Estado ácido-base en obstetricia crítica y altitud / Acid-base status in critical care obstetrics at altitude

OBJETIVO: describir el estado ácido base en pacientes obstétricas críticamente enfermas a muy alta altitud, al momento de su ingreso a la Unidad de Cuidados Intensivos. MATERIAL Y MÉTODO: estudio descriptivo transversal. Se incluyen todas las pacientes obstétricas internadas en la Unidad de Cuidados Intensivos Adultos del Hospital del Norte de la ciudad de El Alto, La Paz a 4150 metros sobre el nivel del mar, ingresadas en el periodo enero 2019-enero 2022. RESULTADOS: se ingresaron 79 pacientes, con media de edad de 29 años (desviación estándar 8.06 años), 52 casos (66%) por preeclampsia severa, 14 casos (18%) por hemorragia obstétrica, 8 casos (10%) por sepsis obstétrica y 5 (6%) por diagnósticos diversos como taquicardia supraventricular e intoxicaciones, existieron 8 pacientes fallecidas (10% de mortalidad) destacando la sepsis obstétrica con mayor fallecimiento y mayor tiempo de internación. CONCLUSIÓN: los cambios fisiológicos propios del embarazo, la convierten en una paciente de riesgo, identificando la diferencia de iones fuertes aparente y abreviada como posibles factores pronóstico en la paciente obstétrica en estado crítico. PALABRAS CLAVE: estado acido-base, obstetricia crítica, gran altitud

OBJECTIVE: to describe the acid base status in critically ill obstetric patients at very high altitude, at the time of admission to the Intensive Care Unit. METHODOLOGY: retrospective descriptive study. All obstetric patients admitted to the Adult Intensive Care Unit of the Hospital del Norte in the city of El Alto, La Paz at 4150 meters above sea level, in the period January 2019-January 2022, are included. RESULTS: 79 patients were admitted, with a mean age of 29 years (standard deviation 8.06 years), 52 cases (66%) due to severe preeclampsia, 14 cases (18%) due to obstetric hemorrhage, 8 cases (10%) due to obstetric sepsis. and 5 (6%) due to various diagnoses such as supraventricular tachycardia and poisoning, there were 8 deceased patients (10% mortality), highlighting obstetric sepsis with the highest death rate and longest hospital stay. DISCUSSION: the physiological changes during pregnancy make her a risk patient, identifying the apparent and abbreviated strong ion difference as possible prognostic factors in the critically ill obstetric patient

Ictus en cuidado intensivo a muy alta altitud / Stroke in intensive care at very high altitude

Objetivo: Describir la casuística de los pacientes con ictus atendidos en la Unidad de Cuidados Intensivos del Centro de Trauma "Hospital Corazón de Jesús" a 4150 metros sobre el nivel del mar. Metodología (casuística): Estudio retrospectivo transversal descriptivo. Se incluyen todos los pacientes residentes permanentes a muy alta altitud, ingresados en el periodo Enero 2019-Enero 2022. Para el análisis de los datos se utilizó estadística descriptiva y creación de una base de datos en el programa Excel v16. Resultados: Se ingresaron 74 pacientes, 39 mujeres (53%), edad promedio de 64.82 (± 10.53 años), 51 casos (69%) por ictus isquémico y 23 casos (31%) por ictus hemorrágico, con una mortalidad de 18% para ictus isquémico y 17% para ictus hemorrágico. La escala de coma de Glasgow, el nivel del hemoglobina, la presión parcial arterial de dióxido de carbono, hiperoxemia y depuración de lactato al ingreso se constituyen en factores pronósticos de mortalidad. Así también se evidencia que, la hipertensión arterial sistémica así como la eritrocitosis son comorbilidades asociadas a la presentación de ictus a muy alta altitud. Discusión: La mortalidad en el presente estudio fue similar a la literatura consultada, constatando que la altitud, por sí sola, no produce mortalidad ni ofrece algún tipo de protección, al menos en pacientes neurocríticos con ictus a muy alta altitud. De igual manera se verifica la edad de presentación del ictus en concordancia a la literatura internacional. Conclusiones: Resulta imperativo describir la casuística concerniente a nuestros Centros Asistenciales para conocer las características propias de la patología de altitud destacando la presión parcial de dióxido de carbono, la hiperoxemia y la depuración de lactato como factores pronóstico en nuestro medio.

