Renal replacement therapy in Latin American end-stage renal disease.

The Latin American Dialysis and Renal Transplant Registry (RLADTR) was founded in 1991; it collects data from 20 countries which are members of Sociedad Latinoamericana de Nefrología e Hipertension. This paper presents the results corresponding to the year 2010. This study is an annual survey requesting data on incident and prevalent patients undergoing renal replacement treatment (RRT) in all modalities: hemodialysis (HD), peritoneal dialysis (PD) and living with a functioning graft (LFG), etc. Prevalence and incidence were compared with previous years. The type of renal replacement therapy was analyzed, with special emphasis on PD and transplant (Tx). These variables were correlated with the gross national income (GNI) and the life expectancy at birth. Twenty countries participed in the surveys, covering 99% of the Latin American. The prevalence of end stage renal disease (ESRD) under RRT in Latin America (LA) increased from 119 patients per million population (pmp) in 1991 to 660 pmp in 2010 (HD 413 pmp, PD 135 pmp and LFG 111 pmp). HD proportionally increased more than PD, and Tx HD continues to be the treatment of choice in the region (75%). The kidney Tx rate increased from 3.7 pmp in 1987 to 6.9 pmp in 1991 and to 19.1 in 2010. The total number of Tx's in 2010 was 10 397, with 58% deceased donors. The total RRT prevalence correlated positively with GNI (r2 0.86; P < 0.05) and life expectancy at birth (r2 0.58; P < 0.05). The HD prevalence and the kidney Tx rate correlated significantly with the same indexes, whereas the PD rate showed no correlation with these variables. A tendency to rate stabilization/little growth was reported in the most regional countries. As in previous reports, the global incidence rate correlated significantly only with GNI (r2 0.63; P < 0.05). Diabetes remained the leading cause of ESRD. The most frequent causes of death were cardiovascular (45%) and infections (22%). Neoplasms accounted for 10% of the causes of death. The prevalence of RRT continues to increase, particularly in countries with 100% public health or insurance coverage for RRT, where it approaches rates comparable to those displayed by developed countries with a better GNI. The incidence also continues to increase in both countries that have not yet extended its coverage to 100% of the population as well as in those that have an adequate program for timely detection and treatment of chronic kidney disease (CKD) and its associated risk factors. PD is still an underutilized strategy for RRT in the region. Even though renal Tx is feasible, its growth rate is still not as fast as it should be in order to compensate for the increased prevalence of patients on waiting lists. Diagnostic and prevention programs for hypertension and diabetes, appropriate policies promoting the expansion of PD and organ procurement as well as transplantation as cost-effective forms of RRT are needed in the region. Regional cooperation among Latin American countries, allowing the more developed to guide and train others in starting registries and CKD programs, may be one of the key initiatives to address this deficit.

Cancer in indigenous people in Latin America and the Caribbean: a review.

Cancer is a leading cause of death in Latin America but there have been few assessments of the cancer burden for the 10% of the population who are indigenous. Evidence from other world regions suggests cancer survival is poorer for indigenous people than for others due to a greater incidence of case-fatal cancers, later stage at diagnosis, and less cancer treatment. A status report on the cancer profile of indigenous people in Latin America and the Caribbean (LAC) is therefore clearly warranted. We undertook a systematic review of the peer-reviewed literature in academic databases, and considered evidence from cancer registries from 1980, to assess cancer epidemiology among indigenous people in LAC. We identified 35 peer-reviewed articles pertaining to cancer in indigenous people. Rates of cervical cancer in parts of Brazil, Ecuador, and Guyana, stomach cancer rates in regions of Chile and gallbladder rates in Chile and Bolivia, were higher for indigenous compared to others. Breast cancer rates were lower in Ecuador, Brazil, and Chile. Six cancer registries in Brazil provided incidence data but no other reports of incidence, mortality, or survival were identified. There was a paucity of data surrounding the cancer burden of indigenous people in LAC. In view of predicted increases in cancer rates in ensuing decades, and the disparities in burden already experienced by indigenous people in the region, it is imperative that cancer profiles are obtained and cancer control measures identified and prioritized.

