Características clínico epidemiológicas de pacientes con Lepra en un centro de referencia

Introducción: La lepra o enfermedad de Hansen es una enfermedad infectocontagiosa, crónica, causada por el bacilo Mycobacterium leprae. Es causante de neuropatía periférica, y afecta a la piel, nervios periféricos, vías aéreas superiores y ojos. El objetivo fue evaluar las características clínicas y sociodemográficas a los pacientes con Lepra que acudieron Hospital Menonita Km 81 de Itacurubi de la Cordillera en los años 2018-2022. Material y Método: Estudio observacional descriptivo. retrospectivo, de corte transversal en pacientes con Lepra del Hospital Menonita Km 81 en la ciudad de Itacurubi de la Cordillera del Departamento de Cordillera del año 2018 al 2022. Los datos se obtuvieron de la revisión de las fichas epidemiológicas de pacientes con diagnóstico de lepra en el período abarcado en un periodo de 5 años, 2018 al 2022. Resultados: Fueron reportados 286 casos de lepra en pacientes provenientes de los 18 departamentos del Paraguay. El año con más casos detectados fue el 2019 con 79 casos, siendo el departamento de Alto Paraná con mayor incidencia con 17 casos diagnosticados, seguido del año 2018 con 76 casos. La ocupación más frecuente de los pacientes fue la agricultura. El sexo más frecuente fue el masculino 203 (71%) casos con lepra. El rango de edad de mayor frecuencia fue entre 49- 63 años de edad (29,56%). El motivo de consulta más frecuente fue el de Mácula en 139 (49%). Conclusión: Se requiere aumentar la calidad de la atención primaria y el compromiso del personal de salud para el control y el diagnóstico oportuno de la Lepra en nuestro país.

Introduction: Leprosy, or Hansen's disease, is a chronic infectious disease caused by Mycobacterium leprae. It causes peripheral neuropathy and affects the skin, peripheral nerves, upper airways, and eyes. The objective was to evaluate the clinical and sociodemographic characteristics to patients with Leprosy who attended Mennonite Hospital Km 81 of Itacurubí de la Cordillera in the years 2018-2022 Material and Method: descriptive observational study, retrospective of cross-sectional in patients with Leprosy of the Mennonite Hospital Km 81 in the city of Itacurubi de la Cordillera of the Department of Cordillera from the year 2018 to 2022. Data were obtained from the review of epidemiological records of patients with a diagnosis of leprosy in the period covered in a period of 5 years, 2018-2022. Results: Of the 18 departments in Paraguay, 286 cases of leprosy were reported. The year with the most cases detected was 2019, with 79 cases, with the department of Alto Paraná having the highest incidence, with 17 cases diagnosed, followed by 2018 with 76 cases. Agriculture was the most common occupation. The most frequent sex was male (203 [71%] patients) with leprosy. The most frequent age range was 49-63 years (29.56%), and the most frequent reason for consultation was macular in 139 patients (49%). Conclusion: It is necessary to increase the quality of primary care and commitment of health personnel in the control and timely diagnosis of leprosy in our country.

Peritonitis primaria por neumococo en un hospital pediátrico de Argentina / Primary pneumococcal peritonitis in a pediatric hospital from Argentina

Resumen La peritonitis por neumococo comprende un pequeno subconjunto de pacientes con enfermedad invasiva (ENI). Durante 15 años (2005-2020) de vigilancia de ENI en un hospital de pediatría, se detectaron 5 casos de peritonitis primaria. Los pacientes, 3 ninas y 2ninos con una media de edad de 5 anos, experimentaron signos y síntomas peritoneales; 3 de ellos presentaban síndrome nefrótico. En coincidencia con los perfiles locales, todos los aislamientos fueron sensibles a betalactámicos, una cepa expresó resistencia a tetraciclina y cotrimoxazol y otra solo a cotrimoxazol. Los serotipos encontrados en 4/5 cepas (una resultó no viable) fueron 1, 19F, 15C y 23A. Los ninos fueron tratados con cefalosporinas de tercera generación o con ampicilina, gentamicina y metronidazol; todos evolucionaron favorablemente. Se destaca la importancia del hallazgo de Streptococcus pneumoniae en peritonitis primarias en niños. Este trabajo contribuye al conocimiento de esta enfermedad en particular y al de la epidemiología local de la ENI.

