Timeliness and Out-of-Sequence Vaccination among Young Children in Burkina Faso – Analysis of Health and Demographic Surveillance System (HDSS) Data.

Aims: The aim of this study is to investigate the timeliness and out-of-sequence vaccination among children aged less than five years through the data of a local Health and Demographic Surveillance System (HDSS) in Burkina Faso. Study Design: Cross-sectional study nested into an existing HDSS. Place and Duration of Study: Nouna Health District in north-western Burkina Faso, over the period of September 2008 to December 2009. Methodology: We used data of 7,644 children born between September 2003 and March 2009. Vaccination data were provided on the basis of events recorded on vaccination cards. We assessed vaccination timeliness and the frequency of out-of-sequence vaccination. Results: The highest rates of timely administration were observed with vaccines recommended at birth (e.g. 68% for BCG) while the lowest rates were observed with vaccines given in late infancy (e.g. 33% for measles). The frequency of out-of-sequence vaccination between BCG and DTP/Penta 1 or between DTP/Penta 3 and measles were respectively around 5% and 4%. Out-of-sequence vaccination in early infancy occurred significantly more frequent in rural compared to urban areas contrary to out-of-sequence vaccination in late infancy. Both, timely and correct sequencing of vaccination have significantly improved in recent years in the study area. Conclusions: This study supports that significant vaccination delay occurs in SSA communities with high vaccination coverage and that the frequency of out-of-sequence vaccinations varies substantially between countries.

Prevalencia de enfermedad renal crónica en centros urbanos de atención primaria / Prevalence of chronic kidney disease in subjects consulting in urban primary care clinics

Background: Chronic kidney disease (CKD) is a major worldwide public health problem and is associated with increased risk of cardiovascular disease and death. Aim: To assess CKD prevalence in urban Primary Care Services (PCS) of Concepcion, Chile. Material and Methods: The clinical records of 27.894 adults aged 55 ± 18 years (66 percent females), consulting in outpatient clinics and in whom serum creatinine was measured, with or without assessment of urine albumin levels, were reviewed. The glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease (MDRD)-4 equation. CKD was defined as an eGFR < 60 ml/min/1.73 m2 and classified according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NFK-KDOQI) guidelines. Results: Mean eGFR was 77.1 ± 16.3 ml/min/1.73 m2. Twelve percent of subjects had CKD (women, 14.5 percent and men 7,4 percent, p < 0,05). The prevalence of stages 3, 4 and 5 of CKD were 11.6, 0.3 and 0.2 percent respectively. eGFR was negatively correlated with age ( r = -0,54, p < 0,05). Among patients with an eGFR < 60 ml/min/1.73 m2, 96.3 percent had eGFR 30-59, 2.3 percent 15-29 and 1.4 percent < of 15. Seventy nine percent were women. 75.1 percent were aged 65 years or more, 26.8 percent had a serum creatinine equal or less than 1.0 mg/dL and 40.5 percent had microalbuminuria. Only 1 percent of outpatients ascribed to Cardiovascular or Diabetes Programs had the diagnosis of CKD registered. Independent risk predictors of CKD were age > 60 years, female sex and microalbuminuria. Conclusions: This study showed a high prevalence of CKD in ambulatory patients, mainly among women and older people. The low level of diagnosis of CKD in cardiovascular and diabetes programs is of concern.

Infecciones por Staphylococcus aureus resistente a meticilina adquiridas en la comunidad en niños antes sanos y en niños relacionados al hospital en la Argentina / Community onset of methicillin resistant Staphylococcus aureus infections in previously healthy or health care-associated children en Argentina