Estudio de la infecciones mosocomiales en el Hospital del Niño "Dr. Ovidio Aliaga Uria" / Mosocomial Infections in the Hospital del Niño

Objetivo: conocer la magnitud de las infecciones nosocomiales en el Hospital del Niño Diseño: estudio de cohorte rospectivo, retrospectivo Lugar: Hospital del Niño, hospital de tercer nivel de la ciudad de La Paz, Bolivia Participantes: durante el estudio retrospectivo, participaron 110 pacientes con infección intrahospitalaria y 1761 sin infección nosocomial. En el estudio prospectivo 11 pacientes con infección nosocomial y 38 sin infeccióñ. Intervenciones: ninguna Resultados: se encontró una tasa de 2.7 a 31.3 por 100 episodios (dependiendo de la fase retrospectiva y prospectiva respectivamente), las tasas más altas corresponden en ambos casos al servicio de quemados. Las infecciones nosocomiales más frecuentes fueron las de piel y partes blandas, seguidas de las heridas operatorias. Los niños menores de 5 años, inmunocomprometidos, desnutridos, con alteración de la conciencia (sometidos a múltiples procedimientos invasivos), portadores de venocisis y sistemas urinarios cenados tuvieron más riesgo de desanollar infección hospitalaria. La mayoría desarrolló una sola infección y los microorganismos más frecuentes fueron la Pseudomonas oeruginoso, Stophylococcus aureus y Escherichia coli, mismos que presentaron mayor sensibilidad a los aminoglucosidos, quinolonas y cefalosporinas de tercera generación y mayor resistencia a antibióticos beta-lactámicos Conclusiones: las áreas mas afectadas fueron las de atención a pacientes crónicos, con mayor promedio de días de estadía y aquellos con compromiso nutricional e inmunológico, siendo en su mayorfa menores de 5 años

Estudio de las infecciones nosocomiales en el Hospital del Niño Dr. Ovidio Aliaga Uria La Paz-Bolivia / Study of the nosocomiales infection in the Hospital of the boy Dr. Ovidio Aliaga Uria, la Paz-Bolivvia

El objetivo principal de este trabajo es conocer la magnitud de las infecciones nosocomiales en el Hospital del Niño. El diseñño se hizo de acuerdo a un estudio de cohorte prospectivo, retrospectivo. Durante el estudio retrospectivo 110 pacientes con infección intrahospitalaria y 1761 sin infección nasocomial. Emn el estudio prospactivo 11 pacientes con infección nosocomial y 38 sin infección. Como resultado de este estudio se encontró una tasa de 2.7 a31.3 por 100 episodios (dependiendo de la fase retrospectiva y prospectiva respectivamente), las tasas más altas corresponden en ambos casos al servicio de cirugía quemados. Las infecciones nosocomiales más frecuentes fieron la piel y partes blandas seguida delas heridas ost operatorias. Los niños menores de 5 años, inmunocomprometidos, desnutridos, con alteración de la conciencia (sometidos a múltiples procedimientos invasivos), portadores de venoclisis y sistemas urinarios cerrados tienen más riesgos de desarrollar infecciones hospitalarias. La mayoría desarrollo una sola infección y los macroorganismos más frecuentes fueron la Pseudomona aeruginosa, Staphylococcus aureus y Escherichia coli, mismo que presentaron mayor sensibilidad a los Aminoglucosidos, Quinolomas y Cefalosporinas de 3ra generación y mayor resistencia a antibióticos Betalactamicos. En conclusion las áreas mas afectadas fueron las de atención a pacientes acrónicos, la mayoría de los cuales presentaban compromiso nutricional e inmunológico siendo en su mayoría menores de 5 años.