Towards leprosy elimination by 2020: forecasts of epidemiological indicators of leprosy in Corrientes, a province of northeastern Argentina that is a pioneer in leprosy elimination

BACKGROUND Corrientes, a province of northeastern Argentina with endemic leprosy, has improved its epidemiological indicators, however, a study of the dynamics over time is lacking. OBJECTIVES We analysed data of 1308 leprosy patients between 1991 to 2014, and the forecast for 2020. METHODS Descriptive statistics and stepwise Bayesian model selection were performed. Forecasts were made using the median of 100,000 projections using the parameters calculated via Monte Carlo methods. RESULTS We found a decreasing number of new leprosy cases (-2.04 cases/year); this decrease is expected to continue by an estimated 20.28 +/- 10.00 cases by 2020, evidenced by a sustained decline in detection rate (from 11 to 2.9/100,000 inhabitants). Age groups that were most affected were 15-44 (40.13%) and 45-64 (38.83%) year olds. Multibacillary forms (MB) predominated (70.35%) and while gradually declining, between 10 and 30% developed disability grade 2 (DG2) (0.175 (0.110 - 0.337) DG2/MB cases), with a time delay between 0 to 15 years (median = 0). The proportion of MB clinic forms and DG2 increased and will continuously increase in the short term (0.036 +/- 0.018 logit (MB/total of cases). MAIN CONCLUSIONS Corrientes is on the way to eliminating leprosy by 2020, however the increased proportion of MB clinical forms and DG2 signals a warning for disease control efforts.

Características epidemiológicas, clínicas y bacteriológicas de meningitis neumocócica en pacientes pediátricos de Lima, Perú / Epidemiologic, clinical and bacteriologic characteristics of pneumococcal meningitis in pediatric patients from Lima, Peru

RESUMEN Objetivos. Describir las características clínicas, letalidad, susceptibilidad antibiótica y distribución de serotipos de meningitis neumocócica en pacientes pediátricos de Lima, Perú. Materiales y Métodos. Serie de casos de meningitis neumocócica en niños menores de 16 años. Los datos fueron obtenidos de dos estudios multicéntricos prospectivos, de vigilancia pasiva de enfermedad neumocócica invasiva realizados en Lima-Perú desde los años 2006 al 2008, y del 2009 al 2011. Resultados. Reportamos 44 episodios de meningitis neumocócica; 68,2% fueron en niños menores de 2 años. La tasa de letalidad fue 32,6; y 92,9% de los casos letales ocurrieron en niños menores de dos años (p<0,05). La desnutrición estuvo asociada a los casos letales (p<0,05). El 64,3% de los casos fatales murieron dentro de los 2 primeros días. El 41,9% de los cultivos con neumococo fueron resistentes a la penicilina, 23,3% mostró resistencia intermedia a ceftriaxona (ninguno mostró resistencia completa) y 9,3% mostró resistencia a cloranfenicol. Los serotipos más frecuentes fueron 6B, 14, 19F y 23F, los cuales constituyeron el 68,3% de todas las cepas; 84,1% de las cepas encontradas están incluidas en los serotipos de la vacuna 13 valente. Conclusiones. La meningitis neumocócica continúa siendo una enfermedad letal, especialmente en niños menores de 2 años. Dado que aproximadamente dos tercios de los casos letales fallecen en las primeras 48 h, es crítico un diagnóstico y tratamiento oportuno, así como asegurar el cumplimiento de la inmunización con la vacuna neumocócica.

ABSTRACT Objectives. To describe the clinical characteristics, lethality, antibiotic susceptibility, and serotype distribution of pneumococcal meningitis in pediatric patients in Lima, Peru. Materials and Methods. A case series of pneumococcal meningitis in children less than 16 years of age from two prospective, multicenter, passive surveillance studies of invasive pneumococcal diseases held in Lima-Peru from 2006 to 2008 and 2009 to 2011. Results. We report 44 pneumococcal meningitis episodes; 68.2% of them were in children less than 2 years old. The overall case fatality rate was 32.6%; 92.9% of fatal cases were in children less than 2 years of age (p<0.05). Malnutrition was associated with fatal cases (p<0.05). 64.3% of fatal cases died within the first two days. 41.9% of pneumococcal isolates were resistant to penicillin, 23.3% were intermediate resistant to ceftriaxone (none were highly resistant) and 9.3% were resistant to chloramphenicol. The most common serotypes were 6B, 14, 19F and 23F, which accounted for 68.3% of all strains; 84.1% of strains were PCV13 serotypes. Conclusions. Pneumococcal meningitis continues to be a lethal disease, especially in children less than 2 years of age. Since almost two third of lethal cases lead to death within the first 48 hours, prompt diagnosis and management is critical, as well as assurance of immunization with pneumococcal vaccine.

Obesidade infantil e suas consequências: uma revisão bibliográfica / Childhood obesity and its consequences: a literature review

Objetivos: alertar os pediatras sobre a importância da obesidade infantil e sua identificação precoce, promovendo assim a sua prevenção de forma efetiva.

Obesidade infantil e suas consequências: uma revisão bibliográfica

Objetivos: alertar os pediatras sobre a importância da obesidade infantil e sua identificação precoce, promovendo assim a sua prevenção de forma efetiva.

Guía técnica de vigilancia de influenza y otros virus respiratorios / Technical guide surveillance of influenza and other respiratory viruses

La presente publicación orienta la prevención y control de la influenza en el país, mediante las evidencias producidas por la vigilancia epidemiológica en el país.

Tratamento cirúrgico das complicaçöes da doença hepática alcoólica / Surgical treatment of the complications of alcoholic liver disease

O sangramento por varizes de esôfago (VE) rotas e a ascite clinicamente intratável constituem complicaçöes graves da hepatopatia crônica alcoólica. Neste estudo, objetivou-se avaliar 33 pacientes cirróticos alcoólatras portadores de tais complicaçöes, sendo 18 submetidos à anastomose espleno-renal distal (AERD) por sangramento de VE rotas (Grupo I) e 15 submetidos à derivaçäo peritôneo-venosa por válvula de LeVeen (VLV) devido à ascite clinicamente intratável (Grupo II). O Grupo I inclui 4 pacientes Child A, 5-B e 4-C, além de 5 portadores de esquistossomose mansônica (EM) associada a alcoolismo. O Grupo II foi constituído de 7 pacientes Child B e 8-C. Concluímos que: 1) A AFRD näo deve ser empregada em pacientes Child C; 2) A AERD representa boa alternativa cirúrgica para os cirróticos Child A e portadores de EM; 3) A dificuldade técnica na realizaçäo da AERD é seguida de alta morbidade e mortalidade, devendo-se, nestas situaçöes, utilizar-se de outras opçöes cirúrgicas; 4) O implante da VLV, quando bem indicado, oferece melhor qualidade de vida ao cirrótico alcoólatra com ascite; 5) Com a perfeita padronizaçäo técnica, os riscos operatórios säo mínimos, sendo a mortalidade pós-operatória geralmente conseqüência da evoluçäo natural da doença