Objective: To describe the casuistry of stroke patients treated in the Intensive Care Unit of the Trauma Center "Hospital Corazón de Jesús". Methodology (casuistry): Retrospective cross-sectional descriptive study. All permanent resident patients at very high altitude, admitted in the period January 2019-January 2022, were included. For the analysis of the data, descriptive statistics and creation of a database in the Excel v16 program were used. Results: 74 patients were admitted, 39 women (53%), mean age 64.82 (± 10.53 years), 51 cases (69%) due to ischemic stroke and 23 cases (31%) due to hemorrhagic stroke, with a mortality of 18%. The Glasgow coma scale, hemoglobin level, arterial partial pressure of carbon dioxide, hyperoxemia, and lactate clearance on admission are prognostic factors for mortality. Thus, it is also evident that systemic arterial hypertension as well as erythrocytosis are comorbidities associated with the presentation of stroke at very high altitude. Discussion: Mortality in this study was similar to the literature consulted, confirming that altitude alone does not cause mortality or offer any type of protection, at least in neurocritical patients with stroke at very high altitude. In the same way, the age of presentation of the stroke is concordant with the international literature. Conclusion: It is imperative to describe the casuistry concerning our Health Centers to know the characteristics of the altitude pathology.

Cuidado intensivo COVID 19 a muy alta altitud / Critical care in COVID 19 at very high altitude

Objetivo: Describir la casuística de los pacientes críticamente enfermos COVID-19 atendidos en la Unidad de Cuidados Intensivos del Hospital del Norte, primer Hospital del Tercer Nivel de Complejidad de la ciudad de El Alto y Centro de Referencia Departamental. Metodología: Estudio retrospectivo transversal observacional. Se incluyen todos los pacientes residentes permanentes a muy alta altitud, ingresados en el periodo 25 Marzo 2020-25 Noviembre 2021. Para el análisis de los datos se utilizó estadística descriptiva y creación de una base de datos en el programa Excel v18. Resultados: Se ingresaron 373 pacientes, 212 (57%) varones, así como 161 (43%) mujeres. Se tiene una mortalidad corregida del 48%, la estancia promedio en la UCI es de 18 días, 26 (± 4) en el grupo de supervivientes y 11 (± 2) en el grupo de fallecidos. La edad promedio de supervivientes es de 47.25 años (± 12 años) y la edad promedio de fallecidos 56.58 años (± 14 años) con valor de p por t de Student de 0.004. La comorbilidad más frecuentemente encontrada fue la hipertensión arterial sistémica en 157 (42%) casos. Únicamente 2 casos contaban con vacuna antiCOVID-19. Discusión: La mortalidad corregida es similar a la casuística reportada en la literatura internacional en Unidades de Cuidados Intensivos. El presente estudio apoya el hecho que la altitud no afecta la evolución de los pacientes críticos COVID-19. Conclusión: Resulta imperativo describir la casuística concerniente a nuestros Centros Asistenciales.

Depuración del lactato y mortalidad en residentes de la gran altitud con trauma grave / Lactate clearance and mortality in high altitude residents with severe trauma