Abstract Pneumococcal peritonitis represents a small subset of patients suffering from inva-sive pneumococcal disease (IPD). We describe 5 cases of primary peritonitis documented in the pediatric hospital over 15 years (2005-2020) of IPD surveillance. The patients, 3girls and 2boys with a mean age of 5 years, experienced peritoneal signs and symptoms; 3of them suffered from nephrotic syndrome. Based on the local resistance profiles, all isolates were sensitive to beta-lactams, one strain showed resistance to cotrimoxazole and tetracycline while another strain, to cotrimoxazole only. Serotypes found in 4/5 strains (one was non-viable) were: 1, 19F, 15C and 23A. Children were treated with third-generation cephalosporins or ampicillin, gentamicin and metronidazole and all of them evolved favorably. Pneumococcal etiology should be included in the differential diagnosis of acute abdominal pain in children. Our study aims to contribute to the knowledge of this condition and to the local epidemiology of IPD.

[Primary pneumococcal peritonitis in a pediatric hospital from Argentina]. / Peritonitis primaria por neumococo en un hospital pediátrico de Argentina.

Pneumococcal peritonitis represents a small subset of patients suffering from invasive pneumococcal disease (IPD). We describe 5 cases of primary peritonitis documented in the pediatric hospital over 15 years (2005-2020) of IPD surveillance. The patients, 3girls and 2boys with a mean age of 5 years, experienced peritoneal signs and symptoms; 3of them suffered from nephrotic syndrome. Based on the local resistance profiles, all isolates were sensitive to beta-lactams, one strain showed resistance to cotrimoxazole and tetracycline while another strain, to cotrimoxazole only. Serotypes found in 4/5 strains (one was non-viable) were: 1, 19F, 15C and 23A. Children were treated with third-generation cephalosporins or ampicillin, gentamicin and metronidazole and all of them evolved favorably. Pneumococcal etiology should be included in the differential diagnosis of acute abdominal pain in children. Our study aims to contribute to the knowledge of this condition and to the local epidemiology of IPD.

[Pneumococcal osteoarticular infections in children admitted to a Pediatric Reference Hospital from Misiones, Argentina. Thirteen years of surveillance]. / Infección neumocócica osteoarticular en niños atendidos en un hospital pediátrico de referencia de Misiones, Argentina. Trece años de vigilancia.

Streptococcus pneumoniae is a rare cause of osteoarticular infections. We describe 5documented cases that occurred in 2005, 2009, 2011, 2015 and 2017 in patients admitted to the Pediatric Provincial Reference Hospital of Misiones. These cases corresponded to a 4-year-old boy and 4 girls aged 11, 10, 6 years and 4 months with a diagnosis of osteomyelitis of the scapula and humerus, arthritis of the hip, ankle and osteomyelitis of the distal fibula. All of them were in good general condition on admission and one of them was seropositive for human immunodeficiency virus. All the recovered isolates were susceptible to ß-lactams and only one isolate showed joint resistance to macrolides and tetracycline. Three isolates were serotyped, 2of which carried vaccine serotypes (19F and 7F). Despite its low frequency, the etiology of S.pneumoniae should be considered among the osteoarticular infections. Our findings enhance the role of the Bacteriology laboratory in the diagnosis by microbiological culture and contribute to documenting the epidemiological behavior of this pathogen.

Evaluating the Impact of Calcification on Plaque Vulnerability from the Aspect of Mechanical Interaction Between Blood Flow and Artery Based on MRI.

