ABSTRACT
Visceral leishmaniasis is a rare parasitosis in our country; in a 30 year period only exists the report of five cases, three in the state of Puebla and two in the state of Guerrero. Now it has been identified another two cases in the state of Chiapas. In these patients the common presentation of the disease were fever, hepatosplenomegaly, hypergammaglobulinemia and pancytopenia. The parasite can be found in liver, spleen, lymph nodes and bone marrow macrophages. A definitive diagnosis depends on the demonstration of the parasite in tissue; spleen biopsy is the most useful because it is positive in 98% of the cases, in other tissues the amastigotes are seen in 50-80% of the cases. Negative PAS-stained smears maintains the diagnosis until another more specific method as electronic microscopy or culture is available. Pentavalent antimonial compounds are the drugs of choice and as an alternative or in case of failure amphotericin B can be used.
Subject(s)
Leishmaniasis, Visceral/diagnosis , Female , Humans , Infant , Leishmaniasis, Visceral/epidemiology , Leishmaniasis, Visceral/parasitology , Male , Mexico/epidemiologyABSTRACT
OBJECTIVES: 1. To identify the quality degree of medical care in patients with acute leukaemia who had fever and granulocytopenia during the hospitalization period. 2. To establish the relationship between the medical care process and the results in this concern. DESIGN: Retrospective survey. STUDY AREA: Children's Hospital of the Mexican Institute of Social Security. STUDY SUBJECTS: Twenty three patients with acute leukaemia were studied. Also, hospitalization episode of these patients, in which they suffered fever and granulocytopenia, was randomly selected. MAIN MEASUREMENTS: Compliance of diagnostic and therapeutic process was measured during hospitalization, according to the protocolized recommendations made by consensus of the hospital expert group. In order to identify the quality degree of medical care, it was taken into account the protocol compliance besides the results observed in the patients. Results were assessed based on patients' survival to fever and granulocytopenia episode, as well as on fever's duration. The correlation was calculated by using Spearman's coefficient. RESULTS: The medical care quality of the hospital was "adequate" (85% on average). Compliance degree, including the total process was 71%; with diagnostic process 63%, and with therapeutic process 76%. The results observed in the patients were considered as "adequate" (89%). By evaluating individual cases, the medical care quality was considered excellent or adequate in 17 patients (74%) regular in five (22%) and poor in one (4%). Diagnostic process was adequate in 6 patients (26%) regular in 12 (53%) poor in three (13%) and very bad in two (8%). On the other hand, therapeutic process was excellent in 14 patients (60%) regular in one (4%) poor in six (26%) and very bad in two (9%). Results observed in 13 cases were excellent (57%) adequate in eight (35%) regular in one (4%) and very bad in one (4%). The relationship between process and result was 0.41 (P < 0.05) between diagnostic process and result 0.14 and, between therapeutic process and result 0.34. CONCLUSIONS: The medical care quality rendered to patients with leukaemia, who suffered a granulocytopenia episode and fever, was considered as adequate. Therapeutic recommendations were followed accurately, meanwhile, diagnostic process had a lower adherence. A positive relationship between process and result was observed.