Introducción: Diversos estudios reportan que la depuración del lactato está asociado a la mortalidad en los pacientes críticos. Se describe la relación entre la depuración del lactato y la normalización del lactato con la mortalidad en los pacientes residentes de la gran altitud con trauma grave. Por lo cual es importante conocer la mortalidad de los pacientes con trauma grave en la altitud y la distribución lesional del trauma grave en la altitud. Material y Métodos: Estudio de cohorte, retrospectivo, realizado en una unidad de cuidados intensivos a 4,150 "msnm" en pacientes que ingresaron por trauma grave. Los criterios de inclusión fueron: a) Diagnóstico de trauma grave. b) Injury severity score mayor a 16. c) Presencia del resultado del análisis del lactato al ingreso y a las 6 horas en UCI y d) Residente de la altitud desde los 12 años. Se excluyeron los pacientes con historias clínicas incompletas y no legibles. Resultados: Se incluyeron 160 pacientes, Mortalidad del 15%, 65% de las lesiones fueron por trauma encefálico grave. En el grupo de supervivientes (n=136), la depuración de lactato fue del 52,27% y en el grupo de fallecidos fue 21,38%. En relación a la normalización (lactato< 2 mmol/L), el grupo de supervivientes tuvo 47% frente a 1% de los fallecidos. Conclusiones: La depuración de lactato y la normalización del lactato a las 6 seis horas son factores de protección para disminuir la mortalidad por trauma grave. La mortalidad por trauma grave es 15%. El trauma encefálico grave fue la lesión más frecuente.

Background: Several studies report that lactate clearance is associated with mortality in critically ill patients. Objectives: To describe the relationship between lactate clearance and lactate normalization with mortality in high-altitude resident patients with severe trauma. To know the mortality of patients with severe trauma at altitude. Know the injury distribution of severe trauma at altitude. Material and Methods: Epidemiological, observational, analytical, cohort, retrospective study, carried out in an intensive care unit located at 4,150 "masl" in patients admitted for severe trauma. The inclusion criteria were: a) Diagnosis of severe trauma. b) Injury severity score greater than 16. c) Presence of the result of the lactate analysis at admission and at 6 hours in the ICU and d) Resident of the altitude since the age of 12. Patients with incomplete and unreadable medical records were excluded. Results: 160 patients were included, mortality of 15%, 65% of the injuries were due to severe brain trauma. In the group of survivors (136), lactate clearance was 52.27% and in the group of deceased it was 21.38%. In relation to normalization (lactate <2 mmol / L), the group of survivors had 47% compared to 1% of the deceased. Conclusions: Lactate clearance and lactate normalization at 6 hours are protective factors to decrease mortality from severe trauma. Mortality from severe trauma is 15%. Severe head trauma was the most frequent injury.

Gasometría arterial en embarazo a muy alta altitud / Arterial blood gas analysis during pregnancy at a very high altitude

La gasometría arterial es fundamental en el diagnóstico y manejo del medio interno. El objetivo es caracterizar los valores de gasometría arterial en gestantes sanas con embarazo normoevolutivo residentes a 4 150 metros sobre el nivel del mar. Serie de casos llevada a cabo durante la gestión 2019, la cual incluye pacientes sin clínica ni antecedentes de enfermedades cardiopulmonares o hematológicas, así como ausencia de tabaquismo y residencia de al menos los últimos 6 meses. Se incluye 30 pacientes, media de edad 25.23 años (desvío estándar 3.69), con edad gestacional media de 26 semanas (desvío estándar 5.5). El valor de pH tiende a ser más alto, así como los valores de PaO2, PaCO2, HCO3 y SatpO2% son más bajos, incluso en comparación con adultos sanos residentes de la misma altitud. Existe cierta tendencia positiva hacia el incremento progresivo del pH mientras la edad gestacional avanza. La gasometría arterial en la altura, debe ser interpretada con suma precaución en relación a las condiciones barométricas, proporcionándose así, valiosa información con aplicación a la obstetricia crítica a muy alta altitud.

