ABSTRACT
Introducción Escoliosis de desarrollo temprano, es aquella escoliosis que se presenta antes de los 10 años de edad secundaria a anomalías estructurales congénitas de la columna, enfermedades neuromusculares, síndromes, o idiopáticamente. Materiales & Métodos Revisión literaria narrativa de todo lo publicado sobre escoliosis de desarrollo temprano durante 2003 al 2018. Resultados Esta deformidad de la columna a temprana edad limitara el crecimiento pulmonar e incapacitara la función respiratoria apropiada, provocando el síndrome de insuficiencia torácica. Históricamente, la historia natural de esta condición puede ser letal y el daño ocasionado por la escoliosis de desarrollo temprano suele ser permanente a pesar de su restauración. Actualmente, la escoliosis de desarrollo temprano se clasifica utilizando la combinación de las variables: edad, etiología, magnitud de la escoliosis y cifosis. Los métodos de tratamiento más utilizados son: enyesado en serie, implantes de distracción costal longitudinal en aleación de titanio, barras de crecimiento dobles, técnica de Shilla™, y barras de crecimiento electromagnéticas. Discusión Indudablemente, es imperativo conocer sus manifestaciones y peculiaridades para poder clasificar, monitorear la severidad, personalizar el tratamiento, detener el deterioro de la columna lo más pronto posible, y prevenir la insuficiencia respiratoria Nivel de evidencia IV
Background Early onset scoliosis presents before the age of 10 years old due to congenital structural anomalies of the thorax, neuromuscular diseases, and syndromes, or is idiopathic. Methods A review of the literature from 2003 to 2018 on the early onset scoliosis. Result A deformity of the spine at an early age limits lung development and proper respiratory function, thereby provoking the onset of a thoracic insufficiency syndrome. Historically, the natural path of this condition can be lethal, and the damage caused by the early onset scoliosis tends to be permanent, regardless of its restoration after the age of 10. The early onset scoliosis classification is currently based on the age, aetiology, and the extent of the deformity. The treatment modalities most often used are: serial casts, vertical expandable prosthetic titanium ribs, double traditional growing rods, Shilla™ growing rods, and magnetically controlled growing rods. Discussion Undoubtedly, it is imperative to know its manifestations and peculiarities in order to classify the disease, as well as to monitor the disease. Treatment should be personalised, and the deterioration of the spine halted as soon as possible, as well as to prevent respiratory insufficiency Level of evidence IV
Subject(s)
Humans , Child , Scoliosis , Spine , Congenital Abnormalities , TherapeuticsABSTRACT
OBJECTIVE: The objective was to estimate the number of hospitalizations associated with influenza and RSV using data from severe acute respiratory infection (SARI) sentinel surveillance from El Alto-La Paz. Bolivia. METHODS: All persons who met the case definition for SARI at one sentinel hospital had a clinical sample collected and analyzed by rRT-PCR for influenza and by indirect immunofluorescence for RSV. The SARI-influenza and SARI-RSV case counts were stratified by six age groups. The proportion of cases captured in the sentinel hospital in relation to the non-sentinel hospitals of area was multiplied by the age-specific census population, to build the denominators. The annual incidence and a 95% confidence interval (CI) were estimated. RESULTS: During 2012-2017, n = 2606 SARI cases were reported (average incidence 120/100 000 inhabitants [95% CI: 116-124]); the average incidence of influenza-associated SARI hospitalization was 15.3/100 000 (95% CI: 14.1-16.7), and the average incidence of RSV-associated SARI hospitalization was 9/100 000 inhabitants (95% CI: 8.1-10.1). The highest incidence of influenza was among those less than one year of age (average 174.7/100 000 [range: 89.1-299.5]), followed by those one to four years of age (average 51.8/100 000 [range: 19.8-115.4]) and then those 65 years of age and older (average 47.7/100 000 [range: 18.8-117]). For RSV, the highest incidence was highest among those less than one year of age (231/100 000 [range: 119.9-322.9]). CONCLUSION: Influenza and RSV represent major causes of hospitalization in La Paz, Bolivia-with the highest burden among children under one year of age. Our estimates support current prevention strategies in this age group.