Introduction: Community-acquired methicillin-resistant Staphylococcus aureus infections (CA-MRSA) are prevalent in several countries of the world. These infections seem to differ clinically from those occurring within the health care system (HCS-MRSA). Objective: To compare clinical characteristics of infections by CA-MRSA and HCA-MRSA in the same communitty. Material and Methods: Prospective, multicentric and comparative study. Children with clinically and microbiologicaly documented CA-MRSA were included. Results: Between 11/2006 and 11/2007, 840 infections caused by S. aureus were diagnosed. Of them 582 (68 percent) were community-acquired. Among these 356 (61 percent) were CA-MRSA. In this group, 75 (21 percent) were HCA-MRSA and 281 (79 percent) CA-MRSA. The median age was 36months (range: 1-201). Chronic skindisease (13) and chronic disease of CNS (9) were the underlying disease predominant. Children with CA-MRSAhad more frequency of previous antibiotic treatment (63 vs 34 percent) and previous medical consult (76 vs 52 percent), invasive procedures (31 vs 8 percent), surgery (15 vs 0,3 percent) and fever (94 vs 74 percent) (p = <05). Children with CA-MRSAhad subcutaneous abscesses (34 vs 15 percent) (p = <.05) more frequently. Bacteremia and sepsis rate was similar in both groups (21 vs 18 percent) and 17 vs 11 percent) respectively) (p = NS). Antibiotic resistance was more frequent in children with HCA-MRSA: Rifampin (7 vs 1 percent), trimethoprim-sulphametoxazole (7 vs 1 percent) and clindamycin (25 vs 9 percent) (p = <.05). Four children (5 percent) with HCA-MRSA infections died and 3 (1 percent) mCA-MRSAgroup (p = .05). Conclusión: Children with HCA-MRSA infections more frequent antibiotic resistance than CA-MRSA should be reconsider the empiric antibiotic treatment of community-acquired infections in children in our área.

Introducción: Staphylococcus aureus meticilina-resistente proveniente de la comunidad (SAMRC) es altamente prevalente en diversos países del planeta. Objetivos: Realizar un análisis clínico comparativo entre las infecciones por SAMRC en niños antes sanos (SAMR-CO) y aquellos con S. aureus MR en pacientes con patologías previas (SAMR-RH). Material y Métodos: Estudio multicéntrico, prospectivo y comparativo. Fueron incluidos los niños que tenían infección clínica y microbiológicamente documentada por SAMRC. Resultados: Entre 11/2006 y 11/2007 fueron diagnosticadas 840 infecciones porS. aureus. De ellas 582 (69 por ciento) fueron detectadas en la comunidad. Entre estas 356 (61 por ciento) fueron SAMRC. Entre estas últimas 75 (21 por ciento) fueron SAMR-RH y 281 (79 por ciento) SAMR-CO. La mediana de edad fue de 36 meses (rango: 1-201). Las enfermedades de base más frecuentes fueron: dermatopatías crónicas (13) y enfermedad crónica del SNC (9). Los niños con infección por SAMR-RH presentaron con mayor frecuencia tratamiento antimicrobiano previo (63 vs 34 por ciento), consultas médicas previas (76 vs 52 por ciento), procedimiento invasor previo (31 vs 8 por cientoo), cirugía (15 vs 0,3 por ciento) y fiebre al momento de la consulta (94 vs 74 por ciento) (p < 0,05). Los niños con infección por SAMR-CO tuvieron con mayor frecuencia abscesos subcutáneos (34 vs 15 por ciento) (p < 0,05). La tasa de bacteriemia y se sepsis fue semejante en ambos grupos (21 vs 18 por ciento y 17 vs 11 por ciento)) (p =NS). La resistencia a antimicrobianos fue mayor en niños con SAMR-RH: rifampicina (7 vs l por cientoo), cotrimoxazol (7 vs 1 por ciento) y clindamicina (25 vs 9 por ciento) (p < 0,05). Fallecieron 4 niños con SAMR-RH (5 por ciento) y 3 niños con SAMR-CO (1 por ciento) (p = 0,05). Conclusión: Los niños con SAMR-RH presentan mayor tasa de resistencia a antimicrobianos que SAMR-CO. Debe replantearse el tratamiento antimicrobiano empírico en niños con ...

