemaglutination test, in regions VII, VIII and IX

In presecuting the investigations on the epidemiology of toxoplasmosis in Chile, a new series of serological surveys has been performed during 1982-1989 in 10 urban and 25 periurban-rural localities form the regions VII, VIII and IX of the country [34-41'-39-38' South lat.]. In 9.758, randomly selected, apparently helathy persons, and indirect hemagglutination test [IHAT] for toxoplasmosis was carried out. The age of these individuals [4.203 males and 5.555 females] varied between 4 and 84 years. The exmined persons represent a 0.33% of the total population of the three studied regions. IHAT titers of 1:> ou = 16 were regarded as positive. The global prevalence for positive IHAT was 45.5% [50.5% in men and 41.7% in women]. A higher proportion of positive tests was observed in urban areas [47.0%] than in periurban-rural sections [33.3%]. An increasing prevalence with age was also observed. Only 5[0.05%] persons had IHATtiters higher than 1:1000

Algunas características epidemiológicas, clínicas y parasitológicas de la enfermedad de Chagas congénita en Chile / Epidemiology clinic and parasitological characteristics of congenital Chagas disease in Chile

La infección chagásica, endemo-enzootia, existe en Chile en sectores rurales y periurbanos de la I a VI Regiones, donde se ha demostrado la existencia de vectores, principalmente el Triatoma infestans, y mamíferos, incluso el hombre, parasitados por el Trypanosoma cruzi. Debido a migraciones, también se ha encontrado individuos infectados por el parásito en centros urbanos de las referidas regiones. Para conocer la prevalencia de la infección humana por T. cruzi en 1982-1987, mediante la reacción de hemaglutinación indirecta (RHAI) para enfermedad de Chagas, se ha examinado a 57.562 habitantes de dichas regiones: 13.515 rurales-periurbanos con RHAI positiva en el 16,9%, y 44.047 urbanos con RHAI positiva en el 1,9%. Entre estos últimos, se incluyeron 14.768 parturientas atendidas en 19 maternidades. La parasitosis puede ser transmitida vía transplacentaria. Con el objeto de conocer mejor el efecto que la infección materna por T. cruzi puede ocasionar sobre el producto de la concepción, se estudió a 1.355 mujeres en edad fértil (646 chagásicas y 709 no chagásicas) y a los productos de los embarazos que tuvieron en 1982-1987. No hubo diferencias significativas en el número ni en la evolución de los embarazos de las madres chagásicas y no chagásicas (peso del niño al nacer, mortinatalidad y abortos). Se estudió desde el momento del parto a 235 hijos de madres chagásicas y 191 de madres no chagásicas, nacidos en maternidades en los que la RHAI fue positiva en el 87,2 y en el 0,0% respectivamente