Vulnerabilidade de pessoas privadas de Liberdade ao virus da imunodeficiência humana / Vulnerabilidad de las personas privadas de libertad ante el virus de la inmunodeficiencia humana / Vulnerability of incarcerated people to the human immunodeficiency virus

RESUMO Introdução: A infecção pelo vírus da imunodeficiência humana é um problema de saúde pública mundial. No contexto de vulnerabilidade, o sistema prisional favorece a transmissão de doenças infectocontagiosas. Objetivo: Analisar a vulnerabilidade para a infecção pelo vírus da imunodeficiência humana, na população privada de liberdade em Teresina-Piauí. Métodos: Estudo transversal desenvolvido por meio de inquérito epidemiológico envolvendo 950 detentos. Resultados: A faixa etária predominante foi até 30 anos de idade (65,37 porcento). A expressiva maioria não frequentou a escola (91,68 porcento), 79,16 porcento referiram beber, 61,37 porcento declararam uso de alguma droga ilícita. Evidenciou-se que 66,21 porcento dos detentos têm tatuagem e 15,58 porcento tem piercing. Quanto às práticas sexuais, 90,84 porcento tem relações sexuais com o sexo oposto, apenas 27,26 porcento usam regularmente preservativo. A maioria dos detentos (75,26 porcento) possui algum conhecimento sobre o vírus. Verificou-se associação estatisticamente significativa no cruzamento do conhecimento com anos de estudo e renda familiar (p<0,01), utilização de algum tipo de droga (p=0,01), compartilhamento de material perfuro cortante (p<0,01), uso de piercing (p=0,01), parceria sexual (p<0,01) e uso de camisinha (p<0,01). Conclusões: Os resultados deste estudo reiteraram que as pessoas privadas de liberdade compõem um grupo vulnerável à infecção pelo vírus e evidenciam a necessidade de ações públicas, incluindo estratégias, que contemplem a demanda de saúde dos internos do sistema prisional do Estado(AU)

RESUMEN Introducción: La infección con el virus de la inmunodeficiencia humana es un problema de salud pública mundial. En el contexto de la vulnerabilidad, el sistema penitenciario favorece la transmisión de enfermedades infecciosas. Objetivo: Analizar la vulnerabilidad a la infección por el virus de la inmunodeficiencia humana, sobre las personas privadas de libertad. Métodos: Estudio transversal, desarrollado a través de la encuesta epidemiológica con 950 reclusos en Teresina, Piauí. Resultados: El grupo de edad predominante fue de 30 años (65,37 por ciento). La mayoría no asistió a la escuela (91,68 por ciento), 79,16 por ciento reportó el uso de bebidas alcohólicas, 61,37 por ciento reportó el uso de cualquier droga ilícita. Se demostró que el 66,21 por ciento de los internos tiene tatuaje y el 15,58 por ciento piercing. En cuanto a las prácticas sexuales, 90,84 por ciento tenía relaciones con el sexo opuesto, solo el 27,26 por ciento utiliza regularmente condones. La mayoría de los internos (75,26 por ciento) tiene algún conocimiento sobre el virus. Se observó asociación estadísticamente significativa al cruzar las variables años de estudio, los ingresos familiares (p <0,01), uso de alguna droga (p = 0,01), corte de perforación intercambio de equipo (p <0,01), uso de perforación (p = 0,01), pareja sexual (p <0,01) y el uso del condón (p <0,01). Conclusiones: Los resultados de este estudio reiteraron que las personas privadas de libertad constituyen un grupo vulnerable a la infección por el virus y ponen de relieve la necesidad de acciones públicas, incluidas las estrategias que responden a las demandas de salud del sistema penitenciario de ese Estado(AU)