Subject(s)
Hospitalization/statistics & numerical data , Influenza, Human/epidemiology , Respiratory Syncytial Virus Infections/epidemiology , Sentinel Surveillance , Adolescent , Adult , Aged , Aged, 80 and over , Bolivia/epidemiology , Child , Child, Preschool , Humans , Incidence , Infant , Middle Aged , Respiratory Tract Infections/epidemiology , Risk Factors , Young AdultABSTRACT
The prevalence of infection caused by different categories of diarrhoeagenic E. coli (DEC) strains, including enteroaggregative (EAEC), enteropathogenic (EPEC), enterotoxigenic (ETEC), enteroinvasive (EIEC) and enterohaemorrhagic (EHEC) E. coli, in children who suffered from diarrhoea (nâ=â3943) or did not have diarrhoea (nâ=â1026) were analysed in two areas in Bolivia over a period of 4 years. We also analysed the seasonality of DEC infections and severity of diarrhoea in children with DEC infection and compared antibiotic resistance in DEC strains isolated from children with and without diarrhoea. Stool samples were analysed for the presence of DEC by culturing followed by PCR. The most prevalent DEC categories in samples from the children were: EAEC (11.2â%); ETEC (6.6â%); EPEC (5.8â%); and EIEC and EHEC (<1â%). DEC strains were isolated significantly more often from diarrhoea cases (21.6â%) than from controls (17.6â%; Pâ=â0.002). The number of children with diarrhoea associated with EAEC, EPEC and ETEC infections peaked in the Bolivian winter (April-September), although the proportion of DEC-positive stool samples was higher during the warm rainy season (October-March). High levels of antibiotic resistance were detected among the DEC strains. In particular, resistance to tetracycline and sulfamethoxazole-trimethoprim was significantly higher in strains isolated from individuals with diarrhoea than in samples from controls. The severity of disease in children infected with EAEC, EPEC and ETEC varied from mild to severe diarrhoea, although disease severity did not differ significantly between the different DEC categories. ETEC, EPEC and EAEC are commonly found in Bolivia and may cause severe disease in children.
Subject(s)
Diarrhea/epidemiology , Diarrhea/pathology , Escherichia coli Infections/epidemiology , Escherichia coli Infections/pathology , Escherichia coli/classification , Bolivia/epidemiology , Child, Preschool , Diarrhea/microbiology , Drug Resistance, Bacterial , Escherichia coli/drug effects , Escherichia coli/genetics , Escherichia coli/isolation & purification , Female , Humans , Infant , Infant, Newborn , Male , Microbial Sensitivity Tests , Polymerase Chain Reaction , Prevalence , SeasonsABSTRACT
OBJECTIVE: To evaluate the effectiveness of two doses of a monovalent rotavirus vaccine (RV1) against hospital admission for rotavirus in Bolivia. DESIGN: Case-control study. SETTING: Six hospitals in Bolivia, between March 2010 and June 2011. PARTICIPANTS: 400 hospital admissions for rotavirus, 1200 non-diarrhea hospital controls, and 718 rotavirus negative hospital controls. MAIN OUTCOME MEASURES: Odds of antecedent vaccination between case patients and controls; effectiveness of vaccination ((1-adjusted odds ratio)×100), adjusted for age and other confounders; and stratified effectiveness by dose, disease severity, age group, and serotype. RESULTS: In comparison with non-diarrhea controls, case patients were more likely to be male and attend day care but less likely to have chronic underlying illness, higher level maternal education, and telephones and computers in their home. Rotavirus negative controls were somewhat more similar to case patients but also were more likely to be male and attend day care and less likely to have higher level maternal education and computers in their homes. The adjusted effectiveness of RV1 against hospital admission for rotavirus was 69% (95% confidence interval 54% to 79%) with rotavirus negative controls and 77% (65% to 84%) with non-diarrhea controls. The effectiveness of one dose of RV1 was 36% and 56%, respectively. With both control groups, protection was sustained through two years of life, with similar efficacy against hospital admission among children under 1 year (64% and 77%) and over 1 year of age (72% and 76%). RV1 provided significant protection against diverse serotypes, partially and fully heterotypic to the G1P[8] vaccine. Effectiveness using the two control groups was 80% and 85% against G9P[8], 74% and 93%% against G3P[8], 59% and 69% against G2P[4], and 80% and 87% against G9P[6] strains. CONCLUSION: The monovalent rotavirus vaccine conferred high protection against hospital admission for diarrhea due to rotavirus in Bolivian children. Protection was sustained through two years of life against diverse serotypes different from the vaccine strain.