Arterial blood gases analysis is essential in the diagnosis and management of pathologies. The objective is to characterize arterial blood gases values in healthy pregnant residents at 4150 meters above sea level. Series case performed during 2019, including patients without a clinical features or antecedents of cardiopulmonary or hematological diseases as well as absence of smoking and residence for at least the last 6 months. Thirty patients are included, mean age 25.23 years (standard deviation 3.69), with average gestational age of 26 weeks (standard deviation 5.5). The pH tends to be higher, as well as the values of PaO2, PaCO2, HCO3 and SatpO2% are lower, even compared to healthy adults living at the same altitude. There is some positive trend towards progressive pH is higher such as gestational age progresses. Arterial gas blood analysis at altitude, should be interpreted with extreme caution in relation to barometric conditions, thus providing, valuable information to critical care obstetrics at very high altitude

Una misma deontología para distintas ciencias?: revisión de pautas nacionales e internacionales en ética de la investigación científica / Uma mesma deontologia para distintas ciências? Revisão de pautas nacionais e internacionais em ética da investigação científica / One same deontology for different sciences? Review of national and international guidelines in ethics of scientific research

Se realizó una revisión de normas jurídicas chilenas y códigos éticos internacionales asociados a la investigación científica con seres humanos, a través de una metodología mixta de análisis de contenido, con el propósito de identificar la presencia de vocablos asociados a la psicología, comprendida como una ciencia intermedia entre la biomedicina y las ciencias sociales. Se busca conocer las consideraciones éticas presentes en ambos tipos de normativas, para delimitar las diferencias entre aquellas asociadas a las ciencias biomédicas y las que corresponden a la psicología. Los resultados muestran una escasa presencia de normas ligadas a las particularidades de la psicología y un limitado y pobre uso de sus conceptos, evidenciando que la bioética, mayoritariamente basada en los desarrollos de la biomedicina, no responde adecuadamente a las necesidades de resolución de conflictos éticos en el contexto investigativo de la ciencia psicológica.

A review of legal Chilean norms and international ethical codes about research involving human beings was carried out, through a mix methodology of content analysis, with the purpose of identifying the presence of words associated to psychology, as an intermediate science between biomedicine and social sciences. Finding ethical issues present in both types of norms was looked out to delimit the differences between those associated to biomedical sciences and those to psychology. Results show a scarce presence of norms linked to the particularities of psychology and a limited and poor use of concepts, demonstrating that bioethics, mainly based on biomedical developments, does not respond adequately to the needs for conflict resolution in the research context of psychology.

Foi realizada uma revisão de normas jurídicas chilenas e códigos éticos internacionais associados à investigação científica com seres humanos, através de uma metodologia mista de análise de conteúdo, com o propósito de identificar a presença de vocábulos associados à psicologia, compreendida como uma ciência intermediária entre a biomedicina e as ciências sociais. Busca-se conhecer as considerações éticas presentes em ambos os tipos de normativas, para delimitar as diferenças entre aquelas associadas às ciências biomédicas e as que correspondem à psicologia. Os resultados mostram uma escassa presença de normas ligadas às particularidades da psicologia e um limitado e pobre uso de seus conceitos, evidenciando que a bioética, majoritariamente baseada nos desenvolvimentos da biomedicina, não responde adequadamente às necessidades de resolução de conflitos éticos no contexto investigativo da ciência psicológica.

Malaria en Chile: 1913-2001 / Malaria in Chile from 1913 to 2001

Background: Malaria was restricted to the I Region of Chile, being Anopheles pseudopunctipennis the only vector species. In 1936 the parasitosis affected more than 50 percent of the population and 62.4 percent of military recruits, proceeding from Southern regions became infected. From 1937 to 1947, an antimalaria campaign was carried out, stressing actions on the battle against the vector and the treatment of malaria infected individuals. Since April 1945 no autochthonous cases of malaria have been detected. Aim: To update the situation of malaria in Chile. Methods: 1) Imported malaria: Analysis of occasional publications on the subject (1945-1988) and the annual reports of the Ministry of Health Department of Epidemiology (1990-2001). Annual reports on the Anopheles specimens collected -mostly larvae- in the provinces of Arica and Iquique and examined in the Parasitology Unit of the School of Medicine, University of Chile, during the period 1980-2001. Results: 1) Imported malaria. A total of 24 cases were published in the period 1945-1988. In the 1980-2001 period, the Ministry of Health recorded 66 cases with 5 (8.8 percent) deaths. 2) Anophelines: Only in 1984, 1985, 1998 and 2001 A. pseudopunctipennis foci were detected. Entomological surveillance was stressed and insecticides were applied on these focuses. Conclusions: Autochthonous malaria does not exist in Chile since 1945. The detection of malaria cases in countries where the parasitosis was eradicated, can be the result of tourism or migrations. In Chile, the Environmental Programs of Arica and Iquique perform periodical surveys in localities where mosquitoes exist. When A. pseudopunctipennis is found, the entomological vigilance is stressed and insecticide applications are reiterated until the situation is controlled

