Long-term cardiology outcomes in children after early treatment for Chagas disease, an observational study.

BACKGROUND: Parasite persistence after acute infection with Trypanosoma cruzi is an important factor in the development of Chagas disease (CD) cardiomyopathy. Few studies have investigated the clinical effectiveness of CD treatment through the evaluation of cardiological events by long term follow-up of treated children. Cardiological evaluation in children is challenging since features that would be diagnosed as abnormal in an adult's ECG may be normal, age-related findings in a pediatric ECG trace. The objective was to evaluate cardiac involvement in patients with Chagas disease with a minimum follow-up of 6 years post-treatment. METHODOLOGY: A descriptive study of a cohort of pediatric patients with CD treated with benznidazole (Bz) or nifurtimox (Nf) was conducted. Children (N = 234) with at least 6 years post CD treatment followed at the Parasitology and Chagas Service, Buenos Aires Children's Hospital (Argentina) were enrolled. By convenience sampling, children who attended a clinical visit between August 2015 and November 2019 were also invited to participate for additional cardiovascular studies like 24-hour Holter monitoring and speckle-tracking 2D echocardiogram (STE). Benznidazole was prescribed in 171 patients and nifurtimox in 63 patients. Baseline parasitemia data was available for 168/234 patients. During the follow-up period, alterations in routine ECG were observed in 11/234 (4.7%, 95% CI [2-7.4%]) patients. In only four patients, with complete right bundle branch block (cRBBB) and left anterior fascicular block (LAFB), ECG alterations were considered probably related to CD. During follow-up, 129/130 (99%) treated patients achieved persistent negative parasitemia by qPCR. Also decrease in T.cruzi antibodies titers was observed in all patients and negative seroconversion occurred in 123/234 (52%) patients. CONCLUSIONS: A low incidence of cardiological lesions related to CD was observed in patients treated early for pediatric CD. This suggests a protective effect of parasiticidal treatment on the development of cardiological lesions and highlights the importance of early treatment of infected children. TRIAL REGISTRATION: ClinicalTrials.gov NCT04090489.

Congenital chagas disease: Development and assessment of a specific IgM capture-based assay for diagnosis of transmission.

Transplacental transmission by Trypanosoma cruzi (T. cruzi) infection can be effectively treated if parasiticide drugs are administered as early as possible during childhood. Furthermore, an ideal situation would be to diagnose the infection near birth in order to avoid the loss of patients during the subsequent follow-up. These situation are desirable due to the maximum benefit of drugs in early stages which, consequently, implies a relevant contribution to eliminate mother-to-child transmission. However, available techniques for that purpose have limitations as being operator-dependent (microhematocrit), require several months follow-up (IgG detection) or specialized laboratories (PCR). In this study we propose to detect specific IgM antibodies (Ab) by developing a capture-based ELISA employing an improved antigen (Ag) to diagnose the transplacental transmission of T. cruzi, and in consequence, to enhance access to effective treatment. Firstly, a new chimera Ag (CP4) was obtained from the fusion of CP1 and CP3 protein, carrying FRA, SAPA, MAP, TSSAII/V/VI and TcD Ag from T. cruzi. Then, we optimized the assay by capturing IgM Ab with a polyclonal anti-IgM Ab and evaluating three Ag formulations to detect specific IgM bound. The formulations were formed as follows: i) F1: CP1 and CP3; ii) F2: CP1, CP3, B13 and P2ß; iii) F3: by CP4. Detection of Ab-binding Ag was carried out using an anti-His Ab since all Ag were expressed with a His-tag. The evaluation panel consisted of sera from vertically infected children under 1-year-old (6 younger than 15 days, 7 older) and samples from non-infected children of women with chronic Chagas Disease. The ELISA assay employing CP4 showed better performance with notable high sensitivity and specificity (92.3% and 93.9%, respectively). Positive and negative likelihood ratios of the test (15.2 and 0.082) suggest its potential clinical relevance in term of post-test probability of infection. In conclution, we developed a standardized and non-operator dependent test to detect specific anti-T. cruzi IgM Ab. Although increased sample size is needed for its validation, our results indicate that this capture-based technique employing CP4 Ag can certainly improve the diagnosis of connatal infection.