ABSTRACT Introduction: The human immunodeficiency virus infection is a world public health problem. In terms of vulnerability, the penitentiary system favors the transmission of infectious diseases. Objective: To analyze the vulnerability of prisoners to human immunodeficiency virus infection. Methods: Cross-sectional study conducted in 950 inmates in Teresina, Piaui based on an epidemiological survey. Results: The prevailing age group was 30 years (65.37 percent). Most of them (91.68 percent) had never attended school, 79.16 percent reported the use of alcohol beverages and 61.37 percent reported the use of any kind of illicit drug. It was proved that 66.21 percent of inmates had tattoos and 15.58 had piercing. As to sexual practice, 90.84 percent had intercourse with the opposite sex but just 27.26 percent regularly used condoms. Most of the prisoners had certain knowledge about the virus. There was statistically significant association when crossing the variables such as years of study, family incomes (p< 0.01), use of some drug (p= 0,01), piercing cut and exchange of devices (p< 0,01), use of piercing (p= 0.01), sexual partner (p< 0.01) and use of condom (p< 0.01). Conclusions: The results of this study reiterated that the prisoners represent a vulnerable group to the virus infection and underlined the need for public actions including the strategies responding to the health demands of the penitentiary system of that state(AU)

Enfermedades infecciosas relacionadas con el agua en el Perú / Infectious diseases related to water in Peru

RESUMEN El crecimiento de la población mundial ha incrementado la demanda de agua, por otro lado, el cambio climático nos muestra que las fuentes de agua que antes eran seguras actualmente ya no lo son. Existen desigualdades entre las zonas urbanas y rurales, así el 96% de la población mundial urbana utiliza fuentes de agua potable frente al 84% de la población rural, mientras que el 82% de la población urbana frente al 51% de la población rural utiliza instalaciones de saneamiento. En el Perú el 80,4% de viviendas se provee de agua por red pública. En el área urbana, este servicio cubre 83,2%; mientras que en el área rural el 71,3% de las viviendas cuenta con servicio higiénico conectado a red pública. Todo lo anterior condiciona la presencia de enfermedades infecciosas relacionadas con el agua como las diarreas, malaria, dengue, leptospirosis, hepatitis virales A y E, cuya clasificación, se muestra en este artículo. En el mundo las diarreas son la tercera causa de muerte entre menores de cinco años y más de 340 000 niños menores de cinco años mueren por enfermedades diarreicas. Una de las metas de los Objetivos de Desarrollo Sostenible (ODS) es la relacionada al acceso universal al agua potable, saneamiento e higiene, lo que no puede lograrse sin prestar la debida atención a las desigualdades en el acceso observadas entre diferentes grupos, evitando las consecuencias de estas deficiencias tanto en nuestro país como en el mundo.

ABSTRACT The growth of the world population has increased the demand for water. On the other hand, climate change shows us that the water sources that were previously safe are not anymore. There are inequalities between urban and rural areas, thus 96% of the urban world population uses drinking water sources compared to 84% of the rural population, while 82% of the urban population versus 51% of the rural population use sanitation facilities. In Peru, 80.4% of homes are supplied with water through a public network. In the urban area, this service covers 83.2%; while in the rural area 71.3% of homes have a toilet service connected to the public network. All the above conditions the presence of water-related infectious diseases, such as diarrhea, malaria, dengue, leptospirosis, viral hepatitis A, and E, whose classification is shown in this article. In the world, diarrhea is the third cause of death among children under five years of age and more than 340,000 children under the age of five die from diarrheal diseases due to poor sanitation. One of the goals of the SDGs is related to universal access drinking water, sanitation and hygiene, which cannot be achieved without due attention to the inequalities in access observed between different groups, avoiding the consequences of these deficiencies both in our country and in the world.

