The metabolic hormone adiponectin affects the correlation between nutritional status and pneumococcal vaccine response in vulnerable indigenous children.

BACKGROUND: Almost 200 million children worldwide are either undernourished or overweight. Only a few studies have addressed the effect of variation in nutritional status on vaccine response. We previously demonstrated an association between stunting and an increased post-vaccination 13-valent pneumococcal conjugate vaccine (PCV13) response. In this prospective study, we assessed to what extent metabolic hormones may be a modifier in the association between nutritional status and PCV13 response. METHODS: Venezuelan children aged 6 weeks to 59 months were vaccinated with a primary series of PCV13. Nutritional status and serum levels of leptin, adiponectin and ghrelin were measured upon vaccination and their combined effect on serum post-vaccination antibody concentrations was assessed by generalized estimating equations multivariable regression analysis. RESULTS: A total of 210 children were included, of whom 80 were stunted, 81 had a normal weight and 49 were overweight. Overweight children had lower post-vaccination antibody concentrations than normal weight children (regression coefficient -1.15, 95% CI -2.22 --0.072). Additionally, there was a significant adiponectin-nutritional status interaction. In stunted children, higher adiponectin serum concentrations were associated with lower post-PCV13 antibody concentrations (regression coefficient -0.19, 95% CI -0.24 --0.14) while the opposite was seen in overweight children (regression coefficient 0.14, 95% CI 0.049-0.22). CONCLUSION: Metabolic hormones, in particular adiponectin, may modify the effect of nutritional status on pneumococcal vaccine response. These findings emphasize the importance of further research to better understand the immunometabolic pathways underlying vaccine response and enable a future of optimal personalized vaccination schedules.

Enfermedades infecciosas más frecuentes en pacientes desnutridos con edades comprendidas entre 6 meses a 10 años, habitantes de la parroquia Curiapo, Estado Delta Amacuro, en el período mayo-julio de 2016

Introducción: En pediatría las enfermedades infecciosas constituyen la causa más frecuente de consulta a nivel de atención primaria en salud. La población del presente trabajo de investigación es predominantemente de la etnia Warao y nuestra línea de investigación pretende realizar diagnóstico clínico oportuno tanto de la gravedad del estado nutricional como de las enfermedades infecciosas, respetando la identidad, cultura y autonomía de dicha etnia. Objetivo: Identificar las enfermedades infecciosas más frecuentes por diagnóstico clínico en pacientes desnutridos con edades comprendidas entre 6 meses a 10 años de edad, habitantes de la Parroquia Curiapo, Municipio Antonio Díaz, Edo. Delta Amacuro en el período mayo-julio de 2016. Métodos: La recolección de datos se basó en la entrevista médico-paciente y en la utilización de equipos médicos como estetoscopio, otorrinolaringoscopio, balanza, cinta métrica, gráficas nutricionales de la Organización Mundial de la Salud y las del Estudio Transversal de Caracas. Resultados: De 608 pacientes en estudio, 296 (48,7 %) se encuentran en un estado de malnutrición por déficit, siendo la desnutrición subclínica la predominante con un total de 107 casos. Por otro lado de esos pacientes con malnutrición por déficit, la diarrea y el catarro común conforman las enfermedades infecciosas más frecuentes. Conclusión: El 50 % de la población en estudio presenta algún grado de desnutrición, y la enfermedad infecciosa más frecuente es la diarrea la cual deteriora el estado nutricional del paciente; generándose un círculo pobreza-enfermedad difícil de romper.

