Recomendación del Comité Asesor de Vacunas y Estrategias de Inmunización (CAVEI) sobre vacunación contra viruela símica en Chile

La viruela del mono fue declarada emergencia de salud pública de importancia internacional por la Organización Mundial de la Salud el año 2022. En Chile, hasta septiembre se han confirmado sobre 450 enfermos, mayoritariamente hombres jóvenes. Este poxvirus zoonótico se transmite entre humanos por contacto estrecho; la enfermedad es autolimitada y puede ser fatal en inmunocomprometidos. La prevención mediante inmunización es importante. MVA-BN es una de las tres vacunas disponibles, de 3° generación, contiene el virus vaccinia atenuado, no replicante por lo que se puede administrar a pacientes inmunocomprometidos y mujeres embarazadas y está aprobada para viruela símica en personas > 18 años. La información disponible sobre eficacia y efectividad es limitada. El CAVEI recomienda incorporar esta vacuna para interrumpir la cadena de transmisión y reducir el riesgo de enfermedad grave, en dos dosis separadas por 28 días, por vía subcutánea, priorizando el uso post-exposición para contactos estrechos con riesgo de enfermedad grave, idealmente en los primeros 4 días y hasta 14 días post contacto de riesgo y en ausencia de síntomas. Cuando el suministro de vacunas lo permita, se recomienda prevención pre-exposición para personas con alto riesgo ocupacional o por prácticas sexuales. Esta recomendación podría modificarse según la epidemiología, el suministro de vacunas y nueva información científica.

Monkeypox was declared a public health emergency of international concern by the World Health Organization during 2022. In Chile, over 450 patients have been confirmed until September, mostly young men. This zoonotic poxvirus is transmitted from humans to humans through close contact; it is a self-limiting disease and can be fatal in people with immunodeficiency. Prevention by immunization is important. MVA-BN, one of the three vaccines available, it is a third generation vaccine, based on non-replicating modified vaccinia virus, therefore can be administered to immunocompromised patients and pregnant women and it has been approved for monkeypox in people over 18 years of age. The available information on efficacy and effectiveness is limited. The CAVEI recommends incorporating this vaccine to interrupt the chain of transmission and reduce the risk of severe disease, administered subcutaneously in two doses, 28 days apart, prioritizing post exposure use for close contacts of confirmed cases with risk of severe disease, ideally within 4 days of exposure and it can be used up to 14 days after exposure and in the absence of symptoms. When the vaccine supply allows it, its application is recommended as pre-exposure prevention for people with high-risk sexual practices or with occupational risk. This recommendation could be modified according to epidemiology, vaccines supply and new scientific information.

The appendicitis inflammatory response score for acute appendicitis: is it important for early diagnosis? / Escore de reposta inflamatória à apendicite aguda: é importante para o diagnóstico precoce?

ABSTRACT - BACKGROUND: The use of Appendicitis Inflammatory Response clinical score in patients with suspected acute appendicitis makes the diagnosis more objective and accurate. AIMS: The aim of this study was to prospectively compare two groups with suspected acute appendicitis, analyzing the number of imaging tests requested, waiting time in the emergency department, until definition of conduct, as well as the sensitivity and specificity of this diagnostic method. METHODS: This is a prospective randomized study comparing 55 patients submitted to clinical-radiological diagnosis according to the routine of the service (control group), with another 55 patients submitted to the Appendicitis Inflammatory Response score flowchart (intervention group). RESULTS: Waiting time for defining the intervention group's conduct was 1.5 h shorter than the control group (p=0.02). Computed tomography was performed in 42 patients in the control group, compared with 25 in the intervention group (p=0.001). The impact of the flowchart based on the Appendicitis Inflammatory Response score of the cases compared to the control group was the reduction of appendectomies with a normal-appearing appendix from 5 to 1 and an increase in the exclusion of appendicitis diagnoses. The use of the Appendicitis Inflammatory Response score resulted in a diagnostic specificity of 92%, compared to 29% in the control group. CONCLUSIONS: The use of the Appendicitis Inflammatory Response score reduced the waiting time for the diagnosis of acute appendicitis, decreased the number of imaging tests, and increased diagnostic specificity of the disease.