Loxoscelismo en pediatría: Región Metropolitana Chile / Loxoscelism in paediatrics: Región Metropolitana Chile

Loxoscelismo es el cuadro tóxico producido por veneno que arañas del género Loxosceles L. Iaeta, en Chile, inyectan en el momento de la mordedura. Puede presentarse en dos formas clínica: loxoscelismo cutáneo-visceral (LCV). El objetivo del presente trabajo es exponer y analizar los aspectos clínico-epidemiológicos de 56 casos pediátrico -38 LC y 18 LCV- atendidos en la Región Metropolitana. En los últimos 45 años se ha encontrado una mayor incidencia de ambas formas en primavera-verano, en dormitorios cuando el niño dormía o se estaba vistiendo, siendo las áreas cutáneas más frecuentemente afectadas las extremidades y cara, con sensación de lancetazo urente como síntoma inicial. Manifestaciones clínicas más frecuentes: dolor, edema y placa livedoide que derivó a escara necrótica. Manifestaciones clínicas del LCV fueron hematuria, hemoglobinuria, ictericia, fiebre y compromiso de conciencia; letalidad 22,2 por ciento. El LCV no tuvo relación con el sitio de mordedura, extensión de la lesión local ni época del año. Si el compromiso visceral no aparece en las primeras 24 h es muy probable que se trate de un LC cuyo pronóstico es bueno. Si el paciente con LCV ha sobrepasado las 48 h, sus posibilidades de recuperación son altas. El tratamiento fue parental: antihistamínicos o corticoides en LC y corticoides en LCV. Conclusiones: En esta serie se observa una predominancia en el sexo femenino, sin diferencias estacionales ni de edad. En su gran mayoría los casos se originaron en el domicilio, afectando en especial las extremidades. El LCV fue más frecuente en mujeres, y sus principales manifestaciones fueron la hematuria y hemoglobinuria, y la precocidad del diagnóstico y su manejo son factores fundamentales en el pronóstico

Estudio comparativo de la sensibilidad y mortalidad de las ninfas III y IV de triatoma infestans usadas en el xenodiagnóstico de pacientes chagásicos crónicos / Comparative study on sensivity and mortality of triatoma infestans nymphs III and IV used in the xenodiagnosis of chronic chagasic patients

Triatoma infestans nymphs have shown a good sensitivity for detecting trypanosoma cruzi in the bood stream of infected hosts when are used in the xenodiagnosis (XD). This method, with its natural limitations, using seven nymphs III of T. infestans, has been routinely utilized with a satisfactory yield. With the aim of an eventual improving of the yield of XD (with 7 nymphs), two series of 54 XD boxes each, containing a total of 378 nymphs III and 378 nymphs IV respectively, were applied one of each during three consecutive days to nine chronic chagasic patients. Each of the nymphs was weighted before an after the application of the boxes, and the intestinal content of them was examined 30, 60 and 90 days later. The main comparative results obtained with nymphs III and IV of T. infestans were: blood ingestion 40 versus 107 mg (2,7 higher), positivity of insects 35,8 percent versus 50,6 percent (15,8 percent higher), positivity of XD boxes (7 nymphs each) 46,3 percent versus 55,6 percent (9,3 percent higher), and mortality rates 28,6 percent versus 12,2 percent (16,4 percent lower). All these results demonstrate that nymphs IV of T. infestans, because their higher capacity of ingesting blood and higher tolerance to examination manipulations, are more suitable for been used in XD