Antropologia das doenças transmissíveis: interpretações do contágio e diferenças culturais / Anthropology of communicable diseases: interpretations of contagion and cultural differences

Este livro apresenta os resultados de diversas pesquisas realizadas pelo autor sobre o tema do contágio ao longo das últimas duas décadas, em diversos países. Trata-se de material inédito na língua portuguesa e reorganizado no intuito de identificar um único fio condutor e elementos comuns entre material recolhido em contextos socioculturais bem diversificados, bem diferenciados.Os diversos capítulos expõem, a seu modo, conclusões parcialmente publicadas em periódicos e capítulos de livros

Webquest: enfermedades infecciosas en situaciones de desastres naturales / Webquest: infectious deseases indisasters

Las enfermedades infecciosas que se originan después de un evento climatológico adverso (huracanes, terremotos, tsunamis, etc.) constituyen una causa importante de morbimortalidad en las poblaciones afectadas. Es por ello que resulta ventajoso que los estudiantes de la carrera de medicina desarrollen habilidades y adquieran conocimientos que perfeccionen su desempeño como profesionales de la salud. Las WebQuest son conocidas desde hace mucho tiempo entre el profesorado que usa habitualmente las Tecnologías de la Información y las Comunicaciones (TICs) en su práctica docente. El valor didáctico de las WebQuest es reconocido por muchos profesores en distintas instituciones y como metodología resulta adecuada para vincular términos que han dominado los finales del siglo XX y los comienzos del XXI: Salud y Tecnologías de la Información y las Comunicaciones. El objetivo fundamental de este trabajo consistió en diseñar un recurso basado en las TICs: la WebQuest Enfermedades Infecciosas en situaciones de desastre, haciendo uso del generador de webquest de Aula 21. En la WebQuest se presentan situaciones problémicas simuladas que afectan el estado de salud de la población luego de una catástrofe ambiental y que deben ser resueltas por los estudiantes. En la solución de la tarea planteada, ellos ponen en práctica los conocimientos adquiridos en la disciplina Microbiología y Parasitología Médicas. Con la aplicación de esta WebQuest se motivan tanto el aprendizaje y la profundización de conocimientos sobre las enfermedades infecciosas que se originan en condiciones de catástrofe ambiental, como la actividad investigativa de los estudiantes de la carrera de medicina(AU)

Infectious diseases that arise after an adverse weather event (hurricanes, earthquakes, tsunamis, etc.) are an important cause of morbidity and mortality in affected populations. That is why it is advantageous for studentsfrom medicine career to develop skills and acquire knowledge to perfect their performance as health professionals. The WebQuest are known longtime among teachers who regularly use the Information Technology and Communication (ICT) in their teaching. The educational value of the WebQuest is recognized by many teachers in various institutions and as a methodology is appropriate to link terms that have dominated the late twentieth and early twenty-first: Health and Information Technologies and Communications.The main objective of this work was to design an ICT based resource: WebQuest Infectious Diseases in disaster situations, using the webquest generator of classroom 21.In the WebQuest are presented problem simulated situations that affect the health of the population after an environmental disaster and that must be solved by the students.In the solution of the task set, they put into practice the knowledge acquired in Medical Microbiology and Parasitology discipline.With the application of this WebQuest are motivated both learning and deepening knowledge of infectious diseases caused by environmental catastrophe conditions, as well as research activity of students of medicine career(AU)

Complicaciones en pacientes con lupus eritematoso sistémico / Complications in patients with systemic lupus erythematosus

Introducción: el Lupus Eritematoso Sistémico (LES) es una enfermedad autoinmune de origen desconocido, que cursa con episodios de brotes alternados con periodos de remisión. Durante los brotes pueden aparecer complicaciones que motivan la hospitalización. Objetivo:identificar complicaciones en pacientes con LES que ingresaron al Servicio de Clínica Médica del Hospital Central "Dr. Emilio Cubas" del Instituto de Previsión Social en el año 2013. Metodología: estudio observacional descriptivo, retrospectivo, de corte transversal. Se excluyeron a pacientes no conocidos portadores de LES y que debutaron con complicaciones, así como también aquellos con LES que ingresaron al Servicio de Clínica Médica provenientes de la Unidad de Terapia Intensiva (UTI). Resultados: 40 pacientes afectados fueron internados en el periodo estudiado, se observó predominio del sexo femenino (92,5%), con un promedio de edad de 38,8 años. Los síntomas de ingreso más importantes en orden de frecuencia fueron: sintomatología respiratoria (35,0%), neurológica (25,0%) y sensación febril (20,0%). Las comorbilidades presentes con mayor frecuencia fueron: hipertensión arterial (40,0%), otra enfermedad autoinmune (18,0%) y enfermedad renal crónica (15,0%). Las complicaciones más frecuentes fueron: infecciosas (67,5%), renales (22,5%), hematológicas (20,0%) y neurológicas (20,0%). Con respecto a la evolución de los pacientes, el 87,5% fueron dados de alta, 7,5% fallecieron y 5,0% fueron trasladados a la UTI. Los 3 fallecimientos correspondieron a causas infecciosas (shock séptico).Conclusión: las complicaciones infecciosas constituyen motivo frecuente de ingreso en pacientes con LES, ya que debido a la enfermedad y al tratamiento inmunosupresor se encuentran más propensos a desarrollar este tipo de complicación.