Subject(s)
Rotavirus Infections/prevention & control , Rotavirus Vaccines/therapeutic use , Rotavirus/immunology , Vaccination/methods , Bolivia/epidemiology , Child, Preschool , Female , Follow-Up Studies , Humans , Incidence , Infant , Infant, Newborn , Male , Odds Ratio , Retrospective Studies , Rotavirus Infections/epidemiology , Rotavirus Infections/virology , Treatment OutcomeABSTRACT
OBJECTIVES: Rotavirus is the most important etiology of severe diarrhea in Bolivia. The monovalent attenuated human oral rotavirus vaccine Rotarix(®) was introduced in Bolivia in 2008. We describe the molecular epidemiology of circulating rotavirus strains before vaccine introduction. METHODS: Two thousand one hundred thirty-five diarrheal samples were collected from hospitals in four Bolivian cities during 2007-2008. Forty-three percent (445 of 1030 rotavirus-positive samples) were analyzed for G and P genotypes. Among those, 331 were electropherotyped by polyacrylamide gel electrophoresis. Disease severity was quantified using a modified Vesikari scale. RESULTS: Among the 445 samples, five genotypes were found to be prevalent: G9P[8] (33%), G1P[6] (17%), G2P[4] (13%), G9P[6] (12%), and G1P[8] (4%). Co-infections with two or more strains accounted for 14% of samples. The most prevalent strain, G9, showed greater electropherotype diversity compared to other serogroups. Strain G1P[6] generally infected younger children and peaked later in the year than other strains. No particular genotype was associated with a higher severity score, though there was a significant difference in the duration of diarrhea between genotypes. CONCLUSIONS: During the 2-year pre-vaccine period, substantial diversity of rotavirus co-circulating strains was observed. These data constitute a baseline against which changes in circulating strains post-vaccine introduction can be monitored.
Subject(s)
Diarrhea/epidemiology , Diarrhea/virology , Genotype , Rotavirus Infections/epidemiology , Rotavirus Infections/virology , Rotavirus/genetics , Antigens, Viral/genetics , Bolivia/epidemiology , Capsid Proteins/genetics , Child, Preschool , Diarrhea/prevention & control , Genetic Variation , Humans , Infant , Infant, Newborn , Rotavirus/classification , Rotavirus/isolation & purification , Rotavirus Infections/prevention & control , Rotavirus Vaccines/immunology , SeasonsABSTRACT
BACKGROUND: In Bolivia, in 2008, the under-five mortality rate is 54 per 1000 live births. Diarrhea causes 15% of these deaths, and 40% of pediatric diarrhea-related hospitalizations are caused by rotavirus illness (RI). Rotavirus vaccination (RV), subsidized by international donors, is expected to reduce morbidity, mortality, and economic burden to the Bolivian state. Estimates of illness and economic burden of RI and their reduction by RV are essential to the Bolivian state's policies on RV program financing. The goal of this report is to estimate the economic burden of RI and the cost-effectiveness of the RV program. METHODS: To assess treatment costs incurred by the healthcare system, we abstracted medical records from 287 inpatients and 6751 outpatients with acute diarrhea between 2005 and 2006 at 5 sentinel hospitals in 4 geographic regions. RI prevalence rates were estimated from 4 years of national hospital surveillance. We used a decision-analytic model to assess the potential cost-effectiveness of universal RV in Bolivia. RESULTS: Our model estimates that, in a 5-year birth cohort, Bolivia will incur over US$3 million in direct medical costs due to RI. RV reduces, by at least 60%, outpatient visits, hospitalizations, deaths, and total direct medical costs associated with rotavirus diarrhea. Further, RV was cost-savings below a price of US$3.81 per dose and cost-effective below a price of US$194.10 per dose. Diarrheal mortality and hospitalization inputs were the most important drivers of rotavirus vaccine cost-effectiveness. DISCUSSION: Our data will guide Bolivia's funding allocation for RV as international subsidies change.
Subject(s)
Health Care Costs/statistics & numerical data , Rotavirus Infections/epidemiology , Rotavirus Infections/prevention & control , Rotavirus Vaccines/administration & dosage , Rotavirus Vaccines/economics , Vaccination/economics , Bolivia/epidemiology , Child, Preschool , Cost-Benefit Analysis , Female , Humans , Infant , Infant, Newborn , Male , Rotavirus Infections/economicsABSTRACT
The genetic variability and distribution of Amazonian fish species have likely been influenced by major disturbance events in recent geological times. Alternatively, the great diversity of aquatic habitat in the Amazon is likely to shape ongoing gene flow and genetic diversity. In this context, complex patterns of genetic structure originating from a joint influence of historical and contemporary gene flow are to be expected. We explored the relative influence of Pleistocene climatic fluctuations and current water chemistry on the genetic structure of a piranha, Serrasalmus rhombeus, in the Upper Amazon by the simultaneous analysis of intron length polymorphism and mitochondrial DNA sequences. The Madeira river is well suited for that purpose as it is characterized by a great diversity of water types, the presence of one of the largest floodplain of the Amazon and the potential occurrence of two Pleistocene refuges. We found evidence of genetic structure even at a small geographical scale (less than 10 km), indicating that the floodplain is not a homogenizing factor promoting interdrainage dispersal in S. rhombeus. Likewise, the hierarchical genetic structure inferred was correlated to geographical distance instead of habitat characteristic. Our results also support the hypothesis that the area underwent population expansion during the last 800,000 years. In addition, a higher level of genetic diversity was found in the samples from the putative Aripuanã refuge. The present findings suggest that Pleistocene refuges contributed significantly to the colonization of the lowlands in the Upper Amazon valley during the Pleistocene.