RESUMO - RACIONAL: A utilização do escore clínico Appendicitis Inflammatory Response em pacientes com suspeita de apendicite aguda torna o diagnóstico mais objetivo e preciso. OBJETIVOS: Comparar prospectivamente dois grupos com suspeita de apendicite aguda, analisando o número de exames de imagem solicitados, o tempo de espera no Pronto-Socorro, até a definição da conduta, bem como a sensibilidade e especificidade desse método diagnóstico. MÉTODOS: Estudo prospectivo randomizado comparando 55 pacientes submetidos ao diagnóstico clínico-radiológico de acordo com a rotina do Serviço (grupo controle), com outros 55 pacientes submetidos ao fluxograma do escore Appendicitis Inflammatory Response (grupo intervenção). RESULTADOS: O tempo de espera para definir a conduta do grupo intervenção foi 1,5 hora menor do que o grupo controle (p=0,02). A tomografia computadorizada foi realizada em 42 pacientes do grupo controle, em comparação com 25 do grupo intervenção (p=0,001). O impacto do fluxograma baseado no escore Appendicitis Inflammatory Response dos casos em relação ao grupo controle foi a redução de apendicectomias com apêndice de aparência normal de 5 para 1 e um aumento na exclusão de diagnósticos de apendicite. O uso do escore Appendicitis Inflammatory Response resultou em especificidade diagnóstica de 92%, comparado a 29% no grupo controle. CONCLUSÕES: A utilização do escore Appendicitis Inflammatory Response reduziu o tempo de espera para o diagnóstico de apendicite aguda, diminuiu o número de exames de imagem e aumentou a especificidade diagnóstica da doença.

Perspectiva ética de la priorización de vacunación contra el COVID-19 en Chile

The SARS-CoV-2 pandemic has generated an important health and economic impact on the world. Vaccines emerge as an intervention that can contribute to the control of the pandemic. Vaccines were approved for emergency use in the United States, Europe, as well as in Chile, however, they will not be immediately available, creating the need to prioritize vaccine distribution. The World Health Organization (WHO) and other international agencies established ethical frameworks to guide the distribution of the COVID-19 vaccine globally. In Chile, the Advisory Council on Vaccines and Immunizations (CAVEI) and the COVID-19 Advisory Council of the Ministry of Health (MINSAL) recommended the groups to prioritize vaccination, based on the available evidence stating that this information could change over time. In this article, we propose a reference framework of ethical principles and values to support the decision-making of prioritization and distribution of vaccines in Chile. We propose three timeless values: maximizing benefits, prioritizing the most vulnerable, reciprocity, and two transversal bioethics principles: justice and transparency. This reference framework contributes to the vaccination plan communication, the decision-making by the authorities and supports the prioritization strategy's valúes framework. With an explicit values framework we can expect better communication or priorities, a greater acceptance of SARS-CoV-2 vaccination plan by the community and an increased vaccination coverage to protect the population.

Tratamiento laparoscópico de un quiste de colédoco gigante en un paciente pediátrico / Laparoscopic treatment of a giant choledochal cyst in a pediatric patient

Resumen Introducción: Se define como quiste de colédoco gigante aquel con un diámetro ≥ 10 cm. A pesar de que el abordaje laparoscópico ha sido contraindicado, se presenta el caso de un adolescente con un quiste de colédoco gigante resuelto por laparoscopía. Caso clínico: Paciente de sexo masculino de 14 años con un quiste de colédoco gigante tratado con anastomosis hepático-duodenal laparoscópica. Conclusiones: El tamaño promedio de los quistes de colédoco tratados por laparoscopía es de 40 mm. No se recomienda la resección de quistes gigantes por mínima invasión debido a adherencias y restricción del campo visual. En este caso se realizó un tratamiento laparoscópico de manera exitosa.

Abstract Background: The giant choledochal cyst has a diameter ≥ 10 cm. Although laparoscopy has been contraindicated, we present the case of a teenager with a giant choledochal cyst resolved by laparoscopy. Case report: A 14-year-old male patient with a giant choledochal cyst treated with hepatic-duodenum laparoscopic anastomosis. Conclusions: The average size of bile duct cysts treated by laparoscopy is 40 mm. Giant cysts should not be resected through minimal invasion due to adhesions and a restricted visual field. We report a case of a giant cyst successfully treated by laparoscopy.

