RESUMO
RESUMEN Introducción: El diagnóstico de hipertensión arterial (HTA) se realiza por la toma de la presión arterial (PA) en el consultorio médico (C) o en enfermería (E). Es frecuente aproximar los valores obtenidos a múltiplos de 10. Esto puede causar imprecisiones en el diagnóstico y el control de la HTA. Objetivo: Determinar cuántos registros de PA terminaban en cero en las mediciones realizadas en E y en C en dos centros de atención primaria de la salud de la ciudad de Salta. Material y métodos: Se efectuó un estudio descriptivo, transversal, de febrero a diciembre de 2018. Se utilizó un tensiómetro digital. A cada paciente se le midió la PA dos veces, primero en E y luego en C. Se utilizaron las pruebas de Chi2 y de Wilcoxon. Resultados: Se estudiaron 311 individuos, 60,77% mujeres. Edad media: 56,15 ± 13,8 años. Los registros terminados en cero tuvieron las siguientes frecuencias: PA sistólica en E: 36%; PA diastólica en E: 40,51%; PA sistólica en C: 11,58%; PA diastólica en C: 7,72% (p <0,0001). La PA sistólica y diastólica terminaron simultáneamente en cero en el 30,87% de los casos cuando se midieron en E y en el 0,64% de los casos cuando se midieron en C (p <0,0001). Conclusiones: La PA sistólica y la PA diastólica terminaron en cero con una frecuencia 3 y 5 veces mayor en E que en C, respectivamente, y la frecuencia de registros de PA sistólica y diastólica coincidentemente terminados en cero fue 48 veces mayor en E que en C. Estos resultados refuerzan la necesidad de una capacitación permanente para mejorar el registro en la medición de la PA.
ABSTRACT Background: The diagnosis of hypertension is established by blood pressure (BP) measurements in doctor (DO) or nursing offices (NO). Frecuently BP measurements are recorded as multiples of ten. This can lead to inaccuracy in diagnosis and control of hypertension. Objetive: To determine the percentage of BP measurements ending in zero in DO and NO, in the records of two health primary centers of Salta city. Methods: Observational study from february to december of 2018. Digital blood pressure monitor was used. Each patient BP was measured twice, first in NO and then in DO. Data were analyzed using the Chi2 and Wilcoxon tests. Results: 311 indivuals were enrolled, 60,77% were female. The average age was 56,15 ± 13,8 years. In NO the systolic BP and diastolic BP ending in zero were 36 and 40,51% respectively, while in DO were 11,58 and 7,72% (p <0,0001). The systolic BP and diastolic BP ending in zero simultaneously in NO was 30,87%, while in DO was 0,64% (p <0,0001). Conclusions: The systolic BP and the diastolic BP records ending in zero were three and five times more frequent in NO than in DO. The systolic BP and diastolic BP ending in zero simultaneously in NO were forty-eight times more frequent than in DO. These results reinforce the need of health personnel permanent training to improve precision for measuring and recording BP in medical centers.
RESUMO
RESUMEN Introducción: La hipertensión arterial (HTA) es la primera causa de morbimortalidad cardiovascular. A menudo es una enfermedad mal controlada porque los sistemas de salud están más orientados a atender enfermedades agudas. El Ministerio de Salud de Argentina propuso un nuevo modelo de atención para pacientes hipertensos conocido como MAPEC, basado en el Modelo de cuidados crónicos. Objetivo: Evaluar el impacto de la implementación del MAPEC en el control de la presión arterial (PA), el cuidado de las medidas higiénico-dietéticas, el conocimiento de la enfermedad y la adherencia al tratamiento en pacientes hipertensos asistidos en tres centros de atención primaria de la ciudad de Salta, Argentina. Material y Métodos: Se midió la PA con tensiómetro digital automático; se evaluó el conocimiento de la HTA y la adherencia al tratamiento con los test de Batalla y Morisky-Green-Levine, respectivamente. Resultados: Se estudiaron 232 pacientes. Hubo diferencias significativas (p <0,0001) luego de la intervención en el control de la PA, el conocimiento de la enfermedad, la adherencia al tratamiento y las medidas higiénico-dietéticas. También en los promedios de PA, con una disminución de 12,97 (IC95: 9,52-16,42) mmHg en la presión sistólica y de 6,93 (IC95: 4,70-9,16) mmHg en la presión diastólica. Conclusiones: Fue evidente la mejoría en los parámetros de salud analizados en los pacientes con la implementación del MAPEC. Este modelo es de fácil aplicación y bajo costo. Además, está en consonancia con los objetivos 25×25 de la OMS, mediante los que se busca una reducción del 25% de las muertes prematuras por enfermedades cardiovasculares hacia el año 2025.