Comparación de la infección por trypanosoma cruzi en niños menores de 10 años de la V Región Chile: 1982-1995 / Comparison of trypanosoma cruzi infection in less than 10 year old children from the V Región Chile: 1982-1995

Evaluation of desinsectation programs carried out in the two health services from the V region, was undertaken by comparing serologic prevalences of T. cruzi infection age groups exposed to the risk of infection in rural areas during the antivectorial campaign activities (1982 vs 1995). Thus, were studied 2,193 blood samples from children under 10 years of age, proceeding from six chagasic endemic provinces in which antitriatomic domiciliary insecticide sprayings had been performed. Indirect hemagglutination and ELISA tests were carried out to each of the blood samples. A total de 42 (1,9 percent) children resulted positive. As an five counties no positive cases were detected in the last five years it is possible to assume that vector trasmission of T. cruzi should have been interrupted in them. When comparing prevalences existing in 1982 with the present ones, it is possible to observe a 63,5 percent of reduction of transmission in the V region, been this reduction higher in the Aconcagua Health services with 79,6 percent and lower in the Viña del Mar - Quillota Health Service with 55,6 percent. According to these results, comparison of prevalence of T. cruzi infection in children less than 10 year old in diverse periods, allows evaluate the vectorial control of Triatoma infestans programs

Hidatidosis en Chile: seroprevalencia y estimación del número de personas infectadas / Human hydatidosis in Chile: seroprevalence and an estimate of the number of infected people

Chile is located in the southwestern border of South America. The country is 4,329 km long and 96-342 wide. From north to south it is divided into five marked different biogeographical zones: deserts, steppes, bushes, forests (cattle raising) and austral (sheep raising). Population (june 1999) 15,017,760 (14,6 percent rural). Human hydatidosis is endemic in Chile. According to Ministry of Health information about 320 cases are registered each year. In order to find out the likely prevalence of human hydatidosis in Chile, a series of serosurveys was carried out in 1988-1997 throughout the total country. By using the indirect hemagglutination reaction and ELISA for hydatidosis (test with good sensibility and specificity) 60,790 unselected apparently healthy persons: 41,399 from urban areas (16,428 blood donors, 13,894 delivering mothers and 11,077 middle grade schoolchildren) and 19,361 from rural areas from randomly selected family groupings were studied. A total individuals 82 (136/100,000) resulted positive: 36 (87/100,000) urban and 46 (241/100,000) rural, being the prevalence higher in rural areas, particularly in the southern austral zone (mean 1068/100,00). These figures agree with those observed in clinical epidemiological studies. In conformity with the present results, in the whole country 17,002 individuals should have hydatidosis: 10,318 urban and 6,784 rural. All these possible infected people, not necessarily should present pathology in the future, as it has been observed in autopsies from unselected individuals, performed at the Medico Legal Service in Santiago, in whom 71,3 percent of diagnosed hydatidosis with hydatid cysts in many different locations, was an autopsy finding

Estudio longitudinal, mediante el xenodiagnóstico, de la parasitemia en pacientes con infección por trypanosoma cruzi crónica / Longitudinal study, by means of xenodiagnosis, of parasitemia in patients with chronic trypanosoma cruzi infection

