Multivariate spatio-temporal approach to identify vulnerable localities in dengue risk areas using Geographic Information System (GIS).

Dengue is one of the most important vector-borne infection in Sri Lanka currently leading to vast economic and social burden. Neither a vaccine nor drug is still not being practiced, vector controlling is the best approach to control disease transmission in the country. Therefore, early warning systems are imminent requirement. The aim of the study was to develop Geographic Information System (GIS)-based multivariate analysis model to detect risk hotspots of dengue in the Gampaha District, Sri Lanka to control diseases transmission. A risk model and spatial Poisson point process model were developed using separate layers for patient incidence locations, positive breeding containers, roads, total buildings, public places, land use maps and elevation in four high risk areas in the district. Spatial correlations of each study layer with patient incidences was identified using Kernel density and Euclidean distance functions with minimum allowed distance parameter. Output files of risk model indicate that high risk localities are in close proximity to roads and coincide with vegetation coverage while the Poisson model highlighted the proximity of high intensity localities to public places and possibility of artificial reservoirs of dengue. The latter model further indicate that clustering of dengue cases in a radius of approximately 150 m in high risk areas indicating areas need intensive attention in future vector surveillances.

Adaptación y validación de las escalas de autoeficacia y expectativa de resultados para la práctica de ejercicios de suelo pélvico en mujeres con cáncer ginecológico / Adaptation and validation in Spanish of self-efficacy and outcomes expectation scales for practice of pelvic floor exercises scale in women with gynecological cancer

ANTECEDENTES: La autoeficacia y expectativa de resultados son constructos teóricos que explican muchos cambios de conductas en salud, como la práctica de ejercicios de suelo pélvico (ESP) y son predictores de adherencia. Las mujeres en tratamiento por cáncer ginecológico presentan distintos grados de disfunción de suelo pélvico que pueden prevenirse con la práctica de ejercicios. El éxito de este tipo de intervenciones depende de la adherencia a ellos. Hay escasez de instrumentos de autoeficacia en idioma español desarrollados en el contexto de intervenciones preventivas. OBJETIVO: Adaptar y validar en Chile la Escala de autoeficacia y expectativa de resultados para la práctica de ejercicios de suelo pélvico (EAPEAP) desarrollada en Brasil. Pacientes y método: Estudio observacional, longitudinal prospectivo y de validación, incluyó traducción-traducción inversa y revisión por pares expertos. Se evaluaron las propiedades psicométricas del instrumento - consistencia interna y capacidad predictiva, aplicado a 53 mujeres chilenas derivadas a tratamiento de radioterapia por cáncer ginecológico. Para los análisis se consideró un p < 0,05. RESULTADOS: La escala presenta buena consistencia interna, siendo el alfa de Cronbach de 0,932 para la Escala de Autoeficacia para ESP y alfa de 0,748, para la Escala de Expectativa de Resultados. Respecto de la validez predictiva, la escala de autoeficacia fue capaz de discriminar entre adherentes y no adherentes a tratamiento (p = 0,034), no así la escala de expectativa de resultados. CONCLUSIÓN: La escala de autoeficacia y expectativa de resultados para la práctica de ejercicios de suelo pélvico es lingüísticamente apropiada y psicométricamente válida para ser aplicada en Chile

BACKGROUND: Self-efficacy and outcomes expectation are theoretical constructs that explain many changes in health behaviors, such as the practice of pelvic floor exercises (PFE), and they are predictors of adherence. Women undergoing treatment for gynaecological cancer have different degrees of pelvic floor dysfunction that can be prevented with PFE. The success of these kinds of procedures are dependent on adherence to them. There is a lack of self-efficacy instruments in Spanish related to preventive approaches. OBJECTIVE: to adapt and validate the Scale of Self-efficacy and Outcomes Expectation for the Practice of Pelvic Floor Exercises (EAPEAP) developed in Brazil. PATIENTS AND METHOD: Observational, prospective longitudinal and validation study that included translation- back translation and expert peer review. The psychometric properties of the instrument (internal consistency and predictive capacity) were evaluated, applied to 53 Chilean women referred for radiotherapy treatment for gynaecological cancer. RESULTS: The scale shows good internal consistency, with a Cronbach's alpha of 0.932 for the self-efficacy scale for PFE; and alpha of 0.748 for the outcomes expectation scale for PFE. Regarding predictive validity, the self-efficacy scale was able to discriminate between adherence and non-adherence to treatment (p = 0.034), but not the outcomes expectation scale. For all the analyses, a p < 0.05 was considered. CONCLUSION: the scale of self-efficacy and outcomes expectation for the practice of PFE is linguistically appropriate and psychometrically valid to be applied in Chile