Introduction: Pediatric infectious diseases are the most frequent cause of consultation at the level of primary health care. The population of this research belongs to ethnic warao, and our research aims to make timely clinical diagnosis of the severity of the nutritional status and the infectious diseases, respecting the identity, culture and autonomy of this ethnic group. Objective: Our main objective is to identify the most common infectious diseases by clinical diagnosis in undernourished patients between 6 months and 10 years old inhabitants of the Curiapo Parish, Municipality Antonio Diaz, Edo. Delta Amacuro in the period May-July 2016. Methods: Data collection was based in Medical-patient interview, also using medical equipment such as stethoscope, tape measure, othorrinolaringoscope, scales, Nutritional charts of the World Health Organization and the Transversal Study of Caracas for a complete physical examination. Results: In our research we found out that, of 608 patients studied, 296 (48,7 %) are in undernourished deficit level, being subclinical malnutrition the most frequent with 107 cases. On the otherside, those patients with undernourished deficit level, Diarrhea and common cold make up the most frequent infectious diseases in our studied population. Conclusions: We conclude that in the population, about 50 %, have some kind of malnutrition and the most common infectious diseases is diarrhea which decrease the nutritional status of the patients, generating a poverty-disease circle, very difficult to break out.

Factores de riesgo para infección por VIH en indígenas de la etnia warao del Municipio Antonio Díaz, Estado Delta Amacuro, Venezuela. Octubre ­ diciembre 2015

Delta Amacuro asienta la mayor población indígena de la etnia Warao en comunidades de difícil acceso y limitadas condiciones de vida. En 2007, la Cruz Roja venezolana diagnosticó los primeros casos de infección por VIH en este estado; posteriormente, diversas publicaciones han reportado que la prevalencia de infección por VIH en comunidades de la etnia Warao es 10 veces mayor a la prevalencia mundial. El objetivo de la investigación fue evaluar factores de riesgo para infección por VIH en indígenas del municipio Antonio Díaz, Estado Delta Amacuro durante octubre ­ diciembre 2015. Los factores de riesgo fueron agrupados en: características socioeconómicas, estatus migratorio, hábitos psicobiológicos y conocimiento sobre la enfermedad. Se realizó un estudio analítico de tipo casos y controles. Se evaluaron 50 pacientes VIH positivo de 7 comunidades y 100 controles del mismo sexo, comunidad y edad. A todos se les realizó una entrevista directa. Se compararon los resultados utilizando pruebas Chi cuadrado y se determinaron los Odds Ratio. La inestabilidad en la pareja sexual, las prácticas de hombres que tienen sexo con hombres, las relaciones sexuales fortuitas y durante viajes, el inicio precoz de relaciones sexuales, el sexo oral, sexo anal y el no uso de métodos de barrera constituyeron factores de riesgo para infección por VIH en la población estudiada. El desconocimiento de la forma de trasmisión y prevención resultaron también estadísticamente significativos. La falta de conocimiento, movimientos migratorios frecuentes y las prácticas sexuales de riesgo pueden explicar la elevada prevalencia de infección por VIH en esta población.

In Delta Amacuro state is established the biggest Amerindian community belonging to the Warao ethnic. This people live in difficult access communities with precarious life conditions. In 2007 the Venezuelan Red Cross diagnosed the first HIV infection cases in the state. Later, many publications have reported HIV prevalence in Waraos communities ten times higher than worldwide prevalence. The main objective was to evaluate risk factors for HIV infection in Waraos Amerindians who live in Antonio Diaz municipality, Delta Amacuro state between October and December 2015. Risk factors were grouped in: socioeconomic conditions, migratory status, sexual and psychobiologic habits and disease knowledge. An analytic case-control study was conducted. Fifty HIV patients from seven communities and 100 controls were evaluated. The information from cases and controls was collected through a direct interview. The results were compared using chi square test, odds ratios were calculated. No stability in sexual partners, men who have sex with other men, casual sex, sex during trips, early sexual initiation, oral sex and anal sex and lacking in use of barrier contraceptive methods were risk factors for HIV infection in the study group. Lack of knowledge about transmission and prevention of the disease were also statistically significant risk factors. Lack of knowledge, frequent migratory movements and risk sexual behavior may explain the high prevalence of HIV infection in this population.

Childhood Vaccine Acceptance and Refusal among Warao Amerindian Caregivers in Venezuela; A Qualitative Approach.