Therapeutic options for primary meningeal angiosarcoma: A case report.

BACKGROUND: Primary angiosarcoma (AS) of the central nervous system (PACNS) is an extremely rare malignancy. The meninges represent an uncommon site of origin of PACNS. This report describes a recurrent meningeal PACNS treated with surgery, radiotherapy, stereotactic radiosurgery, and paclitaxel at different stages of the disease. CASE DESCRIPTION: A 36-year-old Asian male presented to our facility with a 4-month history of worsening headaches and complete right homonymous hemianopia. Neuroimaging revealed a left occipital lobe hematome with an underlying left tentorial tumor. After subtotal resection, neuropathological examination revealed features of a malignant endothelial cell AS. He received a course of adjuvant radiation therapy but experienced disease progression. He subsequently received additional stereotactic radiosurgery followed by weekly paclitaxel. Magnetic resonance imaging during the course of treatment revealed stable disease until patient died following another progression of his tumor. CONCLUSION: This case of a meningeal PACNS highlights the importance of considering this entity in the face of a malignant lesion presenting with intracranial hemorrhagic activity. Our observations suggest that the use of paclitaxel provided a modest clinical response in PACNS, highlighting the need to consider a combined approach structured mainly on surgery and radiotherapy. Stereotactic radiosurgery appears to be a promising treatment option.

Gamification, serious games and action video games in optometry practice / Gamificación, juegos serios y videojuegos de acción en la práctica optométrica

No disponible

Evaluation of the Finnish Diabetes Risk Score to predict type 2 diabetes mellitus in a Colombian population: A longitudinal observational study.

AIM: To assess the performance of the Finnish Diabetes Risk Score (FINDRISC) questionnaire for detecting and predicting type 2 diabetes mellitus (DM2) in a Colombian population. METHODS: This is a longitudinal observational study conducted in Floridablanca, Colombia. Adult subjects (age ≥ 35 years) without known diabetes, were included. A modified version of FINDRISC was completed, and the glycemia values from all the subjects were collected from the hospital's database. Firstly, a cross-sectional analysis was performed and then, the subsample of prediabetic participants was followed for diabetes incidence. RESULTS: A total of 772 subjects were suitable for the study. The overall prevalence of undiagnosed DM2 was 2.59%, and the incidence of DM2 among the prediabetic participants was 7.5 per 100 person-years after a total of 265257 person-years follow-up. The FINDRISC at baseline was significantly associated with undiagnosed and incident DM2. The area under receiver operating characteristics curve of the FINDRISC score for detecting undiagnosed DM2 in both men and women was 0.7477 and 0.7175, respectively; and for predicting the incidence of DM2 among prediabetics was 71.99% in men and 67.74% in women. CONCLUSION: The FINDRISC questionnaire is a useful screening tool to identify cross-sectionally unknown DM2 and to predict the incidence of DM2 among prediabetics in the Colombian population.

Higher household income and the availability of electronic devices and transport at home are associated with higher waist circumference in Colombian children: the ACFIES study.

BACKGROUND: The current "epidemic" of childhood obesity is described as being driven by modern lifestyles with associated socioeconomic and environmental changes that modify dietary habits, discourage physical activity and encourage sedentary behaviors. OBJECTIVE: To evaluate the association between household income and the availability of electronic devices and transport at home, and the values of waist circumference (WC), as an indicator of abdominal obesity, in children and adolescents from Bucaramanga, Colombia. METHODS: Cross-sectional study of public elementary and high school population, of low-middle socioeconomic status. RESULTS: A total of 668 schoolchildren were recruited. After adjusting for potential confounders, significant positive associations between waist circumference and higher household income (p = 0.011), and waist circumference and the availability of electronic devices and transport at home (p = 0.026) were found. CONCLUSIONS: In low-middle socioeconomic status schoolchildren in a developing country, those from relatively more affluent families had greater waist circumference, an association that is opposite to that observed in developed countries. This finding could be related to higher income family's ability to purchase electronic devices and motorized transport which discourage physical activity and for their children to buy desirable and more costly western fast food.