Entomological surveillance with viral tracking demonstrates a migrated viral strain caused dengue epidemic in July, 2017 in Sri Lanka.

Dengue is the most important mosquito-borne viral infection disease in Sri Lanka triggering extensive economic and social burden in the country. Even after numerous source reduction programmes, more than 30,000 incidences are reporting in the country every year. The last and greatest dengue epidemic in the country was reported in July, 2017 with more than 300 dengue related deaths and the highest number of dengue incidences were reported from the District of Gampaha. There is no Dengue Virus (DENV) detection system in field specimens in the district yet and therefore the aim of the study is development of entomological surveillance approach through vector survey programmes together with molecular and phylogenetic methods to identify detection of DENV serotypes circulation in order to minimize adverse effects of imminent dengue outbreaks. Entomological surveys were conducted in five study areas in the district for 36 months and altogether, 10,616 potential breeding places were investigated and 423 were positive for immature stages of dengue vector mosquitoes. During adult collections, 2,718 dengue vector mosquitoes were collected and 4.6% (n = 124) were Aedes aegypti. While entomological indices demonstrate various correlations with meteorological variables and reported dengue incidences, the mosquito pools collected during the epidemic in 2017 were positive for DENV. The results of the phylogenetic analysis illustrated that Envelope (E) gene sequences derived from the isolated DENV belongs to the Clade Ib of Cosmopolitan genotype of the DENV serotype 2 which has been the dominant stain in South-East Asian evidencing that a recent migration of DENV strain to Sri Lanka.

Use of Novaluron-Based Autocidal Gravid Ovitraps to Control Aedes Dengue Vector Mosquitoes in the District of Gampaha, Sri Lanka.

Dengue is the most important mosquito-borne viral infection in Sri Lanka causing an enormous social and economic burden in the country. In the absence of therapeutic drugs and the developed vaccines are under investigation, vector control is the best strategy to reduce the disease transmission. Therefore, the development of novel tools to control dengue vector mosquitoes has become the need of the hour. Novaluron is a recently developed Insect Growth Regulator (IGR) which inhibits chitin synthesis in immature stages of insects. The aim of the study was to identify the efficacy of a simple and cost-effective Autocidal Gravid Ovitrap (AGO) developed using Novaluron to control dengue outbreaks in the District of Gampaha, Sri Lanka. Laboratory and semifield experiments were performed to identify the activity range, optimum field dosage, and residual effects of Novaluron following the World Health Organization guidelines, and field experiments were performed in the Ragama Medical Officer of Health (MOH) area. Two study areas 800 m apart were selected and assigned as treated and control areas randomly. In each study area, 30 households were selected randomly. Each household was given two ovitraps, one placed indoors and the other placed outdoors. Mortality and survival counts were recorded separately for one-year time period and data were analyzed using a two-way repeated measures analysis of variance model. During the laboratory experiments, the adult emerging inhibition was 100% in all tested concentrations. The optimum field dosage was 2 ppm and the residual effect was 28 days. In the field experiments, significantly higher mortality counts were recorded in treated areas both indoor- and outdoor-placed AGOs. Two-factor repeated measures ANOVA followed by Tukey's test confirmed that the mean mortality count is high for the developed AGOs both indoor and outdoor settings. The developed AGO can be deployed to control both indoor and outdoor dengue vector mosquito populations, and in dengue-risk areas, the ovitrap will be supportive to local health authorities to enhance the efficiency of future vector control programs.

A forecasting model for dengue incidence in the District of Gampaha, Sri Lanka.