OBJECTIVES: Acceptance of childhood vaccination varies between societies, affecting worldwide vaccination coverage. Low coverage rates are common in indigenous populations where parents often choose not to vaccinate their children. We aimed to gain insight into reasons for vaccine acceptance or rejection among Warao Amerindians in Venezuela. METHODS: Based on records of vaccine acceptance or refusal, in-depth interviews with 20 vaccine-accepting and 11 vaccine-declining caregivers were performed. Parents' attitudes were explored using a qualitative approach. RESULTS: Although Warao caregivers were generally in favor of vaccination, fear of side effects and the idea that young and sick children are too vulnerable to be vaccinated negatively affected vaccine acceptance. The importance assigned to side effects was related to the perception that these resembled symptoms/diseases of another origin and could thus harm the child. Religious beliefs or traditional healers did not influence the decision-making process. CONCLUSIONS: Parental vaccine acceptance requires educational programs on the preventive nature of vaccines in relation to local beliefs about health and disease. Attention needs to be directed at population-specific concerns, including explanation on the nature of and therapeutic options for side effects.

Recurrent wheezing is associated with intestinal protozoan infections in Warao Amerindian children in Venezuela: a cross-sectional survey.

BACKGROUND: While in developed countries the prevalence of allergic diseases is rising, inflammatory diseases are relatively uncommon in rural developing areas. High prevalence rates of helminth and protozoan infections are commonly found in children living in rural settings and several studies suggest an inverse association between helminth infections and allergies. No studies investigating the relationship between parasitic infections and atopic diseases in rural children of developing countries under the age of 2 years have been published so far. We performed a cross-sectional survey to investigate the association of helminth and protozoan infections and malnutrition with recurrent wheezing and atopic eczema in Warao Amerindian children in Venezuela. METHODS: From August to November 2012, 229 children aged 0 to 2 years residing in the Orinoco Delta in Venezuela were enrolled. Data were collected through standardized questionnaires and physical examination, including inspection of the skin and anthropometric measurements. A stool sample was requested from all participants and detection of different parasites was performed using microscopy and real time polymerase chain reaction (PCR). RESULTS: We observed high prevalence rates of atopic eczema and recurrent wheezing, respectively 19% and 23%. The prevalence of helminth infections was 26% and the prevalence of protozoan infections was 59%. Atopic eczema and recurrent wheezing were more frequently observed in stunted compared with non-stunted children in multivariable analysis (OR 4.3, 95% CI 1.3 - 13.6, p = 0.015 and OR 4.5, 95% CI 0.97 - 21.2, p = 0.055). Furthermore, recurrent wheezing was significantly more often observed in children with protozoan infections than in children without protozoan infections (OR 6.7, 95% CI 1.5 - 30.5). CONCLUSIONS: High prevalence rates of atopic eczema and recurrent wheezing in Warao Amerindian children under 2 years of age were related to stunting and intestinal protozoan infections respectively. Helminth infections were not significantly associated with either atopic eczema or recurrent wheezing.

Immunogenicity of a 7-valent pneumococcal conjugate vaccine (PCV7) and impact on carriage in Venezuelan children at risk of invasive pneumococcal diseases.

BACKGROUND AND AIMS: We evaluated the immunogenicity of the 7-valent pneumococcal conjugate vaccine (PCV7), and its impact on pneumococcal carriage in Venezuelan children at high risk for invasive pneumococcal disease (IPD). METHODS: 82 children (age 2-59 months) with sickle cell anemia (n=22), chronic heart disease (n=19), HIV infection (n=12), immune-suppressive therapy (n=11) and other IPD-predisposing conditions (n=18) were vaccinated with PCV7 according to CDC-recommended age-related immunization schedules. Blood samples were taken to determine the concentration of IgG antibody, and nasopharyngeal swabs were obtained to isolate Streptococcus pneumoniae, before the first vaccine dose and 1 month after completion of the vaccination schedule. RESULTS: Pneumococcal carriage prior to the first immunization was 27% (n=22), with the most frequently carried serotypes being vaccine serotypes 6B (22%) and 14 (13%). One month after completion of the vaccination scheme pneumococcal carriage was 22% (n=17), dominated by non-vaccine serotypes 19A (24%) and 7F (12%). Before immunization, 65% of the subjects had IgG antibody titers >0.35 µg/mL for five serotypes tested. Post-vaccination, 100% of the subjects showed titers >1.0 µg/mL for all PCV7 serotypes with geometric mean concentrations (GMC) ranging from 1.75 µg/mL (serotype 23F) to 17.16 µg/mL (serotype 14). Children previously colonized with serotype 6B had a significantly lower GMC to this serotype following immunization than children not carrying 6B prior to the first PCV dose (p<0.05). CONCLUSIONS: PCV7 is highly immunogenic in Venezuelan children at high-risk for IPD. Vaccination was associated with an immediate shift in nasopharyngeal carriage toward non-PCV7 serotypes. Finally, we observed serotype-specific hyporesponsiveness to immunization after natural carriage with the same serotype in high-risk children.