Association of globalization in its different dimensions with overweight and obesity: an analysis in 10 Latin American and Caribbean countries / Asociación entre la globalización en sus diferentes dimensiones con el sobrepeso y la obesidad: un análisis en 10 países de América Latina y el Caribe

Abstract: Objective: To analyze the association of total globalization and its different dimensions with overweight and obesity in 10 Latin American and Caribbean (LAC) countries between 1995 and 2013. Materials and methods: A sample of 848 405 women aged 20-49 was analyzed. Multiple logistic regression models were used, adjusting for individual- and country-level confounding factors. To evaluate nonlinearities, four levels were defined through quartiles and divided into four dummy variables. Results: Total globalization had a positive association with overweight and obesity. Three dimensions of globalization (economic, political and social) indicated an increase in overweight and obesity. Social globalization presented polynomial behaviour, whereas, in political and economic globalization, a concave relation was observed. Conclusion: The economic, political and social dimensions had a positive association with overweight and obesity.

Resumen: Objetivo: Analizar la asociación entre la globalización total y sus diferentes dimensiones con el sobrepeso y la obesidad en 10 países de América Latina y el Caribe (ALC) entre el periodo 1995 y 2013. Material y métodos: Se analizó una muestra de 848 405 mujeres de 20 a 49 años. Se utilizaron modelos de regresión logística múltiple, ajustando por factores de confusión a nivel individual y país. Para evaluar no linealidades se definieron cuatro niveles a través de cuartiles y se dividieron en cuatro variables indicadoras. Resultados: La globalización total presentó una asociación positiva con el sobrepeso y la obesidad. Las tres dimensiones de globalización (económica, política, social) indicaron un incremento del sobrepeso y obesidad a mayor puntaje de globalización. La globalización social presentó un comportamiento polinomial, mientras que en la globalización política y económica se observó una relación cóncava. Conclusión: Las dimensiones económicas, políticas y sociales tuvieron una asociación positiva con el sobrepeso y la obesidad.

Resultados audiológicos en pacientes mayores de 65 años con hipoacusia neurosensorial unilateral manejados con implante coclear en el Hospital Universitario Clínica San Rafael durante el período 2006 2016 / Audiological outcomes in patients with unilateral sensorineural hearing loss older than 65 years managed with cochlear implant in the University Hospital Clínica San Rafael between 2006 2016

Introducción: Los pacientes mayores de 65 años con hipoacusia neurosensorial unilateral e implante coclear hacen parte de una población especial que requiere estudios más profundos sobre el rendimiento audiológico con este dispositivo. Diseño: Estudio observacional de corte transversal. Métodos: Se analizaron datos de la historia clínica electrónica a partir del año 2006 hasta el año 2016 en 33 pacientes adultos (>65 años) con diagnóstico de hipoacusia neurosensorial severa/profunda unilateral manejados con implante coclear. Resultados: Se reclutaron 33 pacientes con una mediana de edad de 68 años (RIQ 5 años). La mediana para el promedio de tonos puros del habla pre-quirúrgicos fue de 90 con un RIQ de 13dB, mientras que a los 6 meses fue de 31dB con un RIQ de 9 y a los 6 meses de 30db con un RIQ de 5. El porcentaje de discriminación del lenguaje pre-quirúrgico tuvo una mediana de 20 % con un RIQ de 20, a los 6 meses de 85.13 % con un RIQ de 4.07, y a los 12 meses de 90.9 % con un RIQ de 2.65. La correlación de Pearson mostró diferencias estadísticamente significativas entre los valores del promedio de tonos puros del habla pre-quirúrgicos y a los 6 y 12 meses (p=0.004 y 0.028 respectivamente) y entre los valores del porcentaje de discriminación del lenguaje pre-quirúrgico y a los 6 y 12 meses (p=0.000). Conclusiones: Concluimos que el implante coclear mejora los resultados de las pruebas audiológicas en pacientes mayores de 65 años con hipoacusia neurosensorial unilateral.

Introduction: Patients with unilateral sensorineural hearing loss older than 65 years and cochlear implant are part of a special population that requires more in-depth studies on audiological performance with this device. Design: Cross sectional study Methods: Data from the electronic medical history was analyzed from 2006 to 2016 in 33 adult patients (> 65 years old) with diagnosis of unilateral severe/profound sensorineural hearing loss and who were taken to surgical treatment with a cochlear implant. Results: A total of 33 patients were found. The median age was 68 years with a RIQ of 5 years. The median for the pure tone average of all pre-surgical was 90 Db with an RIQ of 13, while at 6 months it was 31 Db with an RIQ of 9 and at 6 months of 30 Db with an RIQ of 5. The percentage of pre-surgical language discrimination had a median of 20 % with a RIQ of 20, at 6 months of 85.13 % with a RIQ of 4.07, and at 12 months of 90.9 % with a RIQ of 2.65. The Pearson correlation showed statistically significant differences between the mean values of all pre-surgical PTA and at 6 and 12 months (p = 0.004 and 0.028 respectively) and between the values of the discrimination percentage of the pre-surgical language and the 6 and 12 months (p = 0.000). Conclusions: We concluded that the cochlear implant improves the results of audiological tests in patients older than 65 years with sensorineural deafness.