A 2-5 years follow-up of parasitemia, by the use of xenodiagnosis (XD) was carried out in nine patients with chronic T. cruzi infection who proceeded from chagasic endemic areas of Chile. The patients (mean age 55 years) were hospitalized in the chronic section of a psychiatry institution sited in a permanent triatomines free urban area. Clinical examination, x-rays images (cardiovascular, esophagus and colon) and electrocardiogram resulted normal in all the patients. Basic study unit of parasitemia was a XD box which contained 7 nymphs III of triatoma infestans which was used in a serial XD consisting in the simultaneous application of a pair of boxes a day during three consecutive days, making a total of six boxes (42 nymphs). The minimal time of duration of infection (MDI.) for each patient was estimated that this was adquired close to hospitalization. The MDI. varied between 6 and 45 years. The global positivity of XD boxes ranged between 6.3 and 84.7 percent, being three patients lower than 12 percent and six patients higher than 52 percent. In considering the yield of XD it is important to stress that during all the study of the mine patients with chronic chagasic infection 1282 XD boxes were applied resulting positive 582 (45,4 percent). At the end of the follow-up all patients received specific treatment for chagasic infection with nifurtimox at the daily dose of 10 mg/kg of body weight during 60 days. According to the result, two main conclusions arise: 1.- serial XD has a hight efficiency for detecting, evaluate and evolve parasitemia in patients with chronic chagasic infection. 2.- parasitemia may present low, medium or high levels in different individuals and has a variable and fluctuating character

Presencia de triatoma spinolai en viviendas humanas / Presence of triatoma spinolai in human dwellings

Triatoma spinolai is a wild species of triatomine existing exclusively in Chile, with scarce epidemological importance in the transmission of trypanosoma cruzi to man. It has been found in enviroments from 3000 meters down to the sea level. Excepcionally it has been found in human dwellings. In order to clarify the possibility of an adaptation of T. spinolai to human dwellings a study was undertaken in 50 rural-periurban dwellings from regions III, IV, V and metropolitan in which this triatomine was found. The dwellings were clasiffied in houses (35) and huts (15). The insects was trapped in 35 dwellings (24 houses and 11 huts) located in declivities (70 for percent) and 15 dwellings (14 and 1) located in plains. This proportion is significantly higher than the average of 26,2 for percent for dwellings located in declivities. It is concluded tahat presence of T. spinolai in dwellings, more than a triatomine invasion is the result of the construction of huts or houses in the insect habitat

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

Evaluación de un programa de erradicación del triatoma infestans en viviendas rurales de la IV Región de Chile mediante serología para la enfermedad de Chagas en niños de 0 a 10 años de edad / Triatoma infestans eradication program assessment in rural dwellings from the IV Region of Chile by serology for Chagas' disease in children 0 to 10 years of age

The present study deals with the evaluation of the effectiveness of the measures employed in the control of triatoma infestans, the vector of trypanosoma cruzi infection (Chagas' disease), in the IV Region of Chile through a serological follow up program. For this reason, a serological survey has been carried out in 2,783 chidren, from 0 to 10 years, who live in rural high endemic areas of the region. The sera were tested using an indirect hemagglutination test (IHAT) and ELISA techniques with results agreeing in 99,9 for percent of the samples. In children with positive serology xenodiagnosis was perfomed and blood samples from the corresponding mothers were submitted to serology for Chagas's disease. These addicional tests should allow to distinguish between congenital infection and vectorial transmission. It was observed that vectorial transmission of T. cruzi was interrupted in some localities where entomological control has been applied for 10 years, or lowered in those which have been submitted to desinsectations in the last 5 years. On the other hand, a relatively high prevalence of the infection has been detected in some localities. These results suggest an apparent increase of vectorial transmision, indicating the need of readjusting the dwellings insecticide sprayings activities to improve the measures against the vector

Positividad del xenodiagnóstico según edad en personas con serología positiva para enfermedad de Chagas / Positive xenodiagnosis according to age in people with seropositive Chagas's disease

An analytical study of positive xerodiagnosis (XD), according age distribution, in people with a positive indirect hemagglutination test (IHAT) for Chagas's disease has been carried out. A total of 1,137 IHAT for Chagas's disease positive persons were submitted to two wooden XD boxes containing 7 triatoma infestans nymphs III each. The positivity in percentage of XD in the different age groups was: 0-9 year old (60,8), 10-19 (35,8), 20-29 (31,5), 30-39 (28,7), 40-49 (30,0), 50-59 (34,3) and ò 60 (43,3). The 60,8 positivy of XD in children under 10 years of age is possibly due to the rather recent trypanosoma cruzi infection in this age group and to diverse inmunological mechanisms, which decrease with the age increasing

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