BACKGROUND: Dengue is one of the major health problems in Sri Lanka causing an enormous social and economic burden to the country. An accurate early warning system can enhance the efficiency of preventive measures. The aim of the study was to develop and validate a simple accurate forecasting model for the District of Gampaha, Sri Lanka. Three time-series regression models were developed using monthly rainfall, rainy days, temperature, humidity, wind speed and retrospective dengue incidences over the period January 2012 to November 2015 for the District of Gampaha, Sri Lanka. Various lag times were analyzed to identify optimum forecasting periods including interactions of multiple lags. The models were validated using epidemiological data from December 2015 to November 2017. Prepared models were compared based on Akaike's information criterion, Bayesian information criterion and residual analysis. RESULTS: The selected model forecasted correctly with mean absolute errors of 0.07 and 0.22, and root mean squared errors of 0.09 and 0.28, for training and validation periods, respectively. There were no dengue epidemics observed in the district during the training period and nine outbreaks occurred during the forecasting period. The proposed model captured five outbreaks and correctly rejected 14 within the testing period of 24 months. The Pierce skill score of the model was 0.49, with a receiver operating characteristic of 86% and 92% sensitivity. CONCLUSIONS: The developed weather based forecasting model allows warnings of impending dengue outbreaks and epidemics in advance of one month with high accuracy. Depending upon climatic factors, the previous month's dengue cases had a significant effect on the dengue incidences of the current month. The simple, precise and understandable forecasting model developed could be used to manage limited public health resources effectively for patient management, vector surveillance and intervention programmes in the district.

Survival of patients with vulvar cancer

Background: Vulvar cancer corresponds to 3 to 5 percent of all female reproductive tract malignancies. Therefore it is classifed as a low frequency disease. Aim: To estimate overall and conditional survival one and two years after diagnosing women with vulvar cancer. Material and Methods: Retrospective cohort study. The patient database of an oncological hospital was revised and patients with vulvar cancer diagnosed between 1997 and 2006 were selected. The clinical records of these women were reviewed. Results: Eighty six women aged 32 to 92 years, were identified. Eighty percent had a squamous carcinoma, 46 percent were in stage III, 48 percent received incomplete treatment, 40 percent consulted due to the presence of a vulvar mass and 18 percent had lesions in labia majora or minora. Overall five years survival at 5 years was 41.8 percent. There were statistically significant differences in survival depending on the initial stage of cancer (p = 0.02). Five year conditional survival, one and two years after the diagnosis, was 59 and 79 percent, respectively. Conclusions: Five years overall survival of these group of women with vulvar cancer was 41.8 percent. The figures increased to 59 and 79 percent in patients who had survived one and two years after the diagnosis. The stage of the lesion and the initial survival are survival prognostic factors for vulvar cancer.

Radioterapia lumboaórtica en pacientes con cáncer de cuello uterino: experiencia del Instituto Nacional del Cáncer / Paraortic radiotherapy in patients with uterine cervical carcinoma: Instituto Nacional del Cáncer experience

Antecedentes: El cáncer de cérvicouterino continúa siendo una enfermedad prevalente en Chile. Es frecuente recibir pacientes en etapas IIB y IIIB donde el riesgo de compromiso ganglionar pelviano y lumbo-aórtico es elevado y el tratamiento es radioquimioterapia. Objetivo: Análisis retrospectivo de pacientes con cáncer cérvicouterino que recibieron radioterapia que incluía los territorios lumboaórticos. Método: Revisión de pacientes con cáncer cérvicouterino tratadas entre 1995 y 2007 en el Instituto Nacional del Cáncer, Santiago, Chile. En 39 pacientes el tratamiento incluyó las cadenas lumboaórticas. Se analizó toxicidad y evolución. Se utilizaron dos técnicas de radioterapia: la primera durante la década del 90, donde se empleaban dos campos paralelos y opuestos (anterior y posterior) y una segunda actual, donde se irradian en conjunto la pelvis y los lumboaórticos a través de 4 campos (laterales y AP-PA). Resultados: El análisis dosimétrico de las dos técnicas confirma un mayor volumen irradiado de tejidos normales con la técnica de dos campos, fundamentalmente intestino delgado. La toxicidad fue significativamente diferente, siendo la que utilizamos hoy menos tóxica y con bajas complicaciones gastrointestinales, a pesar de recibir un tratamiento de radio-quimioterapia concomitante (55 por ciento vs 0 por ciento). Conclusión: La radioterapia lumboaórtica es un tratamiento con una tolerancia aceptable incluso con quimioterapia concomitante. Esta revisión nos obliga a elaborar un nuevo trabajo para evaluar si la radioterapia lumboaórtica reduce el riesgo de recidiva y aumenta la sobrevida.