Introduction: Systemic Lupus Erythematosus (SLE) is an autoimmune disease of unknown origin that causes outbreaks episodes alternating with periods of remission. During outbreaks motivating hospitalization complications can occur. Objective: To identify complications in SLE patients admitted to the Internal Medicine Service of Central Hospital "Dr. Emilio Cubas" Institute for Social Welfare in 2013. Methods: Descriptive observational, retrospective, cross-sectional research. Patients not known carriers of SLE and who developed complications at the onset of the disease were excluded, as well as those with SLE who were admitted to the Internal Medicine Service from the Intensive Care Unit (ICU). Results: 40 patients affected were hospitalized during the study period, predominantly female (92.5%), with an average age of 38.8 years. Main symptoms in order of frequency were: respiratory (35.0%), neurological (25.0%) and febrile sensation (20.0%). The most common comorbidities present were hypertension (40.0%), another autoimmune disease (18.0%) and chronic kidney disease (15.0%). The most common complications were infection (67.5%), renal (22.5%), hematologic (20.0%) and neurological (20.0%). About the evolution of patients, 87.5% were discharged, 7.5% died and 5.0% were transferred to the ICU. The 3 deaths corresponded to infectious causes (septic shock). Conclusion: Infectious complications are a frequent reason for hospitalization in patients with SLE, because of the disease and the immunosuppressive therapy they are more likely to develop this complication.

The Lives and Diseases of Females during the Latter Half of the Joseon Dynasty as Reconstructed with Cases in Yeoksi Manpil (Stray Notes with Experienced Tests) / 의사학

Through the cases of approximately 80 females in the case records of traditional physician Yi Sugwi (1664-1740?), the present study divided and reclassified the lives and diseases of females during the latter half of the Joseon Dynasty into childhood, obstetrics- and gynecology-related problems in adulthood, other diseases in adulthood, and old age and analyzed them. According to the results, female children were treated less preciously than were male children so that treatments by traditional physicians were sought out less when they were ill than in the case of male children, and acute infectious diseases were the most serious health problems. In the process of receiving treatment from traditional physicians as adults, females came in contact with traditional physicians, who were male, when necessary including face-to-face sessions and the reception of pulse examination but the yangban (literati-official) class practiced sex segregation as much as possible while the lower classes were considerably free from such restrictions. For female adults, the most serious health issues were pregnancy and childbirth so that they received help from traditional physicians and midwives when there were problems. Traditional physicians determined females' pregnancy and the health of fetuses and pregnant women through pulse examinations and medication and actively responded to diverse problems that surfaced in the process with medication and other treatments. Acute infectious diseases, too, were serious diseases suffered by females, and problems involving cold damage and the digestive system were among diseases frequently suffered by females in adulthood and old age. In old age, females often became ill in the arduous process of dealing with the deaths of adult descendants, siblings, and spouses, and tumors were among the major causes of their deaths. The deaths of those aged 70 or above were accepted as quite natural. Aged females endeavored to maintain their health and played the role of elders giving care to their descendants.