Acute cerebral ischemic events and thrombosis are associated with the rupture/erosion of carotid atherosclerotic plaques. The aim of the present study was to determine the impact of calcification deposition on the wall shear stress (WSS) and stresses within the plaques using 3D fluid-structure interaction (FSI) models. Six patients with calcified carotid atherosclerosis underwent multisequence magnetic resonance imaging (MRI) and were divided into three groups according to the calcification volume. To evaluate the role of the calcification deposition on the stresses, the calcification content was replaced by lipids and arterial tissue, respectively. By comparing the results from the simulation with calcification, and when changing it to lipids there was a significant increment in the stresses at the fibrous cap (p = 0.004). Instead, by changing it to arterial tissue, there was no significant difference (p = 0.07). The calcification shapes that presented the highest stresses were thin concave arc-shaped (AS1) and thin convex arc-shaped (AS3), with mean stress values of 107 ± 54.2 and 99.6 ± 23.4 kPa, respectively. It was also observed that, the calcification shape has more influence on the level of stress than its distance to the lumen. Higher WSS values were associated with the presence of calcification. Calcification shape plays an important role in producing high stresses in the plaque. This work further clarifies the impact of calcification on plaque vulnerability.

Situación laboral de odontólogos egresados de la Universidad de Antioquia antes y durante la pandemia por la COVID-19, periodo 2015(1)-2019(2) / Labor situation of dentists graduated from the Universidad de Antioquia before and during the pandemic COVID-19, period 2015(1)-2019(2)

Objetivo: reconocer y determinar las condiciones laborales de los odontólogos de la Facultad de Odontología de la Universidad de Antioquia en las cohortes de egresados del periodo 2015(1)-2019(2), antes y durante la pandemia por la COVID-19. Métodos: estudio descriptivo transversal abordado a partir de una muestra representativa de 142 odontólogos. Esta fue obtenida de las bases de datos proporcionadas por el Observatorio Estudiantil de dicha facultad. Resultados: se encontró que durante la pandemia el 13,5% de encuestados perdió su empleo, el 75% manifestó reducción en su salario y el 10,5% interrumpió su afiliación al régimen de prestaciones sociales. Conclusiones: si bien, la situación laboral de los odontólogos antes de la pandemia por la COVID-19 era precaria, esta se agravó durante la misma en los aspectos que ya venían siendo críticos en relación con temas salariales y prestacionales, en específico el tipo de contratación, los tiempos de inserción laboral, la duración de los contratos y la afiliación a la seguridad social y al régimen prestacional.

Objective: to recognize and determine the working conditions of the dentists of the Faculty of Dentistry of the University of Antioquia in the 2015(1)-2019(2) cohorts of graduates before and during the Covid-19 pandemic. Methods: cross-sectional descriptive study approached from a representative sample of 142 dentists obtained from the databases provided by the Student Observatory of that faculty. Results: it was found that during the pandemic 13.5% of respondents were unemployed, 75% reported a reduction in salary and 10,5% interrupted their affiliation to the social benefits system. Conclusions: although the employment situation of dentists before the Covid-19 pandemic was precarious, these deteriorating conditions worsened during the pandemic in aspects that were already critical in relation to salary and benefits: type of contract, time of employment, duration of contracts, affiliation to the social security and benefits system.

A novel add-on collimator for preclinical radiotherapy applications using a standard cell irradiator: design, construction, and validation.

PURPOSE: Preclinical radiotherapy applications require dedicated irradiation systems which are expensive and not widely available. In this work, a clinical dual source 137 Cs cell irradiator was adapted to deliver 1-cm diameter preclinical treatment beams using a lead and stainless steel custom-made collimator to treat one or two mice at a time. METHODS: The dosimetric characteristics of all the different components of the system (including collimator, phantoms, and radiation sources) have been simulated with EGSnrc Monte Carlo methods. The collimator was constructed based on these simulations and the calculated results were verified against dosimetric measurements with MOSKin detectors, GAFchromic films, and dosimetric gels. RESULTS: The comparisons showed an agreement, in terms of full width half maximum values, between the simulated and the measured dose cross profiles at the midline within 4% for both gel dosimetry and GAFchromic films. Out of beam dose, measured in air at the collimator midplane with MOSFET detectors was between 6% and 10% of the beam axis dose. The dimensions of the beam are constant along the vertical axis of the collimator and also the simulated and measured Percentage Depth Dose (PDD) curves show an agreement within 1%. CONCLUSIONS: The collimator design developed in this work allows the creation of a beam with the necessary characteristics for ablative radiotherapy treatments on small animals using a standard clinical cell irradiator. This collimator design will make advanced preclinical studies with ablative beams possible for all those institutions which do not have collimated preclinical irradiators available.