Impacto de la inactividad física en la mortalidad y los costos económicos por defunciones cardiovasculares: evidencia desde Argentina / Impact of physical inactivity on mortality and the economic costs of cardiovascular deaths: evidence from Argentina / Impacto da inatividade física na mortalidade e custos econômicos por mortes cardiovasculares: evidências provenientes da Argentina

RESUMEN Objetivo Estimar la mortalidad y los costos económicos por enfermedades cardiovasculares atribuibles a la inactividad física en Argentina. Métodos Se estimó la mortalidad atribuible (MA) a la inactividad física como el producto entre la fracción atribuible poblacional (FAP) y el número de muertes originadas por las enfermedades cardiovasculares asociadas. Se realizó una valoración del valor estadístico de la vida (VEV) siguiendo el enfoque del capital humano, bajo el cual el VEV se estimó mediante la productividad perdida por muerte prematura. Se calcularon los costos económicos empleando la MA y el VEV, estratificando por sexo, grupo de edad y nivel de actividad física. Se empleó un análisis de sensibilidad para evaluar cómo varían los costos en tres escenarios posibles. Resultados La MA a la actividad física baja y moderada varió entre 33 (18 a 24 años) y 7 857 (> 84 años) defunciones anualmente en ambos sexos. El VEV se encontraba entre I$ 441 005 (dólares internacionales) (18 a 24 años) y I$ 4 121 (> 84 años). La valoración de los costos totales por sexo indica que las pérdidas económicas ascendieron a I$ 752,5 millones para los hombres y a I$ 444,5 millones para las mujeres. Conclusión Las pérdidas económicas variaron entre 0,61% del PIB para el escenario mínimo, 0,85% para el escenario medio, y 1,48% para el escenario máximo. Se recomienda fortalecer el desarrollo de políticas públicas orientadas a la reducción del sedentarismo en Argentina.

ABSTRACT Objective Estimate mortality and economic costs from cardiovascular diseases attributable to physical inactivity in Argentina. Methods Attributable mortality (AM) from physical inactivity was estimated as the product of the population attributable fraction and the number of deaths caused by associated cardiovascular diseases. Value of statistical life (VSL) was calculated using the human capital approach, in which VSL was estimated through lost productivity from premature death. Economic costs were calculated using AM and VSL, stratifying by sex, age group, and physical activity level. A sensitivity analysis was used to evaluate how costs vary in three possible scenarios. Results AM from low and moderate physical activity ranged from 33 (18 to 24 years) to 7 857 (>84 years) deaths annually in both sexes. VSL ranged from I$441 005 (international dollars) (18 to 24 years) to I$4,121 (>84 years). Assessment of total costs by sex indicates that economic losses amounted to I$752.5 million for men and I$444.5 million for women. Conclusion Economic losses ranged from 0.61% of GDP for the minimum scenario, 0.85% for the average scenario, and 1.48% for the maximum scenario. Stronger public policy-making aimed at reduction of sedentary lifestyles in Argentina is recommended.

RESUMO Objetivo Estimar a mortalidade e os custos econômicos por doenças cardiovasculares atribuíveis à inatividade física na Argentina. Métodos Foi estimada a mortalidade atribuível à inatividade física como o produto entre a fração atribuível populacional (FAP) e o número de mortes por doenças cardiovasculares associadas. Foi realizada uma avaliação do valor estatístico da vida (VEV) segundo o enfoque do capital humano em que o VEV foi estimado pela produtividade perdida por morte prematura. Foram calculados os custos econômicos empregando a mortalidade atribuível e o VEV, estratificados por sexo, faixa etária e nível de atividade física. Foi feita uma análise de sensibilidade para avaliar a variação dos custos nos três cenários possíveis. Resultados A mortalidade atribuível a um nível baixo e moderado de atividade física variou entre 33 (18 a 24 anos) e 7 857 (>84 anos) mortes ao ano em ambos os sexos. O VEV foi de 441 005 dólares internacionais (18 a 24 anos) a 4 121 dólares internacionais (>84 anos). A avaliação dos custos totais por sexo indicou que as perdas econômicas atingiram 752,5 milhões de dólares internacionais no sexo masculino e 444,5 milhões de dólares internacionais no sexo feminino. Conclusão Os prejuízos econômicos variaram entre 0,61% do PIB no cenário mínimo, 0,85% no cenário intermediário e 1,48% no cenário máximo. Recomenda-se o reforço na elaboração de políticas públicas orientadas à redução do sedentarismo na Argentina.