Influence of Bacille Calmette-Guérin on tuberculin skin testing in Venezuelan Amerindians in high tuberculosis burden areas.

INTRODUCTION: Extraordinarily high tuberculosis (TB) prevalence rates have been reported in Venezuelan Amerindians. Amerindian populations often live in geographically isolated villages where they receive little medical attention and live under precarious sanitary conditions. TB prevalence varies by ethnicity and geographic location and is generally higher in Amerindians than in non-indigenous (Creole) people. METHODOLOGY: Between January 1, 1998 and December 31, 2009, the tuberculin skin test (TST) was administered during field operations to 9,538 Amerindian and Creole people between 0 and 94 years of age living in Venezuela. In 6,979 individuals (73%), Bacille Calmette-Guérin (BCG) vaccination status, age, and ethnicity were recorded. Univariate and multivariate analyses were performed to determine the influence of previous BCG vaccination, age, and ethnicity on TST outcomes. RESULTS: Age, ethnicity, and the number of BCG vaccinations administered each had a significant influence on TST outcomes (p < 0.001). The influence of BCG vaccination on TST outcomes varied by ethnicity and was only significant in children aged between 0 and 3 years. CONCLUSIONS: The utility of TST in the diagnosis of TB infection in high TB burden settings with widespread BCG vaccination should be evaluated locally and individually as this depends on ethnicity, age, and the number of BCG vaccinations administered. In Venezuelan children 4 years of age and older, the TST remains a useful tool for the detection of TB infection, independent of BCG vaccination status.

High prevalence of asthma symptoms in Warao Amerindian children in Venezuela is significantly associated with open-fire cooking: a cross-sectional observational study.

BACKGROUND: The International Study on Asthma and Allergies in Childhood (ISAAC) reported a prevalence of asthma symptoms in 17 centers in nine Latin American countries that was similar to prevalence rates reported in non-tropical countries. It has been proposed that the continuous exposure to infectious diseases in rural populations residing in tropical areas leads to a relatively low prevalence of asthma symptoms. As almost a quarter of Latin American people live in rural tropical areas, the encountered high prevalence of asthma symptoms is remarkable. Wood smoke exposure and environmental tobacco smoke have been identified as possible risk factors for having asthma symptoms. METHODS: We performed a cross-sectional observational study from June 1, 2012 to September 30, 2012 in which we interviewed parents and guardians of Warao Amerindian children from Venezuela. Asthma symptoms were defined according to the ISAAC definition as self-reported wheezing in the last 12 months. The associations between wood smoke exposure and environmental tobacco smoke and the prevalence of asthma symptoms were calculated by means of univariate and multivariable logistic regression analyses. RESULTS: We included 630 children between two and ten years of age. Asthma symptoms were recorded in 164 of these children (26%). The prevalence of asthma symptoms was associated with the cooking method. Children exposed to the smoke produced by cooking on open wood fires were at higher risk of having asthma symptoms compared to children exposed to cooking with gas (AOR 2.12, 95% CI 1.18 - 3.84). Four percent of the children lived in a household where more than ten cigarettes were smoked per day and they had a higher risk of having asthma symptoms compared to children who were not exposed to cigarette smoke (AOR 2.69, 95% CI 1.11 - 6.48). CONCLUSION: Our findings suggest that children living in rural settings in a household where wood is used for cooking or where more than ten cigarettes are smoked daily have a higher risk of having asthma symptoms.

