Valoración del daño corporal en cardiopatía isquémica, basado en las guías de valoración del deterioro permanente de la academia americana de medicina / Assessment of body damage in ischemic heart disease, based on the guidelines for assessing the permanent deterioration of the American Academy of Medicine

ResumenEn este artículo se describirán los elementos básicos necesarios que deben tomarse en cuenta cuando se está valorando médico legalmente a una persona con cardiopatía isquémica, tanto en la historia clínica, examen físico y los estudios complementarios. Además se dará una explicación breve sobre el uso de tabla de enfermedad coronaria para la asignación de porcentaje basado en las Guías de Valoración del Deterioro Permanente de la Academia Americana de Medicina y con ello brindarle al médico forense las herramientas necesarias para asignar de forma objetiva un porcentaje de pérdida de la capacidad funcional por los efectos de la cardiopatía de origen isquémico.

AbstractIn this article will be described the necessary basic elements to be taken into account when using a forensic medical approach to diagnose a person with ischemic heart disease, both in clinical history, physical examination and complementary studies. In addition, is a brief explanation of how to use the table of coronary heart disease for the allocation of a percentage based on the Guidelines for Evaluation of Permanent Impairment of the American Academy of Medicine and thereby provide to the medical examiner the necessary tools to assign subjectively the percentage of loss of functional capacity by the effects of ischemic heart disease.

Usage pattern, physical integrity & insecticidal efficacy of long-lasting insecticidal nets in Odisha State, India.

Background & objectives: One of the major strategies being pursued for malaria control by the National Vector Borne Disease Control Programme is the distribution of long lasting insecticidal nets (LLINs) in endemic areas since 2009. Information on durability of insecticidal efficacy and physical integrity of LLINs and community usage at different time intervals of their use is essential to plan net replacements to maintain universal coverage for an effective and sustainable malaria control strategy. Therefore, a study was undertaken to assess these parameters in two malaria endemic districts of the Odisha State. Methods: A total of 309 households were selected in 15 villages of two community health centres (CHCs) (Borigumma and Laxmipur) from Koraput district and one (Khairput) from Malkangiri district. Data on net usage were collected during March to July 2014 using semi-structured questionnaires. PermaNet 2.0 were sampled from all households, replaced with new ones, and bioassays were carried out to determine the insecticidal efficacy of LLINs after four and half, four and two years of field use following the standard procedure of World Health Organization. Results: LLIN use rate varied from 57.9 to 90.2 per cent in the study CHCs. The annual washing rate per net in Borigumma, Khairput and Laxmipur was 6.6, 3.2 and 4.8, respectively. The LLINs used two years in the field caused 100 per cent mortality and four to four and half years caused below 80 per cent mortality, except one net. Interpretation & conclusions: Nearly 20 per cent of the people were out of net coverage and hence the Programme to ensure 100 per cent coverage. The community should adequately be educated so as to increase the net use rate and avoid incorrect washing practices.

Experimental hut evaluation of Fendona 6SC®-treated bednets and Interceptor® long-lasting nets against Anopheles gambiae s.l. in Burkina Faso.

Background & objectives: Malaria prevention relies heavily on insecticide-treated bednets. Even though the benefits of bednets have been proven that in most of the studies carried out in Africa, their efficacy remains dependent on local conditions. In this study, under field conditions, we evaluated the efficacy of two LLINs (PermaNet® vs Interceptor®) and two bednet treatment kits (K-O TAB® vs Fendona 6SC®) against Anopheles gambiae s.l. Methods: Bednets were evaluated using experimental huts in the village of Pissy located in the Saponé health district of Burkina Faso. Treatments and sleepers were randomly rotated between huts. Results are expressed in terms of induced exophily, mortality after 24 h and blood-feeding inhibition. Results: A total of 1392 An. gambiae s.l. mosquitoes were collected during 120 nights in the experimental huts. The overall mortality rates were 85.4% (CL: 79.7–91.4) and 77.5% (CL: 56.9–97.3) for PermaNet® and Interceptor®, respectively. For the conventionally treated bednets, the mortality was 78.2% (CL: 63.13–96.7) with the Fendona 6SC®-treated nets and 75.5% (CL: 61.2–93) with the K-O TAB®-treated nets. The proportion of blood-fed mosquitoes was significantly higher in the untreated bednet arm than in the treated one, as well as for long-lasting nets than for conventionally treated nets. The entry rate did not vary significantly according to the bednet type, but the treated bednets increased the level of exophily by at least 43%. Conclusion: In the field, the Fendona 6SC® kit and the Interceptor bednets showed comparable efficacy to the already used K-O TAB® kit and PermaNet® bednets. These results could help National Malaria Program managers to formulate appropriate policy for effective vector control.

Laboratory and semi-field evaluation of long-lasting insecticidal nets against leishmaniasis vector, Phlebotomus (Phlebotomus) duboscqi in Kenya.

Background & objectives: Phlebotomine sandflies are vectors of leishmaniases and other diseases. Long-lasting insecticidal nets (LLINs) as possible tools for control have not been widely tested against them. The objective of this study was to determine the efficacy of Olyset® Net and PermaNet® LLINs alongside a local brand, K-O Tab® treated net (Supanet) against Phlebotomus duboscqi female sandflies. Methods: Four replicates of unwashed and 20x washed Olyset Nets and PermaNets, K-O Tabtreated and untreated Supanet and ‘no net’ treatments were evaluated against sandflies within the laboratory by tunnel tests and in semi-field conditions in the greenhouse model for their efficacy. Results: All bednets allowed entry of P. duboscqi sandflies and subsequent blood-feeding. Olyset net’s blood feeding inhibition was significantly higher than that of Supanet in the laboratory but not in semi-field condition. Of the LLINs, only Olyset net had sandflies that could not feed significantly more than those of Supanet. Additionally, no significant efficacy difference was observed between LLINs washed 20x and unwashed ones. The only significant difference noted in number of sandflies that were found dead or paralyzed within bednets in the semi-field condition was between Olyset and K-O Tab treated Supanet. In the laboratory, unwashed Olyset had a significantly higher number of sandflies killed than all other bednet treatments. Conclusion: Olyset net use in areas where sandflies are nuisance biters and/or disease vectors could be more beneficial in preventing sandfly bites than other tested bednets. It is recommended that mesh sizes of LLINs should be smaller for control of sandflies than those used for control of mosquitoes.