Cucarachas y vinchucas en patología general y respiratoria / Cockroaches abd vinchucas in general and respiratory pathology

Se exponen los datos sobre la antigenicidad de las proteasas de la cucaracha Periplaneta americana y de la vinchuca Triatoma infestans en seres humanos residentes en la CABA y Gran Buenos Aires, así como en las provincias del Norte y Noreste del país. La antigenicidad cruzada entre ambas las convierte en 2 insectos de gran importancia en el ecosistema, y sus restos momificados de estadios adultos y ninfales de trascendencia para diversas patologías infecciosas y respiratorias...

Data concerning the cross-reactivity between the serinproteases of the cockroach Periplaneta Americana and the reduviid Triatoma infestans are exposed. Humans living in Buenos Aires as well as those living in the north of the country inhale mummified particles containing the powerful antigens of both insects and develop chronic respiratory illnesses...

Situação Epidemiológica da hepatite A em Goiás / Epidemiological situation of hepatitis A in Goiás

A hepatite pelo vírus A é uma doença autolimitante do fígado, de um modo geral com evolução boa para cura, cuja gravidade aumenta com a idade. No Brasil, a notificação compulsória da hepatite A teve início em 1996. No período de 2007 até a semana epidemiológica n° 31 de 2014, em Goiás, foram notificados 46500 casos suspeitos de hepatites virais. O documento analisa número de casos e incidência, por sexo e ano e de casos por regional de saúde de residência em Goiás. O Ministério da Saúde introduziu no calendário nacional de vacinação a vacina contra a Hepatite A, para crianças a partir de 12 meses até menores de 2 anos. Além da garantia de água e condições sanitárias adequadas para a população, outro desafio apresentado nas ações de controle da doença, a garantia da manutenção de cobertura vacinal de acordo com a meta preconizada, 95%, e de forma homogênea nos municípios.

Hepatitis A virus is a self-limiting disease of the liver, generally with good evolution to cure, the severity of which increases with age. In Brazil, compulsory notification of hepatitis A began in 1996. From 2007 to epidemiological week no. 31 of 2014, in Goiás, 46,500 suspected cases of viral hepatitis were reported. The document analyzes the number of cases and incidence, by sex and year and by regional health of residence in Goiás. The Ministry of Health has introduced hepatitis A vaccine to the national vaccination calendar for children from 12 months to under 2 years of age. In addition to ensuring adequate water and sanitary conditions for the population, another challenge presented in disease control actions, the guarantee of the maintenance of vaccination coverage according to the recommended target, 95%, and homogeneously in the municipalities.

Postoperative care in pediatric liver transplantation

In the last 25 years, liver transplantation in children has become an effective, definitive, and universally accepted treatment for terminal liver diseases. Long-term survival exceeds 80% and improves each year as the result of constant technical advancements and improvements in immediate postoperative intensive care and clinical control.

Selected infectious disease disasters for nursing staff training at Egyptian eastern border

Infectious disease disasters are events that involve a biological agent, disease and that result in mass casualties, such as a bioterrorism attack, an emerging outbreak of infectious disease; all disasters pose a risk of infection transmission. But, infectious disease disasters pose the great-risk to illness or death from an infectious disease. This study raised the awareness and improved knowledge by educational program for Military Nursing Staff on selected infectious disease disasters acquired at Egyptian Eastern Border. The selected arthropodborne diseases were Anthrax, Tick borne relapsing, Louse borne replasing fever and liver fluke; Clonorchis sinensis. An interventional study was used, for 125 staff nurse who accepted to participate. The tools dealt with four questionnaires: [1] Some socio-demographic characteristics data [2] Educational needs assessment a structured questionnaire. [3] Knowledge test [pre/ post-test] and [4] Participants' reactions questionnaire. The results showed that educational intervention significantly improvements the nursing staff knowledge, which were achieved at the immediate post intervention phase, and retained via three months post-test phase. In the service training programs about infectious disease disasters at Egyptian Eastern Border must be established and continued on regular basis. This would improve their knowledge about the epidemiology of these infectious disease disasters