A predictive signature gene set for discriminating active from latent tuberculosis in Warao Amerindian children.

BACKGROUND: Tuberculosis (TB) continues to cause a high toll of disease and death among children worldwide. The diagnosis of childhood TB is challenged by the paucibacillary nature of the disease and the difficulties in obtaining specimens. Whereas scientific and clinical research efforts to develop novel diagnostic tools have focused on TB in adults, childhood TB has been relatively neglected. Blood transcriptional profiling has improved our understanding of disease pathogenesis of adult TB and may offer future leads for diagnosis and treatment. No studies applying gene expression profiling of children with TB have been published so far. RESULTS: We identified a 116-gene signature set that showed an average prediction error of 11% for TB vs. latent TB infection (LTBI) and for TB vs. LTBI vs. healthy controls (HC) in our dataset. A minimal gene set of only 9 genes showed the same prediction error of 11% for TB vs. LTBI in our dataset. Furthermore, this minimal set showed a significant discriminatory value for TB vs. LTBI for all previously published adult studies using whole blood gene expression, with average prediction errors between 17% and 23%. In order to identify a robust representative gene set that would perform well in populations of different genetic backgrounds, we selected ten genes that were highly discriminative between TB, LTBI and HC in all literature datasets as well as in our dataset. Functional annotation of these genes highlights a possible role for genes involved in calcium signaling and calcium metabolism as biomarkers for active TB. These ten genes were validated by quantitative real-time polymerase chain reaction in an additional cohort of 54 Warao Amerindian children with LTBI, HC and non-TB pneumonia. Decision tree analysis indicated that five of the ten genes were sufficient to classify 78% of the TB cases correctly with no LTBI subjects wrongly classified as TB (100% specificity). CONCLUSIONS: Our data justify the further exploration of our signature set as biomarkers for potential childhood TB diagnosis. We show that, as the identification of different biomarkers in ethnically distinct cohorts is apparent, it is important to cross-validate newly identified markers in all available cohorts.

Low child survival index in a multi-dimensionally poor Amerindian population in Venezuela.

BACKGROUND: Warao Amerindians, who inhabit the Orinoco Delta, are the second largest indigenous group in Venezuela.  High Warao general mortality rates were mentioned in a limited study 21 years ago. However, there have been no comprehensive studies addressing child survival across the entire population. OBJECTIVES: To determine the Child Survival-Index (CSI) (ratio: still-living children/total-live births) in the Warao population, the principal causes of childhood death and the socio-demographic factors associated with childhood deaths. METHODS: We conducted a cross-sectional epidemiological survey of 688 women from 97 communities in 7 different subregions of the Orinoco Delta. Data collected included socio-demographic characteristics and the reproductive history of each woman surveyed. The multidimensional poverty index (MPI) was used to classify the households as deprived across the three dimensions of the Human Development Index. Multivariable linear regression and Generalized Linear Model Procedures were used to identify socioeconomic and environmental characteristics statistically associated with the CSI. FINDINGS: The average CSI was 73.8% ±26. The two most common causes of death were gastroenteritis/diarrhea (63%) and acute respiratory tract Infection/pneumonia (18%).  Deaths in children under five years accounted for 97.3% of childhood deaths, with 54% occurring in the neonatal period or first year of life.  Most of the women (95.5%) were classified as multidimensionally poor.  The general MPI in the sample was 0.56.   CSI was negatively correlated with MPI, maternal age, residence in a traditional dwelling and profession of the head of household other than nurse or teacher. CONCLUSIONS: The Warao have a low CSI which is correlated with MPI and maternal age.  Infectious diseases are responsible for 85% of childhood deaths.  The low socioeconomic development, lack of infrastructure and geographic and cultural isolation suggest that an integrated approach is urgently needed to improve the child survival and overall health of the Warao Amerindians. 

High prevalence of acute respiratory tract infections among Warao Amerindian children in Venezuela in relation to low immunization coverage and chronic malnutrition.