Educating Mental Health Clinicians About Sensory Modulation to Enhance Clinical Practice in a Youth Acute Inpatient Mental Health Unit: A Feasibility Study.

There is an emergence of literature describing effective sensory modulation (SM) interventions to de-escalate violence and aggression among mental health inpatients. However, the evidence is limited to adult settings, with the effect of SM in youth acute settings unknown. Yet, before SM may be used as a de-escalation intervention in youth acute settings, multidisciplinary staff need to be educated about and supported in the clinical application of SM. In the current study, an online SM education package was developed to assist mental health staff understand SM. This was blended with action learning sets (ALS), small group experiential opportunities consisting staff and consumers to learn about SM resources, and the support of SM trained nurses. The aims of the study were to evaluate the effectiveness of this SM education intervention in (a) transferring knowledge of SM to staff, and (b) translating this knowledge into practice in a youth acute inpatient mental health unit. A mixed methods research design with an 11-item pre- and post-education questionnaire was used along with three-month follow-up focus groups. The SM education improved understanding about SM (all 11-items p ≤ 0.004, r ≥ 0.47). Three-months after SM education, four themes evident in the focus group data emerged about the practice and process of SM; (1) translating of learning into practice, (2) SM in practice, (3) perceptions of SM benefits, and (4) limitations of SM. A blended SM education process enhanced clinical practice in the unit, yet participants were mindful of limitations of SM in situations of distress or escalating agitation.

An fMRI study of prefrontal brain activation during multiple tasks in patients with major depressive disorder.

OBJECTIVE: Previous research has provided conflicting information regarding the pattern of brain activation associated with cognitive performance in depressed people. We aimed to assess brain activation related to cognitive performance during planning and working memory tasks. METHOD: fMRI scans were conducted using a modified Tower of London task and a 2-back task in 13 patients with major depressive disorder and a matched control group. RESULTS: Task performance was impaired in the depressed group on the Tower of London task but there were no differences between the groups in task performance on the n-back task. The patient group showed widespread increased brain activation in both tasks. There was considerable overlap in increased activation between the two tasks, especially in right prefrontal cortical regions. CONCLUSIONS: Patients with depression exhibit increased brain activation, especially in right prefrontal regions, across several types of cognitive task activity. Patients with depression may recruit greater brain regions to achieve similar or even poorer task performance than control subjects.

A preliminary fMRI study of the effects on cortical activation of the treatment of refractory auditory hallucinations with rTMS.

Three patients underwent fMRI during a word generation task before and after successful treatment of auditory hallucinations with rTMS and were compared to four control subjects. There was a significant increase and more normal task related brain activation in brain areas involved in language processing including left temporoparietal cortex after rTMS treatment.

Naturalistic study of the use of transcranial magnetic stimulation in the treatment of depressive relapse.

BACKGROUND: The efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression has been assessed in a number of acute treatment trials during the last 10 years. Little is known about the long-term impact of the treatment on the disorder and its effectiveness when applied for repeated relapses of depression over time. METHOD: Nineteen patients who had previously responded to rTMS in clinical trials received treatment with rTMS for a total of 30 episodes of depressive relapse. RESULTS: Approximately 10 months elapsed between treatment episodes. The majority of patients achieved a significant improvement in each treatment course with significant improvements achieved in patients treated with both low-frequency right-sided rTMS and high-frequency left-sided rTMS. CONCLUSIONS: The study suggests that rTMS may have value in the treatment of episodes of depressive relapse with little reduction in efficacy over time.

The treatment of recurring auditory hallucinations in schizophrenia with rTMS.