Evaluación económica de la elastografía de transición (FibroScan ®) en el diagnóstico de fibrosis hepática en pacientes con hepatitis C coinfectados con VIH / No disponible

Introducción: La evaluación del estadio de fibrosis es crucial en la toma de decisiones terapéuticas en los pacientes infectados con VIH/sida coinfectados por el VHC ya que permite realizar un pronóstico de la enfermedad y establecer la necesidad de priorizar el tratamiento de la hepatitis C en estos pacientes. Métodos Se ha desarrollado un modelo de simulación de eventos discretos y un modelo de Markov para representar la evolución de fibrosis a cirrosis hepática en pacientes coinfectados por VIH/VHC. El modelo evaluó dos alternativas para el diagnóstico y seguimiento de estos pacientes, la elastografía de transición realizada de forma anual y la biopsia hepática realizada cada 7 años. El modelo fue desarrollado desde la perspectiva del Sistema Nacional de Salud y solo incluyó los costes médicos directos (tratamiento de la patología y de estados de salud). Se llevaron a cabo varios análisis de sensibilidad univariante para evaluar el impacto de los parámetros con mayor incertidumbre. Se aplicó una tasa de descuento del 3%.ResultadosLos resultados del caso base muestran que el diagnóstico y seguimiento de los pacientes con elastografía de transición es una estrategia dominante frente a biopsia hepática, obteniendo mayor esperanza de vida a menor coste. Los análisis de sensibilidad realizados confirmaron la robustez de estos resultados. Conclusión La elastografía de transición demostró ser una estrategia dominante frente a biopsia hepática en el diagnóstico y seguimiento de la fibrosis hepática en los pacientes coinfectados por VIH/VHC en España (AU)

Introduction: The assessment of liver fibrosis is crucial for taking therapeutic decisions in patients infected with HIV/AIDS coinfected with HCV, because it allows the prognosis of the disease and the prioritization of hepatitis C treatment in these patients. Methods: A discrete events model simulation (DEMS) and a Markov model have been developed to represent the evolution of liver fibrosis to cirrhosis in patients coinfected with HIV/HVC. The model evaluated two alternatives for the diagnosis and monitoring of these patients, transient elastography performed annually and liver biopsy performed every seven years. The models have been developed under Health Care System perspective and only considered direct medical costs (disease treatment and health state costs). One-way sensitivity analyses were carried out to assess the impact of parameters with higher (..) (AU)

[Evaluation of the costs of transient elastography (FibroScan(®)) in the diagnosis of liver fibrosis in HIV patients with hepatitis C virus]. / Evaluación económica de la elastografía de transición (FibroScan(®)) en el diagnóstico de fibrosis hepática en pacientes con hepatitis C coinfectados con VIH.

INTRODUCTION: The assessment of liver fibrosis is crucial for taking therapeutic decisions in patients infected with HIV/AIDS coinfected with HCV, because it allows the prognosis of the disease and the prioritization of hepatitis C treatment in these patients. METHODS: A discrete events model simulation (DEMS) and a Markov model have been developed to represent the evolution of liver fibrosis to cirrhosis in patients coinfected with HIV/HVC. The model evaluated two alternatives for the diagnosis and monitoring of these patients, transient elastography performed annually and liver biopsy performed every seven years. The models have been developed under Health Care System perspective and only considered direct medical costs (disease treatment and health state costs). One-way sensitivity analyses were carried out to assess the impact of parameters with higher uncertainty. A discount rate of 3% was applied. RESULTS: Base case analysis shows that the diagnosis and monitoring of patients with transient elastography is a dominant strategy compared with to liver biopsy, resulting in greater life expectancy at lower cost. The sensitivity analysis performed confirmed the robustness of these results. CONCLUSION: Transient elastography has proved to be a dominant strategy compared to liver biopsy in the diagnosis and monitoring of liver fibrosis in patients coinfected with HIV/HCV in Spain.

