Validación del Timed up and go test como predictor de riesgo de caídas en sujetos con artritis reumatoide. Parte I: confiabilidad y aplicabilidad clínica / Validation of the timed up and go test as a predictor of the risk of falls in persons with rheumatoid arthritis. Part I: reliability and clinical applicability

Introducción. Los sujetos con artritis reumatoide (AR) tienen un elevado riesgo de caídas. Se necesitan herramientas para determinar qué pacientes tienen mayor riesgo de caerse. El Timed up and go test (TUG) es utilizado para predecir el riesgo de caídas, pero es imprescindible que se estudien sus propiedades psicométricas. El objetivo es establecer la confiabilidad intra e interobservador, test-retest y aplicabilidad clínica del TUG a la velocidad habitual y máxima-segura en sujetos con diagnóstico de AR. Material y método. Estudio observacional, prospectivo y longitudinal. Se estableció la confiabilidad intra e interobservador y test-retest del TUG con el coeficiente de correlación intraclase. Se construyeron gráficos de Bland-Altman para la concordancia intra e interobservador. Resultados. La confiabilidad intraobservador fue CCI 0,98 (IC 95%: 0,96-0,99) y CCI 0,99 (IC 95%: 0,98-0,99) a velocidad habitual y máxima CCI 0,97 (IC 95%: 0,95-0,98) y CCI 0,99 (IC 95%: 0,99-0,99). La confiabilidad interobservador a velocidad habitual obtuvo CCI 0,99 (IC 95% 0,98-0,99) y a velocidad máxima CCI 0,99 (IC 95% 0,99-0,99). La confiabilidad test-retest a velocidad habitual CCI 0,77 (IC 95%: 0,61-0,87) y a máxima CCI 0,91 (IC 95%: 0,83-0,95). El 23% reportó mínima dificultad para comprender el test. La mediana del tiempo de administración fue 90 segundos. Conclusión. El estudio permitió establecer la confiabilidad intra e interobservador, test-retest y aplicabilidad clínica del TUG test a velocidad habitual y máxima segura en sujetos con AR (AU)

Introduction. Persons with rheumatoid arthritis (RA) have a high risk of falls. There is a need for tools that identify at-risk patients. The Timed Up and Go test (TUG) is used to predict the risk of falls but it is essential to study its psychometric properties. The aim of this study was to establish intra- and interobserver reliability, test-retest reliability and the clinical applicability of the TUG test in persons with a diagnosis of RA. Material and method. Observational, prospective, longitudinal study. intra- and interobserver reliability and the test-retest reliability of the TUG were established with intraclass correlation coefficients (ICC). Bland-Altman plots were constructed for intra- and interobserver reliability. Results. The intraobserver reliability ICC for the two assessors was 0.98 (95% CI 0.96-0.99) and 0.99 (95% CI 0.98-0.99), and was 0.97 (95% CI 0.95-0.98) at normal speed and 0.99 (95% CI 0.99-0.99) at maximal speed. The interobserver reliability ICC at normal speed was 0.99 (95% CI 0.98-0.99) and 0.99 (95% CI 0.99-0.99) at maximal speed. The test-retest reliability ICC was 0.77 (95% CI 0.61-0.87) at normal speed and 0.91 (95% CI 0.83-0.95) at maximal speed. A total of 23% of the participants reported minimal difficulty in understanding the test. The average administration time was 90seconds. Conclusion. This study identifies the intra- and interobserver reliability, test-retest reliability and the clinical applicability of the TUG test at normal and maximal speed in RA patients (AU)

La reactogenicidad y los aspectos inmune específicos de la vacuna pentavalente combinada: DTPw-HepB-Hib en el lactante menor de un año en el Hospital Distrital de Lambaré, Paraguay en 2007-2008 / The reactogenicity and specific immune aspects of the combined pentavalent vaccine: DTPw-HepB-Hib in breastfed babies under one year of age that attended the District Hospital of Lambaré, Paraguay in 2007 and 2008