Uso de cânula venovenosa com duplo-lúmen para oxigenação por membrana extracorpórea em paciente com síndrome de angústia respiratória aguda com prévia inserção de filtro na veia cava inferior: relato de caso / Use of a dual lumen cannula for venovenous extra corporeal membrane oxygenation in a patient with acute respiratory distress syndrome and a previously inserted inferior vena cava filter: a case report

RESUMO A oxigenação por membrana extracorpórea é utilizada em casos de hipoxemia refratária em diversas condições clínicas. Pacientes vítimas de traumatismo torácico geralmente desenvolvem síndrome da angústia respiratória aguda. Em razão do elevado risco de sangramentos, as complicações trombóticas que se apresentam neste contexto são particularmente difíceis de tratar e, geralmente, demandam a inserção de um filtro na veia cava inferior, com a finalidade de prevenir a migração de êmbolos oriundos das veias distais para a circulação pulmonar. Neste artigo, apresentamos o caso de um paciente com traumatismo torácico, que apresentou grave síndrome de angústia respiratória aguda, com necessidade de utilizar oxigenação por membrana extracorpórea aplicada por meio da introdução de uma cânula com duplo-lúmen na veia jugular interna direita. Este procedimento foi realizado tendo em vista a prévia inserção de um filtro na veia cava inferior, por conta da ocorrência de trombose venosa profunda em ambas as panturrilhas.

ABSTRACT Extracorporeal membrane oxygenation is used in refractory hypoxemia in many clinical settings. Thoracic trauma patients usually develop acute respiratory distress syndrome. Due to high risk of bleeding, thrombotic complications present in this context are particularly difficult to manage and usually require insertion of an inferior vena cava filter to prevent embolism from the distal veins to the pulmonary circulation. Here, we present a case of a thoracic trauma patient with severe acute respiratory distress syndrome requiring venovenous extracorporeal membrane oxygenation via a right internal jugular double lumen cannula due to a previously inserted inferior vena cava filter caused by distal bilateral calf muscle vein deep vein thrombosis.

Resultados de SPECT miocárdico y eventos cardiovasculares en dos servicios de Medicina nuclear de Bogotá durante 2011 a 2012 / Myocardial SPECT results and cardiovascular events in two nuclear medicine departments in Bogota from 2011 to 2012

Objective: This study sought to determine the relationship between the results obtained from myocardial SPECT with pharmacologic stress with dipyridamole and the development of major cardiovascular events in the follow-up of patients treated at two nuclear medicine departments in Bogota, Colombia. Materials and methods: 183 patients undergoing myocardial SPECT with pharmacological stress with dipyridamole between November 2011 and April 2012 with a twelve month follow-up, were included. The relationship between the development of major cardiovascular events and the functional or perfusion results of the myocardial SPECT were analyzed. Results: 14 patients from the 154 who completed the follow-up, developed cardiovascular events. Patients with abnormal studies had higher number of events (13 vs 1. p = 0.019) compared to those with normal studies. The results of abnormal perfusion were associated with higher incidence of events (15.19%). Conclusions: A normal myocardial SPECT study is related to reduced incidence of major cardiovascular events in a one year follow-up, even in patients with high-risk clinical characteristics.

Objective: This study sought to determine the relationship between the results obtained from myocardial SPECT with pharmacologic stress with dipyridamole and the development of major cardiovascular events in the follow-up of patients treated at two nuclear medicine departments in Bogota, Colombia. Materials and methods: 183 patients undergoing myocardial SPECT with pharmacological stress with dipyridamole between November 2011 and April 2012 with a twelve month follow-up, were included. The relationship between the development of major cardiovascular events and the functional or perfusion results of the myocardial SPECT were analyzed. Results: 14 patients from the 154 who completed the follow-up, developed cardiovascular events. Patients with abnormal studies had higher number of events (13 vs 1. p = 0.019) compared to those with normal studies. The results of abnormal perfusion were associated with higher incidence of events (15.19%). Conclusions: A normal myocardial SPECT study is related to reduced incidence of major cardiovascular events in a one year follow-up, even in patients with high-risk clinical characteristics.