Cochlear implants: our experience and literature review

Introduction: Cochlear Implants are important for individuals with severe to profound bilateral sensorineural hearing loss. Objective: Evaluate the experience of cochlear implant center of Otorhinolaryngology through the analysis of records of 9 patients who underwent cochlear implant surgery. Methods: This is a retrospective study performed with the patients records. Number 0191.0.107.000-11 ethics committee approval. We evaluated gender, etiology, age at surgery, duration of deafness, classification of deafness, unilateral or bilateral surgery, intraoperative and postoperative neural response and impedance of the electrodes in intraoperative and preoperative tests and found those that counter-indicated surgery. Results: There were 6 pediatric and 3 adult patients. Four male and 5 female. Etiologies: maternal rubella, cytomegalovirus, ototoxicity, meningitis, and sudden deafness. The age at surgery and duration of deafness ranged from 2 - 46 years and 2 - 18 years, respectively. Seven patients were pre-lingual. All had profound bilateral PA. There were 7 bilateral implants. Intraoperative complications: hemorrhage. Complications after surgery: vertigo and internal device failure. In 7 patients the electrodes were implanted through. Telemetry showed satisfactory neural response and impedance. CT and MRI was performed in all patients. We found enlargement of the vestibular aqueduct in a patient and incudomalleolar malformation. Conclusion: The cochlear implant as a form of auditory rehabilitation is well established and spreading to different centers specialized in otoaudiology. Thus, the need for structured services and trained professionals in this type of procedure is clear...

El cambio global y las enfermedades transmitidas por vectores en Europa / Global change and vector-transmitted diseases in Europe

El presente trabajo analiza los principales aspectos ecoepidemiológicos relacionados con las enfermedades transmitidas por mosquitos culícidos en Europa, haciendo especial hincapié en las consecuencias del proceso de cambio global emergente. Los episodios de transmisión inestable de paludismo y los recientes casos de dengue en el viejo continente son claros ejemplos de que algunos parámetros están cambiando. Pese a que la receptibilidad palúdica es relativamente elevada en ciertas regiones, el potencial malariogénico es bajo en la mayoría de los países europeos debido a cuestiones bioecológicas concretas de los principales vectores y a la baja vulnerabilidad palúdica. Por el contrario, las virosis transmitidas por culícidos sí son una amenaza real y creciente. Entre ellas, el dengue ha adquirido un lugar destacado debido a la expansión de excelentes vectores urbanos de la enfermedad y al incremento en el número de casos importados en los últimos años.

This paper discusses the main eco-epidemiological aspects related to mosquito-borne diseases in Euro-pe, with particular emphasis on the implications of the emerging process of global change. The episodesof unstable malaria transmission and the recent cases of dengue in the old continent are clear examplesthat some parameters are changing. Although malaria receptivity is relatively high in certain regions, themalariogenic potential is very low in most European countries due to specific bioecological issues relatedwith the main vectors and the low malaria vulnerability. By contrast, mosquito-borne viruses themselvesare a real and growing threat. Among them, dengue has become prominent due to the great expansionof urban vectors of disease and the increase in the number of imported cases in recent years.

The challenge of health & environment: Profiling risks & strategic priorities for now & the future.

A substantial burden of communicable and non-communicable diseases in the developing countries is attributable to environmental risk factors. WHO estimates that the environmental factors are responsible for an estimated 24 per cent of the global burden of disease in terms of healthy life years lost and 23 per cent of all deaths; children being the worst sufferers. Given that the environment is linked with most of the Millennium Development Goals (MDGs), without proper attention to the environmental risk factors and their management, it will be difficult to achieve many MDGs by 2015. The impact of environmental degradation on health may continue well into the future and the situation in fact, is likely to get worse. In order to address this challenge, two facts are worth noting. First, that much of the environmental disease burden is attributable to a few critical risk factors which include unsafe water and sanitation, exposure to indoor smoke from cooking fuel, outdoor air pollution, exposure to chemicals such as arsenic, and climate change. Second, that environment and health aspects must become, as a matter of urgency, a national priority, both in terms of policy and resources allocation. To meet the challenge of health and environment now and in the future, the following strategic approaches must be considered which include conducting environmental and health impact assessments; strengthening national environmental health policy and infrastructure; fostering inter-sectoral co-ordination and partnerships; mobilizing public participation; and enhancing the leadership role of health in advocacy, stewardship and capacity building.