ABSTRACT Background: blood hypertension is the first cause of worldwide cardiovascular morbidity and mortality. Nevertheless, it is a poorly controlled disease, largely because health care systems are oriented to the attention of acute diseases. The Argentine Ministry of Health proposed a new care model for hypertensive patients called MAPEC, based on the Chronic Care Model. Objective: to evaluate the impact made by the implementation of MAPEC to improve the blood pressure control, the treatment adherence and changes in life style, and disease awareness, in three primary health centers of Salta city Argentine. Methods: the blood pressure was measured with automated device, Batalla and Morisky-Green-Levine were used to evaluate the disease awareness and treatment adherence, respectively. Results: 232 patients were included. After model implementation, significant difference (p<0,0001) were found in blood pressure control, disease awareness, treatment adherence and changes in life style. There was a decrease in blood pressure average with reduction of 12,97 (IC 95: 9,52-16,42) mm Hg and 6,93 (IC 95: 4,70-9,16) mm Hg in sistolic and diastolic pressure, respectively. Conclusions: there was evident improvement in the analyzed health parameters after MAPEC implementation. This can be easily adapted for primary health centers and with low cost. This is in order with WHO 25×25 target to reduce 25% cardiovascular premature deaths in 2025.
RESUMO
OBJECTIVE: To determine the course of serological tests in subjects with chronic Trypanosoma cruzi infection treated with anti-trypanosomal drugs. METHODS: A systematic review and meta-analysis was conducted using individual participant data. Survival analysis and the Cox proportional hazards regression model with random effects to adjust for covariates were applied. The protocol was registered in the PROSPERO database (http://www.crd.york.ac.uk/PROSPERO; CRD42012002162). RESULTS: A total of 27 studies (1296 subjects) conducted in eight countries were included. The risk of bias was low for all domains in 17 studies (63.0%). Nine hundred and thirteen subjects were assessed (149 seroreversion events, 83.7% censored data) for enzyme-linked immunosorbent assay (ELISA), 670 subjects (134 events, 80.0% censored) for indirect immunofluorescence assay (IIF), and 548 subjects (99 events, 82.0% censored) for indirect hemagglutination assay (IHA). A higher probability of seroreversion was observed within a shorter time span in subjects aged 1-19 years compared to adults. The chance of seroreversion also varied according to the country where the infection might have been acquired. For instance, the pooled adjusted hazard ratio between children/adolescents and adults for the IIF test was 1.54 (95% confidence interval 0.64-3.71) for certain countries of South America (Argentina, Bolivia, Chile, and Paraguay) and 9.37 (95% confidence interval 3.44-25.50) for Brazil. CONCLUSIONS: The disappearance of anti-T. cruzi antibodies was demonstrated along the course of follow-up. An interaction between age at treatment and country setting was found.
Assuntos
Anticorpos Antiprotozoários/sangue , Doença de Chagas/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Doença Crônica , Ensaio de Imunoadsorção Enzimática , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Testes de Hemaglutinação , Humanos , Lactente , Masculino , Testes Sorológicos , Adulto JovemRESUMO
Serological tests are the main laboratory procedures used for diagnosis during the indeterminate and chronic stages of Chagas' disease. A serological regression to negativity is the main criterion used to define parasitological cure in treated patients. The aim of this work was to monitor the individual specificities of antibody levels for 3 years posttreatment in 18 adult patients. Conventional serological techniques (hemagglutination assays and enzyme-linked immunosorbent assay [ELISA]) were modified by using recombinant antigens to detect early markers of treatment effectiveness. For this purpose, serum samples were taken before and during treatment and every 6 months after treatment for at least 3 years. When hemagglutination assays were used, a decrease in antibody levels was observed in only one patient. When ELISA with serum dilutions was used, antibody clearance became much more apparent: in 77.7% (14/18) of the patients, antibody titers became negative with time. This was observed at serum dilutions of 1/320 and occurred between the 6th and the 30th months posttreatment. The immune response and the interval for a serological regression to negativity were different for each patient. For some of the recombinant antigens, only 50% (9/18) of the patients reached the serological regression to negativity. Recombinant antigen 13 might be a good marker of treatment effectiveness, since 66.6% (six of nine) of the patients presented with an early regression to negativity for specific antibodies to this antigen (P = 0.002).