Background: Uterine cancer is still a prevalent disease in Chile. Is common to treat patients with tumors in stages IIB and IIIB where the risk of pelvic and paraortic limph node involvement is very high. Its treatment is radio-chemotherapy. Objective: To present a retrospective analysis of patients that suffered cervix-uterine cancer who were treated with radiotherapy including the aortic-lumbar area. Methods: From the revision of patients who were treated of cervix-uterine cancer between the years 1995 and 2007, 39 were treated including aortic-lumbar chains. Evolution and toxicity were analyzed. Two radiotherapy techniques were used. The first one, during the nineties, included two parallel previous and later and opposed fields, and a second technique, currently used, where pelvis and paraortic are radiated at the same time through four lateral (AP-PA) fields. Results: The dosimeter analysis of both techniques shows that there is a higher volume of radiated normal tissue with the two fields techniques, mainly in the small bowel. On the other hand, the toxicity was significantly different being today's technique less toxic and showing low gastrointestinal side effects, despite receiving a simultaneous radio-chemotherapy (55 percent vs 0 percent). Conclusion: The paraortic radiotherapy treatment has an acceptable level of tolerance even under simultaneous radio-chemotherapy. Given the results of this study, we see the need for undergoing a new research project in order to evaluate if the aortic-lumbar radiotherapy may reduce the risk of relapse and increase in survival rate.

[The significance of meconium in the intrahepatic cholestasis of pregnancy]. / Significado del meconio en la colestasia intrahepática del embarazo.

1. We studied 202 pregnant women who were porter of pregnancy intrahepatic cholestasis (CIE). They were attended at the High Risk Fetus Unity (FAR) at the Hospital Salvador Maternity. They were compared with a control group that was composed by 404 patients with normal pregnancy. 2. The patients with CIE presented three times more risk of having a newborn infant of preterm than the other group (p < 0.01) omitting the cesarean factor. 3. The patients with CIE but without an associated pathology, also didn't present a greater risk of having a newborn infant of below weight (< 2,500 g) neither a newborn infant with Apgar 1' > 7, at any gestational age and any way of delivery, than the control group. 4. The risk of having meconium is three times greater in the patients with CIE. This risk increases (Odds ratio = 4.87 with p < 0.01) when they present an associated pathology. 5. Analyzing separately the group of patients with CIE and meconium and comparing with the control group, we didn't find any difference between both groups in relation with the risk of below weight (< 2,500 g), Apgar 1' < 7 and strangely preterm delivery. 6. The presence of meconium in patients with CIE and without an associated pathology, disposing adequate monitoring of pregnancy and delivery, is postulate that it isn't in relation with bad new born infant prognostic.

Significado del meconio en la colestasia intrahepática del embarazo / Meconium in pregnancy intrahepatic cholestasis

1. Se estudiaron 202 pacientes embarazadas portadoras de colestasia intrahepática del embarazo (CIE) que fueron atendidas en la Unidad de Feto de Alto Riesgo (FAR) de la Maternidad del Hospital del Salvador. Se compararon con un grupo control compuesto por 404 pacientes con embarazo de evolución normal. 2. Las pacientes portadoras de CIE presentaron tres veces más riesgo de tener un recién nacido (RN) de pretérmino con respecto a los controles (p < 0,01), descartando la cesárea como factor confundente. 3. Las pacientes con CIE sin patología asociada no presentaron mayor riesgo que los controles de tener un RN de bajo peso de nacimiento (< 2.500 g) o con Apgar al minuto < 7, a cualquier edad gestacional y vía del parto. 4. El riesgo de presentar meconio fue tres veces mayor en las pacientes portadoras de CIE, y éste aumentó aún más (Odds ratio = 4,87 con p < 0,01) al presentar una patología asociada. 5. Analizando separadamente el grupo de pacientes colestásicas con meconio y comparándolas con el 2.500 g), Apgar < 7 al minuto y extrañámente para parto de pretérmino. 6. Se postula que la presencia de meconio en portadores de CIE sin patología asociada, disponiéndose de monitorización adecuada de embarazo y parto, no se relaciona con mal pronóstico perinatal