Mortalidad por infección VIH/SIDA en Venezuela: 1996-2007 / Mortality by HIV/AIDS infectious in Venezuela: 1996-2007

La reducción en la morbilidad y particularmente mortalidad por VIH/SIDA se ha logrado a través de los programas de prevención y tratamiento, los cuales han demostrado ser exitosos en muchas partes del mundo. El objeto de este trabajo es revisar y analizar el patrón de comportamiento de la mortalidad por la infección VIH/SIDA en Venezuela durante el período 1996 a 2007. Es un estudio descriptivo de la mortalidad por "Enfermedad por virus de la inmunodeficiencia humana (B20-B24)" a partir de los anuarios de mortalidad del Ministerio del Poder Popular para la Salud de Venezuela para el período 1996 a 2007. El virus de la inmunodeficiencia humana ha incrementado en número de muertes, tasas de mortalidad y posición como causa específica de muerte en Venezuela durante el período de estudio, teniendo una mayor importancia en el Distrito Capital y el Estado Bolívar, siendo más relevante en la población de 25 a 35 años de edad, y del sexo masculino, aun cuando se está incrementando en el sexo femenino. Estos resultados plantean la necesidad de una aproximación integral a la prevención del problema para poder reducir significativamente la carga de la enfermedad en Venezuela.

Reduction in morbidity and particularly in mortality due to HIV/AIDS has been achieved through prevention and treatment programs. These have demostrated being successful in many places of the World. The objetive of this study is to review and analyze the pattern of accurrence of HIV/AIDS mortality in Venezuela between 1996 and 2007. This is a descriptive study of the mortality due to "Disease due to Human Immunodeficiency Virus (B20-B24)" from the annual records of mortality of the Ministry of Health of Venezuela for the period 1996-2007. Human Immunodeficiency Virus has increased in dealth numbers, mortality rates and position as specific cause of death in Venezuela during the study period, having a higher importance at the Capital District and at the Bolivar state, being more relevant in the population of 25-35 years-old, and from the male sex, although in female is also increasing. These results represent a need for an integral approach to the problem prevention in order to significantly reduce the burden of disease in Venezuela.

Enseñanza de la medicina tropical mediante la discusión de casos clínicos / Teaching tropical medicine through discussion of clinical cases

En los últimos años se han propuestos cambios en la enseñanza de la medicina tropical, basando la docencia en el estudiante. El objetivo de la investigación fue utilizar la metodología de la discusión organizada y razonada de casos clínicos, con la participación activa del estudiante, a fin de llegar a un diagnóstico prsuntivo de las patologías presentadas. Se describe el proceso de discusción con los estudiantes de medicina tropical, de cinco pacientes con enfermedades infecciosas bacterianas (fiebre tifoidea, brucelosis, leptospirosis, cólera y shigellosis), diagnósticados y tratados en la consulta de Endemias Rurales del Instituto de Medicina Tropical y en los servicios de Pediatría Médica Infecciosa y de Enfermedades Infecciosas del Adulto del Hospital Universitario de Caracas, Universidad Central de Venezuela, relacionado sus manifestaciones clínicas y de laboratorio con sus antecedentes epidemiológicos para establecer los diagnósticos e iniciar el tratamiento específico. En cada uno de los casos, siguiendo la metodología descrita se llegó al diagnóstico definitivo permitiendo el tratamiento oportuno de los pacientes de acuerdo a los agentes etiológicos. Mediante la discusión de casos clínicos y la utilización de la medicina basada en evidencia incluyendo al estudiante como ente activo es posible transmitir el conocimiento de la medicina tropical, llegando a los diagnósticos etiológicos de las enfermedades.