Análisis del nivel de empatía en un curso de quinto año de medicina, a través de una escala validada para este efecto / Analysis of level empathy in fifth grader medicine students, through falidated scale

La empatía es un concepto amplio y en la literatura se pueden encontrar múltiples definiciones. El aspecto cognitivo de la empatía se refiere la habilidad para entenderlas experiencias y sentimientos de la otra persona y la capacidad de ver el mundo desde la perspectiva del otro. Se ha demostrado que la empatía presente en el personal de salud otorga ventajas. Por ejemplo, mejora la satisfacción del paciente, aumenta la complacencia, incrementa la habilidad del médico en el diagnóstico y tratamiento y baja significativamente el riesgo de juicio por mala práctica. El objetivo del presente trabajo es implementar la escala de empatía denominada“The Jefferson Scale of Physician Empathy” en un curso de alumnos de medicina del HCUCh y realizar un análisis descriptivo del grado de empatía presente, según sexo y especialidad a seguir. Las mujeres obtuvieron un puntaje mayor de empatía con respecto a los hombres. Se encontraron diferencias en el grado de empatía según la especialidad a seguir del estudiante. El análisis estadístico no mostró que estas diferencias fueran significativas.

The empathy is a wide concept and in literature there are many definitions. Thecognitive aspect of the empathy talks about the ability to understand the experiences and feelings of the other person and the capacity to see the world from the perspective of the other. It has been shown that empathy foster patient’s satisfaction, improve compliance, increase physician’s ability to properly diagnose and reducesrisk of malpractice. The objective of the present work is to implement “TheJefferson Scale of Physician Empathy ” in a medicine course of the HCUCh and make a descriptive analysis ofthe degree of empathy, according to sex and speciality to follow. The women tend to score higher on empathy rating than men. Differences were found in the empathy degree of the students according to the speciality they follow. No statistical differences were found in both cases.

Recurrent and de novo non-alcoholic steatohepatitis following orthotopic liver transplantation

Non-alcoholic steatohepatitis was coined in 1980 to describe pathological and clinical features of non-alcoholic disease associated with pathological features, commonly seen in alcoholic-liver disease itself. It is now a well-recognised cause of end-stage liver disease and a rare cause of orthotopic liver transplantation. A small number of cases with recurrent non-alcoholic steatohepatitis following liver transplantation have been reported, however de novo non-alcoholic steatohepatitis in the liver allograft is not well recognised. AIMS/RESULTS: We report four cases of non-alcoholic steatohepatitis following orthotopic liver transplantation describing the factors related with the pathology. The recurrence of fatty infiltration occurred within 21 months and transition from mild steatosis to non-alcoholic steatohepatitis and early fibrosis was observed within 60 months post transplant in all four patients. All four cases had association with one or multiples risk factors (obesity, type 2 diabetes and/or hyperlipidemia). CONCLUSIONS: Management of this risk factors may play a therapeutic role in the prevention of recurrent and de novo non-alcoholic steatohepatitis following orthotopic liver transplantation

Incidência de enteroparasitas em crianças de Joinville (SC) / Incidence of intestinal parasitosis in children from Joinville (SC)

Para determinar a incidência de enteroparasitoses em crianças de Joinville (SC) foram estudadas 156 crianças matriculadas em um colégio de regime aberto e 31 crianças matriculadas em regime de semi-internato. Realizou-se exame parasitológico de fezes pelos métodos de Faust et al. e Hoffman, Pons & Janner para cada criança. Determinou-se que no regime aberto 39 por cento das crianças estavam infectadas, contra 74 por cento do regime de semi-internato; quanto ao sexo 50 por cento dos meninos contra 31 por cento das meninas estavam infectados. No regime aberto a maior incidência foi de Giardia lamblia (41 por cento), já no semi-internato foi de Entamoeba coli. Os resultados demonstram as más condiçoes de saneamento básico que nos atinge, e a relaçao entre o convívio e a disseminaçao dos parasitas.