La vacunación rutinaria de difteria, pertussis y tétanos a células enteras (DPTw) está presente desde 1940 y con elevadas coberturas en muchos países del mundo. La Organización Mundial de la Salud ha aprobado el uso universal de la vacuna anti-hepatitis B (HB) y combinaciones con DPT, en los últimos años ha sido incorporada la vacuna anti-Haemophilus influenzae tipo b (Hib) en programas de vacunación del niño. Es aplicada en Paraguay desde el 2002 a través del Programa Ampliado de Inmunizaciones del Ministerio de Salud Pública y Bienestar Social. Determinamos la reactoinmunogenicidad secundaria a la vacunación primaria pentavalente combinada en infantes concurrentes al Hospital Distrital de Lambaré­Paraguay en los años 2007-2008. Estudio longitudinal, observacional prospectivo de los efectos secundarios y los aspectos inmune- específicos de la vacuna Berna DTPw-HepB-Hib (QUINVAXEMTM) en lactantes menores de un año, a los 2 meses de edad, datos basales y post vacunales (1 mes luego de 3ª dosis). Efectos locales: 30(75%); rubor 17 (42.5%); tumefacción (menos 20 mm); 13 (32.5%); calor local 11 (27.5%). Efectos generales: fiebre: 37 (92.5%) llanto fuerte y persistente: 32(80%); irritabilidad: 23 (57.5%); hiporreactividad 16 (40%), anorexia 8 (20%); Inmunogenicidad: antes de la 1ª dosis; antitetánica IgG (+) 38/40 (95%), anti-difteria (+) IgG 29/40 (72.5%); anti-HBsAg 0/40 (0%) negativos. Respuesta post-vacuna penta comb. (7m. edad): antitetánica IgG 14/14 (100%) (+); anti-difteria IgG 12/14 (83%) (+); anti-HBsAg 14/14 (100%) positivos. Se evidencia la reactogenicidad de grado variable y decreciente. Niveles de anticuerpos de los componentes DT, satisfactorios y la Hep B excelentes

The combined cellular pentavalent vaccine is one the greatest achievements of human kind in the 20th century and is still successful in the 21st century. It is made up of five components and protects against the following diseases: diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b. The vaccine provides specific active immunization against infections caused by Corynebacterium diphtheriae, Clostridium tetani, Bordetella pertussis, Haemophilus influenzae type B and the Hepatitis B virus in children from six weeks of age. In Paraguay, it has been used since 2002 through the Widened Program of Immunization (PAI in Spanish) of the Ministry of Public Health. The objective of this work was to determine the secondary reactoinmunogenicity to the primary combined pentavalent vaccination in children attending the District Hospital of Lambaré, Paraguay in 2007 and 2008. This is a longitudinal, prospective observational study to evaluate the secondary effects and immune-specific aspects of the Berna DTPw-HepB-Hib combined pentavalent vaccine (QUINVAXEMTM) applied to breastfed babies under one year old, of both sexes, all races, origins and nutrition statuses in the Hospital of Lambaré. The vaccination was free, according to PAI's guidelines and by consecutive sampling previous written consent of the parents, at 2 months of age. Data were collected at baseline an post-vaccination after one month and a third dose. In a total population of 40 breastfed babies, good nutrition was found in 36 (90%). Local effects were seen in 30 (75%) distributed as follows: blush in 17 (42.5%), tumefaction (less than 20 mm) in 13 (32.5%) and local heat in 11 (27.5%). General effects were distributed as follows: fever in 37 (92.5%), loud and persistent cry in 32 (80%), irritability in 23 (57.5%), hyporeactivity in 16 (40%), anorexia in 8 (20%), hypotonicity and allergy, 2 each (5%), convulsions and paralysis in none. The effects are an average after the three doses with a decreasing trend at the end. The immunogenicity basal data before the 1st dose were as follows: antitetanic IgG (+) 38/40 (95%), antidiphtheria IgG (+) 29/40 (72.5%) and anti HBs Ag (-) 0/40 (0%). Post - vaccination responses (at 7 months old) were as follows: antitetanic IgG (+) 14/14 (100%), antidiphtheria IgG (+) 12/14 (83%) and anti HBs Ag (+) 14/14 (100%). These results show a reactogenicity of variable and decreasing degree. The antibodies levels of the DT components were satisfactory and those of Hep B excellent

La reactogenicidad y los aspectos inmune específicos de la vacuna pentavalente combinada: DTPw-HepB-Hib en el lactante menor de un año en el Hospital Distrital de Lambaré, Paraguay en 2007-2008 / The reactogenicity and specific immune aspects of the combined pentavalent vaccine: DTPw-HepB-Hib in breastfed babies under one year of age that attended the District Hospital of Lambaré, Paraguay in 2007-2008