In recent years changes have been proposed in the teaching of tropical medicine, basing the teaching on the student. To use the methodology of organized and reasoned discussion of clinical cases, with active student participation in order to reach a presumptive diagnosis of pathology present. We describe the process of discussion with students of tropical medicine, five patients with baceterial infectious diseases (typhoid fever, brucellosis, leptospirosis, cholera and shigellosis), diagnosed and treated at the Outpatient Clinic of Rural Endemic Disease, Institute of Tropical Medicine, and Services of Pediatrics and Adult Infectious Diseases, Hospital Universitario de Caracas, Universidad Central de Venezuela, Relating clinicial manifestations and laboratory findings to epidemiological background to establish the diagnosis and initiate specific treatment. In each case, following the methodology described definitive diganosis was reached allowing timely tratment of tatients accoring to etiologic agents. Trough discussion of clinical cases and the use of evidence-based medicine including the student as an active entity the knowledge of tropical medicine may be transmitted, reaching the etiologic diagnosis of disease, and getting publications of articles.

[Epidemiologic features of admitted patients with infectious diseases in Qom]

Despite decades of dramatic progress in their treatment and prevention, infectious diseases remain a major cause of death and debility responsible for worsening the living conditions of millions of people around the world. This study was conducted to determine the epidemiologic features of patients admitted with infectious disases at Kamkar Hospital in Qom. A routine data base study was carried out to obtain relevant data from medical records of patients admitted with infectious diseases at the Kamkar Hospital during summer 2007. The epidemiologic features of patients were obtained and analyzed using chi-square, t-test and Mann Whitney statistical tests. Out of 2907 admitted cases at the Kamkar hospital 331 [11.3%] pertained to infectious diseases. The most frequent infections were urinary tract infection, septicemia and pneumonia; 61cases [18.4%], 48cases [14.5%] and 45cases [13.6%], respectively. The most common involved systems were respiratory tract and urogenital tract, with each one having 73cases [22.05%].This study confirms the continuing importance of infectious diseases especially urinary tract infection, septicemia and pneumonia in Qom, which requires more research to be done to better identify their epidemiology and pathogenesis

Enfermedad de chagas sistémico en fase aguda por transmisión oral: diagnóstico integral de un caso autopsiado / Acute phase of systemic chagas disease due to oral transmission: integral diagnosis of an autopsied case

Se presenta el primer caso autopsiado en Venezuela con enfermedad de Chagas por transmisión oral. Se trata de una joven de 24 años de edad con 8 semanas de embarazo quien contrajo la enfermedad conjuntamente con 71 niños y 14 adultos, la mayoría integrantes de la comunidad escolar “Rómulo Monasterios” en la localidad de Chichiriviche de la costa Vargas, donde ocurrió el segundo brote agudo de enfermedad de Chagas por transmisión oral registrado en Venezuela. El diagnóstico epidemiológico, clínico, serológico y parasitológico en sangre y líquido pleural extraídos en vida, fueron confirmados con los hallazgos histopatológicos y moleculares (PCR) de los tejidos. Se plantearon las características peculiares del caso así como algunos aspectos de la transmisión oral, ampliamente estudiados en nuestro país en animales de experimentación.

This first autopsy case with Chagas disease by oral transmissions in Venezuela is presented. This is a 24 year old girl with 8 weeks of pregnancy who contracted the disease together with 71 and 14 adults, the majority members of the school community “Romulo Monasterios” in the town of Vargas State, where occurred the second acute Chagas disease outbreak by oral transmission in Venezuela.The epidemiological, clinical, serological and parasitological diagnosis in the blood and pleural fluid extracted in life, were confirmed with the histopathology and molecular (PCR) finding in the tissues, Special features of the case are shown, as well as, some aspects of oral transmission widely studied in our country in experimental animals.