BACKGROUND: Auditory hallucinations are a common and disabling problem for many patients with schizophrenia and often fail to respond to optimal antipsychotic therapy. Repetitive transcranial magnetic stimulation (rTMS) has recently been trialled as an alternative treatment option for these patients. These studies have generally been positive, but treatment has only been provided for short periods of time and little is known about the longer-term impact of TMS on the course of hallucinations. METHOD: We describe two cases in which rTMS was provided to patients upon relapse of hallucinations following initial successful rTMS treatment in a clinical trial. RESULTS: A repeat course of rTMS resulted in a marked improvement in the symptoms experienced by these two patients. CONCLUSIONS: rTMS appears to have potential as a long-term treatment for patients with auditory hallucinations, but requires ongoing systematic investigation.

A randomized, controlled trial of sequential bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression.

OBJECTIVE: High-frequency left-side repetitive transcranial magnetic stimulation (rTMS) and low-frequency stimulation to the right prefrontal cortex have both been shown to have antidepressant effects, but doubts remain about the magnitude of previously demonstrated treatment effects. The authors evaluated sequentially combined high-frequency left-side rTMS and low-frequency rTMS to the right prefrontal cortex for treatment-resistant depression. METHOD: The authors conducted a 6-week double-blind, randomized, sham-controlled trial in 50 patients with treatment-resistant depression. Three trains of low-frequency rTMS to the right prefrontal cortex of 140 seconds' duration at 1 Hz were applied daily, followed immediately by 15 trains of 5 seconds' duration of high-frequency left-side rTMS at 10 Hz. Sham stimulation was applied with the coil angled at 45 degrees from the scalp, resting on the side of one wing of the coil. The primary outcome variable was the score on the Montgomery-Asberg Depression Rating Scale. RESULTS: There was a significantly greater response to active than sham stimulation at 2 weeks and across the full duration of the study. A significant proportion of the study group receiving active treatment met response (11 of 25 [44%]) or remission (nine of 25 [36%]) criteria by study end compared to the sham stimulation group (two of 25 [8%] and none of 25 respectively). CONCLUSIONS: Sequentially applying both high-frequency left-side rTMS and low-frequency rTMS to the right prefrontal cortex, has substantial treatment efficacy in patients with treatment-resistant major depression. The treatment response accumulates to a clinically meaningful level over 4 to 6 weeks of active treatment.

A study of the effects of lorazepam and dextromethorphan on the response to cortical 1 Hz repetitive transcranial magnetic stimulation.

We studied the effects of lorazepam and dextromethorphan on the responses to 1 Hz repetitive transcranial magnetic stimulation applied to the left human motor cortex. Lorazepam, dextromethorphan or placebo was administered to 45 normal controls in a double-blind fashion 2.5 h before the repetitive transcranial magnetic stimulation procedure. Motor cortical excitability was measured with single transcranial magnetic stimulation pulses before and after 15 min of 1 Hz repetitive transcranial magnetic stimulation applied at supra-threshold intensity. 1 Hz repetitive transcranial magnetic stimulation resulted in a decrease in motor cortical excitability in the placebo group but not in the groups taking lorazepam or dextromethorphan. These results suggest that cortical responses to 1 Hz repetitive transcranial magnetic stimulation are dependent on activity at both gamma-aminobutyric acid and N-methyl-D-asparate receptor systems.

A double-blind sham-controlled trial of repetitive transcranial magnetic stimulation in the treatment of refractory auditory hallucinations.

BACKGROUND: Previous research suggests that repetitive transcranial magnetic stimulation (rTMS) applied to the temporoparietal cortex may have therapeutic benefits for patients with schizophrenia and treatment-resistant auditory hallucinations. We aimed to test this hypothesis in a randomized double-blind trial. METHODS: Thirty-three patients with treatment-resistant auditory hallucinations entered a randomized sham-controlled, double-blind trial. rTMS was applied for 10 consecutive weekdays, for 15 minutes at 1 Hz and 90% of the resting motor threshold. We assessed clinical symptoms and cognitive function. RESULTS: rTMS was safe with no adverse effects on memory and cognitive parameters assessed. Active treatment did not result in a greater therapeutic effect than sham on any measure except for the loudness of hallucinations where there was a significant reduction in the active versus the sham group over time. CONCLUSIONS: The study does not support the effectiveness of rTMS using the stimulation parameters provided. However, it does suggest that rTMS methods may have a therapeutic role and indicates the need for further exploration of alternative and more effective stimulation methods.