La vacunación rutinaria de difteria, pertussis y tétanos a células enteras (DPTw) está presente desde 1940 y con elevadas coberturas en muchos países del mundo. La Organización Mundial de la Salud ha aprobado el uso universal de la vacuna anti-hepatitis B (HB) y combinaciones con DPT, en los últimos años ha sido incorporada la vacuna anti-Haemophilus influenzae tipo b (Hib) en programas de vacunación del niño. Es aplicada en Paraguay desde el 2002 a través del Programa Ampliado de Inmunizaciones del Ministeriode Salud Pública y Bienestar Social. Determinamos la reactoinmunogenicidad secundaria a la vacunación primaria pentavalente combinada en infantes concurrentes al Hospital Distrital de Lambaré–Paraguay en los años 2007-2008. Estudio longitudinal,observacional prospectivo de los efectos secundarios y los aspectos inmune- específicos de la vacuna Berna DTPw-HepB-Hib (QUINVAXEMTM) en lactantes menores de un año, a los 2 meses de edad, datos basales y post vacunales (1 mes luego de 3ª dosis). Efectoslocales: 30(75%); rubor 17 (42.5%); tumefacción (menos 20 mm); 13 (32.5%); calor local 11 (27.5%). Efectos generales: fiebre: 37 (92.5%) llanto fuerte y persistente: 32(80%); irritabilidad: 23 (57.5%); hiporreactividad 16 (40%), anorexia 8 (20%); Inmunogenicidad: antes de la 1ª dosis; antitetánica IgG (+) 38/40 (95%), anti-difteria (+) IgG 29/40 (72.5%); anti-HBsAg 0/40 (0%) negativos. Respuesta post-vacuna pentacomb. (7m. edad): antitetánica IgG 14/14 (100%) (+); anti-difteria IgG 12/14 (83%) (+); anti-HBsAg 14/14 (100%) positivos. Se evidencia la reactogenicidad de grado variable y decreciente. Niveles de anticuerpos de los componentes DT, satisfactorios y laHep B excelentes.

The combined cellular pentavalent vaccine is one the greatest achievements of human kind in the 20th century and is still successful in the 21st century. It is made up of fivecomponents and protects against the following diseases: diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b. The vaccine provides specific active immunization against infections caused by Corynebacterium diphtheriae, Clostridium tetani, Bordetella pertussis, Haemophilus influenzae type B and the Hepatitis B virus in children from six weeks of age. In Paraguay, it has been used since 2002 through the Widened Program of Immunization (PAI in Spanish) of the Ministry of Public Health. Theobjective of this work was to determine the secondary reactoinmunogenicity to the primary combined pentavalent vaccination in children attending the District Hospital of Lambaré, Paraguay in 2007 and 2008. This is a longitudinal, prospective observational study to evaluate the secondary effects and immune-specific aspects of the Berna DTPw- HepB-Hib combined pentavalent vaccine (QUINVAXEMTM) applied to breastfed babies under one year old, of both sexes, all races, origins and nutrition statuses in the Hospitalof Lambaré. The vaccination was free, according to PAI's guidelines and by consecutive sampling previous written consent of the parents, at 2 months of age. Data were collected at baseline an post-vaccination after one month and a third dose. In a total population of 40 breastfed babies, good nutrition was found in 36 (90%). Local effectswere seen in 30 (75%) distributed as follows: blush in 17 (42.5%), tumefaction (less than 20 mm) in 13 (32.5%) and local heat in 11 (27.5%). General effects were distributed as follows: fever in 37 (92.5%), loud and persistent cry in 32 (80%),irritability in 23 (57.5%), hyporeactivity in 16 (40%), anorexia in 8 (20%), hypotonicity and allergy, 2 each (5%), convulsions and paralysis in none. The effects are an average after the three...

[Uncinariasis in younger infants]. / Uncinariasis en el lactante menor.

In order to determine the main clinical and laboratory manifestations associated with the infestation by an uncinaria during the first year of life, 42 children were studied from a group hospitalized between the years 1980 and 1985 in whom the main diagnosis at their time of leave from the hospital was parasitosis. Over 31 patients (74%) showed some degree of malnutrition, and severe in 24 of them (57% of the total). Clinical manifestations were mainly related to anemia (paleness, lack of air) and active intestinal bleeding (enterorrhagia, melena). Among the laboratory findings, 80% of the patients were shown to have anemia and in 24% of them, their hemoglobin levels were less than 5 g/dL, in more than half the anemia was normocytic normochromic. Also included are particularities concerning uncinariasis in the breast-feeding infant and some differences with the infection in the adult.