EFECTO DE DENSIDAD POBLACIONAL DE HUEVOS SOBRE VIABILIDAD Y TIEMPO DE DESARROLLO DE Drosophila melanogaster (DROSOPHILIDAE) / Effect Of Eggs Population Density On Viability And Time Of Development Of Drosophila melanogaster (Drosophilidae)

Para estimar el efecto de la densidad poblacional de huevos sobre la viabilidad huevoadulto de Drosophila melanogaster se realizaron tres tratamientos en frascos con medio de cultivo agar-banano: a densidad de 10, 50 y 90 huevos. La variable de respuesta fue la proporción de individuos adultos emergidos desde la aparición del primer imago hasta 15 días después de la siembra. Las viabilidades huevo-adulto promedio fueron 0,320, 0,338 y 0,328 para las densidades de 10, 50 y 90 huevos respectivamente. No se evidenciaron diferencias significativas entre los tres tratamientos (p>0.05). Por lo tanto, no se detectó en este estudio influencia de la densidad poblacional de huevos sobre la viabilidad huevo-adulto. Probablemente debido a que la proporción entre el número de huevos y la cantidad de medio fue suficientemente alta para no generar competencia en otros estadios del desarrollo huevo/adulto.

For estimating the effect from population density of eggs over viability egg-adult in Drosophila melanogaster, it was made three treatments in flasks with agar-banana culture media: densities of 10, 50 and 90 eggs. The effect evaluated was the adult’s proportion that emerged after 15 days of planting. The mean proportions of viability egg-adult were 0.32, 0.338 and 0.328 for the density of 10, 50 and 90 eggs respectively. Significant differences in viability were not evident (p>0.05). Consequently, it was not found effects from the eggs densities in the present study over egg-adult viability. These results probably were due to that the relation among number of eggs and quantity of culture media was not enough of a high for generate competition at another stadiums through the egg-adult development.

[Nursing diagnoses and reports. An appropriate relationship?]. / Diagnósticos e informes de enfermeria. Una relación adecuada?

The objective of this study is to evaluate the use of nursing diagnosis in nursing discharge planning, according to NANDA taxonomy adapted to the model of V. Henderson. We have made a retrospective descriptive study analyzing 260 discharge care plan reports, from a county hospital of Jaén (Spain), during the period 1994-1998. We found 4.2 +/- 2.0 (average +/- standard deviation) nursing problems by discharge plan report. 62.4% of the problems were stated correctly as nursing diagnosis, with an average of 2.6 +/- 1.9 correct nursing diagnosis by report and 37.6% were incorrect nursing diagnosis, 1.6 +/- 1.1 by report as average. Most of the registered nursing problems (95.6%) were actual problems, present in the patients; a 4.3% were potential or high risk problems, and only one possible type nursing diagnosis was identified. After grouping the nursing problems according to the needs of the model of Virginia Henderson, we find that most of diagnosis cited were included in biological needs, and in smaller number to the psychosocial needs.

Diagnósticos e informes de enfermería ¿Una relación adecuada? / Accuracy of nursing diagnosis use in nursing discharge planning

Se evalúa el uso de los diagnósticos de enfermería (DdE) en informes de enfermería al alta, según la taxonomía diagnóstica N.A.N.D.A. adaptada al modelo de Virginia Henderson. Estudio descriptivo retrospectivo analizando 260 informes de alta de enfermería, realizados en un hospital de Jaén, durante el período 1994-1998. Se obtuvo una media de 4,2 ñ 2,0 (x ñ d.s) problemas de enfermería por informe de alta. El 62,4 por ciento de los problemas estaban enunciados correctamente como diagnósticos de enfermería, con una media de 2,6 ñ 1,9 DdE correctos por informe y el 37,6 por ciento eran DdE incorrectos, con una media de 1,6 ñ 1,1 por informe. La mayor parte de los problemas de enfermería registrados (95,6 por ciento) correspondían a problemas de tipo real, presentes en los pacientes; un 4,3 por ciento eran problemas de alto riesgo o potenciales; y sólo se identificó un DdE de tipo posible. Tras agrupar los problemas de enfermería según las necesidades del modelo de Virginia Henderson, encontramos que la mayoría de diagnósticos citados correspondían a necesidades de tipo biológico, y en menor número a las psicosociales (AU)