BACKGROUND: Higher prevalence rates of acute respiratory tract infections (ARTIs) have been described in Australian and Canadian indigenous populations than in nonindigenous age-matched counterparts. Few studies on ARTIs in South American indigenous populations have been published. We performed a cross-sectional survey to describe the prevalence of upper respiratory tract infections and acute lower respiratory tract infections (ALRTIs) and associations with malnutrition and immunization status. METHODS: From December 1, 2009 to May 31, 2010, 487 Warao Amerindian children 0 to 59 months of age living in the Delta Amacuro in Venezuela were included in a cross-sectional survey. Data were obtained through parent questionnaires, vaccination cards, and physical examinations including anthropometric measurements. RESULTS: Of the 487 children, 47% presented with an ARTI. Of these, 60% had upper respiratory tract infections and 40% were ALRTI. Immunization coverage was low, with only 27% of all children presenting a vaccination card being fully immunized. The prevalence of malnutrition was high (52%), with stunting (height-for-age <-2 standard deviations) being the most frequent presentation affecting 45% of children. ARTI and ALRTI prevalence diminished with increasing age (odds ratio for ALRTI in children 25-59 months of age vs. children younger than 12 months, 0.49; 95% confidence interval, 0.26-0.93). Furthermore, significant differences in ARTI prevalence were seen between villages. No significant associations between immunization status or malnutrition and ARTI or ALRTI prevalence were identified. CONCLUSIONS: A high prevalence of ARTIs and chronic malnutrition in combination with a low immunization status highlights the need for an integrated approach to improve the health status of indigenous Venezuelan children.

Pneumococcal carriage among indigenous Warao children in Venezuela: serotypes, susceptibility patterns, and molecular epidemiology.

Little attention has been paid to pneumococcal carriage and disease in Amerindians from Latin America. The Warao people, an indigenous population from Venezuela, live in the delta of the Orinoco River in geographically isolated communities with difficult access to medical care. To obtain insight into pneumococcal carriage and the theoretical coverage of pneumococcal vaccines in this population, we investigated pneumococcal colonization, serotype, and genotype distribution among Warao children in 9 distinct, geographically isolated communities in the Delta Amacuro area in the northeast of Venezuela. From April 2004 through January 2005, a total of 161 Streptococcus pneumoniae isolates were recovered from single nasopharyngeal swab samples obtained from 356 children aged 0-72 months. The overall pneumococcal carriage rate was 49%, ranging from 13% to 76%, depending on the community investigated and the age of the children (50% among children aged <2 years and 25% among children aged >2 years). The most frequent serotypes were 23F (19.5% of isolates), 6A (19.5%), 15B (10.4%), 6B (9.1%), and 19F (7.2%). The theoretical coverage of the 7-valent pneumococcal conjugate vaccine, including the cross-reactive nonvaccine serotype 6A, was 65%. A total of 26% of the isolates were resistant to first-line antibiotics, with 70% of these strains being covered by the 7-valent pneumococcal conjugate vaccine. Restriction fragment end labelling analysis revealed 65 different genotypes, with 125 (80%) of the isolates belonging to 27 different genetic clusters, suggesting a high degree of horizontal spread of pneumococcal strains in and between the villages. The high colonization rates and high (registered) acute respiratory tract infection morbidity and mortality in this part of Venezuela suggest that Warao children are at increased risk for pneumococcal disease and, therefore, benefit from vaccination.

Estado de portador de Streptococcus pneumoniae y morbilidad por infecciones respiratorias agudas (IRA) en la población infantil Warao / Pneumococcal carriage and morbility caused by acute respiratory tract infections among Warao indigenous children