Evaluación de la calidad de vida en pacientes en hemodiálisis crónica mediante el cuestionario "Kidney Disease Quality of Life (KDQOL-36)" / Health related quality of life among patients on chronic hemodialysis

patients on chronic hemodialysis Background: Health-related quality of life (HRQOL) among patients on chronic hemodialysis (CHD), is associated with mortality, complications and compliance to treatment. Aim: To assess HRQOL in a group of patients on CHD. Patients andmethods: A cross-sectional multicenter study was carried out, involving 224 patients from five CHD units (3 private and 2 public) in Bio Bio Region, using the Kidney Disease Quality of Life – 36 items (KDQOL-36) questionnaire and Karnofsky scale. Scores range from 0 to 100, with higher values representing a better HRQOL. Results: Physical and Mental scales and subscales of symptoms, effect and the burden of kidney disease subscales rendered scores below 50 (the referential value), in 80%, 61%, 8%, 43% and 80% of evaluations, respectively. The lower scores were observed in patients with diabetes, coronary artery disease, hypoalbuminemia...

Hiponatremia e hipokalemia graves, recientes, asociadas a hidroclorotiazida, enalaprila y citalopram: caso clínico / Severe and recent hyponatremia and hypokalemia associated to the use of hydrochlorothiazide, enalapril and cytalopram: clinical case

We report a 72 years old hypertensive female, treated with enalapril 10 mg/day and hydrochlorothiazide 25 mg/day during three years. She presented a depressive disorder and cytalopram was prescribed in a dose of 10 mg/day. Two weeks before admission, a serum electrolyte analysis disclosed normal results and the cytalopram dose was increased to 20 mg/day. The patient was admitted with a hyponatremic encephalopathy with a plasma sodium of 100 mEq/L and a plasma potassium of 2.0 mEq/L. cytalopram, enalapril and hydrochlorothiazide were discontinued, hypertonic NaCl and KCl were administered. The patient had a favorable evolution with a remarkable improvement of her symptoms

The clinical and parasitological presentation of Plasmodium falciparum malaria in Uganda is unaffected by HIV-1 infection

The relation between Plasmodium falciparum malaria and symptomatic human immunodeficiency virus 1 (HIV-1) infection was investigated in paediatric and adult patients in Kampala; Uganda; from 1987 to 1989. Both infections contributed largely to hospital morbidity. Of 1527 clinically suspicious in-patients; 61pc were positive for HIV-1 infection. 52pc of patients with positive HIV-1 serology fulfilled the World Health Organization clinical case definition for acquired immune deficiency syndrome (AIDS) in Africa. No association could be found between HIV-1 infection and malaria either in paediatrics or in adults. P. falciparum parasitaemia was present in 18pc of all patients and no differences in prevalence of malaria infection or in parasite density could be demonstrated between HIV-1 positive and HIV-1 negative patients. The comparison of clinical symptoms showed typical differences in AIDS-related morbidity but no difference in malaria-specific morbidity. Also; the response to malaria treatment was the same in HIV-1 positive and HIV-1 negative patients. P. falciparum malaria does not appear to act as an opportunistic agent in AIDS patients in Uganda

Resultados do tratamento da incontinencia urinaria de esforco pela operacao de Burch. / Results of treatment of effort urinary incontinence by Burch's operation

Sao analisados 51 casos de incontinencia urinaria de esforco, tratados pela tecnica de Burch, no periodo compreendido entre 1975 e 1979 no Departamento de Tocoginecologia do Hospital de Clinicas da Universidade Federal do Parana. A idade das pacientes variou entre 30 e 49 anos e a maioria era de multiparas. O sintoma mais constante foi a perda de urina aos esforcos, existindo tambem disuria e polaciuria. O teste de Bonney e a uretrocistografia miccional foram poucas vezes excutados (27% o primeiro e 14% o segundo). Concomitantemente, foram realizados 28 perineoplastias, 7 laqueaduras e 3 histerectomias. Por ocasiao da alta, todas as pacientes estavam assintomaticas. Durante o seguimento houve recidiva da incontinencia urinaria em 6 casos (12%) e a cura efetuou-se em 45 pacientes (88%). As complicacoes foram em numero reduzido: alem da recidiva em 6 casos, ocorreram 13 casos de infeccao urinaria e 2 casos com infeccao de sutura da pele