Cistitis crónica hemorrágica por ciclofosfamida en dermatomiositis refractaria a tratamiento esteroidal / Chronic hemorrhagic cystitis induced by cyclophosphamide in dermatomyositis refractory to corticosteroid treatment

Se describe el caso de una niña de 14 años que a la edad de 7 años consultó por debilidad muscular de grupos proximales y compromiso cutáneo característico de dermatomiositis, confirmada con concentraciones altas de creatinfosfokinasa sérica y alteraciones características en la electromiografía y biopsia muscular. Debido a falta de respuesta a dosis altas de prednisona se le dio ciclofosfamida oral 0,8 mg.kg.día (25 mg.m*), que debió suspenderse a las dieciséis semanas por cistitis hemorrágica, cambiándose el tratamiento a azatioprina por 2 años, después de lo cual hubo remisión completa de la enfermedad. Fue estudiada a los 13 años por hematuria microscópica persistente, demostrándose cistitis crónica mediante cistoscopía y biopsia vesical. Se destaca la presencia de esta complicación con dosis y tiempo total de tratamiento menores a los descritos en la literatura

[A microsurgical technic in infertility due to a tuboperitoneal factor. The results]. / Técnica microquirúrgica en infertilidad por factor tuboperitoneal. Resultados.

The experience with microsurgical technique in 131 infertile women is presented. The 65.7% had distal tubal occlusion and 16.7% had proximal occlusion. In 48.9% of the women the peritoneal factor was present. In 61.8% distal surgery was done: 16.8% fimbrioplasties and 45% neosalphingostomies. The pregnancy rate was 47.4%. The incidence of ectopic pregnancy was 20%. The 85.5% of the pregnancies was performed in the two first years of follow up. With these results the good prognosis factors, with statistical significance, were: a. Age under 30 years. b. Infertility under 10 years of evolution. c. Normal male factor. The results are commented.

Técnica microquirúrgica en infertilidad por factor tuboperitoneal: resultados / Microsurgical technic in infertility by tubal peritoneal factor: results

Se presenta la experiencia con tratamiento microquirúrgico en 131 mujeres infértiles por factor tuboperitoneal. El 65,7% de los casos correspondió a obstrucción tubaria distal y el 16,7% a obstrucción tubaria proximal. El factor peritoneal estuvo presente en 48,9% de los casos. Se efectuó cirugía distal en 61,8% del total, correspondiendo un 16,8% a fimbrioplastias y un 45% a neostomías. La tasa de embarazos fue de 47,4% de las pacientes con seguimiento, con una incidencia de 20% de embarazos tubarios. El 85,5% de los embarazos obtenidos ocurrieron durante los dos primeros años de seguimiento. Del estudio se desprende que factores de buen pronóstico con significancia estadística, son: a. Edad menor de 30 años. b. Infertilidad de menos de 10 años de evolución. c. Factor masculino normal. Se comentan los resultados

Reversión de la esterilidad tubaria con técnica microquirúrgica / Tubal sterility reversal with microsurgical technic

Ciento un pacientes portadoras de una esterilización tubaria, fueron sometidas a recanalización por microcirugía. En 84 pacientes, se logró embarazo, lo que representó un éxito de 83,2. En el primer año de seguimiento, el 79,8% había conseguido el embarazo. La incidencia de Embarazo tubario fue de 9,5%. Se destaca que con una técnica de microcirugía adecuada, efectuada por expertos, se logran excelentes resultados en la reversión de la esterilización de trompas