Anualmente 1.9 millones de niños menores de 5 años mueren por una infección Respiratoria Aguda (IRA) y según la OMS el Streptococcus pnumoniae es responsable de mas de 1 millón en países en desarrollo. Determinar la frecuencia de portadores de S. Pneumoniae, los serotipos de las cepas aisladas, la presencia de dichos serotipos en la vacuna conjugada 7- valente (Prevener, Wyeth) y la morbilidad por IRA en la población infantil Warao menor de 5 años en tres comunidades del Estado Delta Amacuro: san Francisco de Guayo, Nabasanuka y Santa Catalina. Estudio de campo, epidemiológico, transversal y comparativo entre mayo de 2004- enero 2005 que incluyó estudio microbiológico de 110 muestras de hisopado nasofaríngeo y evaluación clínica de 259 niños. 42,7% de los niños estaba colonizado por S. Pneumoniae. Se aislaron 47 cepas, porcentaje de portadores: Nabasanuka 55% Guayo 37,7%, Santa Catalina 29,4%. Serotipos aislados incluidos en la vacuna conjugada 7-valente (19F, 6B y 23F) con 19,15%, 12,8%, 18,6%. Al comparar las proporciones de IRA versus estado de portador de S. Pneumoniae por comunidad no hubo una relación estadísticamente significativa. La población infantil Warao presenta una alta colonización por S.pneumoniae 42,7%. Los serotipos encontrados implican teóricamente una cobertura de 70,23% de la vacuna conjugada 7-valente. Los niños Warao podrían beneficiarse con un programa de vacunación. El mayor porcentaje de IRA y de portadores correspondió a la Comunidad de Nabasanuka.

Evaluación nutricional de la población infantil Warao en la comunidad de Yakariyene estado Delta Amacuro: agosto-octubre 2004 / Nutritional assessment of the Warao children in the community of Delta Amacuro state Yakariyene: august-october 2004

Es conocida la relación que existe entre el estado nutricional y el mantenimiento de las funciones vitales a través de la ingestión de los alimentos en cantidades adecuadas; esto proporciona un buen estado nutricional y por consiguiente salud. Este trabajo persigue a través de la evaluación del estado de nutrición de la población infantil de 107 niños, Warao de la comunidad de Yakariyene conocer la magnitud y la distribución de la desnutrición entre los integrantes de dicha población. Se utilizaron mediciones antropométricas partiendo de que la desnutrición afecta las dimensiones y la composición general del cuerpo. Cuando se emplean mediciones antropométricas hay que contar con un patrón de referencia en nuestro caso se utilizaron las Curvas de la Organización Mundial de la Salud (OMS). Se utilizaron las siguientes variables: Peso, Talla, Circunferencia del brazo izquierdo (CBI), Índice de masa corporal y edad, relacionados de la siguiente manera: Peso/edad, Peso/talla, Talla/edad, CBI/edad e IMC/edad. Este estudio demostró que la mitad de la población menor de 15 años de Yakariyene presentaba estado nutricional normal, de manera que en el resto se encontró algún problema ya sea por exceso (sobrepeso) o por déficit (desnutrición en algún grado), siendo éste el más frecuente. Esto constituye un porcentaje significativo de niños (as) con riesgo de padecer alguna patología infecciosa y/o complicaciones de las mismas.

Evaluación nutricional de la población infantil Warao en la comunidad de Yakariyene-Estado Delta Amacuro: agosto-octubre 2004 / Evaluation nutritional in of the population infant Warao of the Yakariyene: august-october 2004

Este trabajo tiene como objetivo determinar el estado nutricional de la población infantil de Yakariyene y relacionarla con los resultados positivos del derivado proteico purificado para determinar infección tuberculosa. Estudio de investigación clínica de diseñó descriptivo, transversal con una muestra de 107 niños en edad entre 1 día de nacido y 15 años, que acudieron a la consulta entre agosto y octubre del 2004. Se evaluaron indicadores de dimensión corporal: peso para la edad y talla para la edad circunferencia del brazo izquierdo, siguiendo las tablas de la Organización Mundial de la Salud, se agregó la prueba del derivado proteico purificado. Predominó el sexo masculino 54 por ciento, el mayor porcentaje de pacientes estaba en edad pre escolar 35 por ciento. El 43 por ciento tuvo un resultado de desnutrición 3 por ciento malnutrición en déficit o exceso. El mayor índice de desnutrición se observó en 25 por ciento de los lactantes mayores. 63 por ciento tenía talla normal y 21 por ciento talla baja, el 100 por ciento de la población tenía cicatriz de vacunación y el 45 por ciento de ellos estaban en edad escolar, esto nos demostró que aquellos con PPD positivo 3 por ciento se ubicaban en el grupo etario de lactantes mayores y tenían desnutrición grave. La mayoría de los pacientes tenían una nutrición normal, al destete se presentan los casos de desnutrición, la cobertura de vacunación es buena y no se obtuvieron casos de tuberculosis en la población infantil Warao.

Epidemiología de la candidiasis diseminada neonatal / epidemiology of the candidiasis disseminated neonatal

La candidiasis sistémica neonatal se considera una infección nosocomial, presente en las unidades de cuidados intensivos neonatales, a pesar de los esfuerzos realizados por la comunidad médica para el entendimiento de la fisiopatología y terapéutica de la enfermedad. Se realizó un estudio descriptivo, mixto e inferencial, sobre 705 ingresos de Servicio de Patología Neonatal del Hospital de Niños "J.M de Los Rios", entre enero de 1995 hasta diciembre de 1998. Fueron elegidos 39 recién nacidos con diagnóstico de candidiasis diseminada comprobada por hemocultivo. El análisis estadístico se realizó a travéz de porcentajes, análisis entre diferencias, promedio de porcentajes y aplicación del Chi cuadrado con p<0.05 en las variables en donde fue posible realizar contraste. En el grupo de estudio un 58,9 por ciento de los neonatos tenían un peso menor de 2.500 gr y un 65,8 por ciento eran pretérminos. En su mayoría recibieron antibióticos de amplio espectro (70 por ciento) esteroides, aminofilina, bloqueantes de la secreción gástrica y nutrición parenteral total (60.5 por ciento); presentaron un promedio de estancia prolongada (38,75 días), ameritando ventilación mecánica (79,6 por ciento), catéteres (100 por ciento) y cirugía (30 por ciento). Entre las patologías asociadas destaca la sepsis (82,8 por ciento). El promedio de porcentaje de ingresos correspondió a un 5,27 por ciento y de fallecidos a 10,1 por ciento. La tasa de letalidad fue de 37 por ciento. La candidiasis diseminada está asociada con una alta mortalidad a pesar del tratamiento, por la que la identificacion precoz de los factores de riesgo, un diagnóstico y tratamiento rápidos podría ayudar a reducir la alta letalidad relacionada con esta patología

Clínica y métodos diagnósticos utilizados en la candidiasis invasiva neonatal / Clinic and diagnostic methods used in the candidiasis invasiva neonatal

Con la intención de implementar un abordaje integral en la atención del neonato con alta vulnerabilidad para adquirir candidiasis diseminada se realizó una investigación en el Servicio de Patología Neonatal del Hospital de Niños "J.M. de Los Rios". Incluyó 39 niños con hemocultivo positivo para cándida; se dividió en dos fases: la primera retrospectiva (enero 1995-diciembre 1996) reunió 10 pacientes con factores de riesgo, clínica y enfermedades asociadas. La segunda fase (enero 1997-diciembre 1998) insertó una evaluación prospectiva continua de 29 neonatos en los caules, al momento del diagnóstico, también se adicionó la tipificación de la cándida, evaluación especializada cardíaca y oftalmológica, ecosonogramas renal y abdominal, cultivos de orina, líquido cefalorraquídeo y catéteres. La prematuridad, sintomatología y plaquetopenia fueron similares. En el segundo paríodo destacó un incremento de casos diagnosticados precozmente y a menor edad, gracias a los nuevos métodos de tipificación implementados; presencia de endocarditis en 2 pacientes y el predominio de Cándida Tropicalis en 55 por ciento de los casos. La Cándida tropicalis fue la especie asociada a mayor mortalidad (17,94 por ciento) seguida de Cándida albicans (10,25 por ciento). Se reconoce la candidiasis invasiva como problema de salud pública por su alta morbimortalidad, por lo que la realización de métodos de diagnóstico rápidos permitió la instauración temprana de tratamiento específico