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Introducción: El virus chikungunya (CHIKV) causa una enfermedad con manifestaciones agudas bien documentadas, pero existen pocos datos sobre la persistencia de síntomas y secuelas a largo plazo. Objetivos: Evaluar la persistencia de signos, síntomas y factores asociados en pacientes con infección por CHIKV en un seguimiento de 6 meses posinfección. Materiales y métodos: Estudio de cohorte ambispectivo que incluyó casos confirmados de CHIKV notificados en abril de 2023 en Coronel Oviedo, Paraguay. Se realizaron entrevistas al mes, a los tres meses y a los 6 meses posinfección. Se analizaron características demográficas, comorbilidades, manifestaciones reumáticas y sintomáticas. Resultados: Ingresaron 333 participantes, completando seguimiento a 6 meses 170 pacientes. A los 6 meses persistieron: dolor de espalda (61.2%), artritis (57.1%), cefalea (54.1%), fatiga (51.2%), mialgia (49.4%), debilidad (47.6%), depresión (45.9%) y artralgia (45.9%). La persistencia de artritis (OR 7.54; p=0.008) y mialgia (OR 3.24; p=0.031) a 6 meses fue mayor en el grupo de 36-45 años. Conclusiones: Alta persistencia de síntomas musculoesqueléticos y fatiga hasta 6 meses posinfección, con tendencia decreciente, pero exacerbación de depresión. Edad entre 36-45 años asociada a mayor persistencia. Se requieren protocolos de seguimiento integral, investigar mecanismos fisiopatológicos y fortalecer prevención, dado el impacto individual y socioeconómico de la enfermedad.
Introduction: Chikungunya virus (CHIKV) causes a disease with well-documented acute manifestations, but there is limited data on the persistence of symptoms and long-term sequelae. Objectives: To evaluate the persistence of signs, symptoms, and associated factors in patients with CHIKV infection during a 6-month post-infection follow-up. Material and Methods: An ambispective cohort study that included confirmed cases of CHIKV reported in April 2023 in Coronel Oviedo, Paraguay. Interviews were conducted at 1, 3 and 6 months post-infection. Demographic characteristics, comorbidities, rheumatic, and symptomatic manifestations were analyzed. Results: 333 participants were enrolled, with 170 patients completing the 6-month follow-up. At 6 months, the following symptoms persisted: back pain (61.2%), arthritis (57.1%), headache (54.1%), fatigue (51.2%), myalgia (49.4%), weakness (47.6%), depression (45.9%), and arthralgia (45.9%). The persistence of arthritis (OR 7.54, p=0.008) and myalgia (OR 3.24, p=0.031) at 6 months was higher in the 36-45 age group. Conclusions: High persistence of musculoskeletal symptoms and fatigue up to 6 months post-infection, with a decreasing trend but exacerbation of depression. Age between 36-45 years was associated with greater persistence. Comprehensive follow-up protocols, investigation of pathophysiological mechanisms, and strengthening prevention are required, given the individual and socioeconomic impact of the disease.
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Introducción: La Comisión Nacional de Residencias Médicas (CONAREM) es el principal sistema de admisión para la tutoría clínica de residencias médicas en Paraguay, avalado por Ministerio de Salud Pública y Bienestar Social. Objetivos. Determinar la relación entre el puntaje final obtenido y el promedio de grado en postulantes a convocatorias CONAREM 2019-2023. Metodología: Estudio transversal con variables sociodemográficas, académicas, puntajes del examen y puntaje final. Se aplicaron métodos descriptivos y pruebas de Kolmogórov-Smirnov, t de Student, U de Mann-Whitney, Kruskal-Wallis y correlación de Spearman; utilizando software Stata© 17.0 de StataCorp LLC. Se consideraron significativos cuando p<0.05. Resultados: De 2019 a 2023, 4.768 médicos postularon examen CONAREM. 62,12 % eran mujeres, 34,51 % tenían entre 22 y 25 años y 95,30 % estaban solteros. El promedio de grado fue 3,56 ï± 0, 49. La mayoría (69,09 %) provenían de universidades privadas. En las especialidades preferidas, clínica médica fue más común (20,31 %), luego cirugía general y pediatría (ambas 14,30 %), 39,14 % pudo acceder a especialidad preferida. El puntaje final promedio fue 67,92 (RIC 60,78 - 76,76) con diferencias significativas según edad, universidad de procedencia y año de examen. Con modelo de regresión logística se demostró que promedio de grado, edad, universidad pública y primera participación en examen estaban asociados con mayor probabilidad de obtener mejores puntajes. El modelo tenía coeficiente de ajuste de 0, 318, indicando que solo predice el 32 % de resultados. La correlación fue moderada y significativa entre puntaje final y promedio general de grado. Según universidad, la correlación fue baja y no significativa para universidades extranjeras, mientras que universidades públicas y privadas mostraron correlación moderada pero significativa. Discusión. Los mejores promedios de grado se correlacionan moderadamente con mayor probabilidad de puntajes altos y acceder a especialidades de preferencia de los médicos recientemente graduados, provenientes de universidades públicas que hayan rendido por primera vez el examen de la CONAREM.
Introduction: The National Commission of Medical Residencies (CONAREM) is the main admission system for clinical tutoring of medical residencies in Paraguay, endorsed by the Ministry of Public Health and Social Welfare. Objectives: Determine the relationship between the final score obtained and the average degree in applicants to CONAREM calls 2019-2023. Methods: Cross-sectional study with sociodemographic and academic variables, exam scores and final score. Descriptive methods and tests of Kolmogorov-Smirnov, Student's t, Mann-Whitney U, Kruskal-Wallis and Spearman's correlation were applied; using Stata© 17.0 software from StataCorp LLC. They were considered significant when p<0.05. Results: From 2019 to 2023, 4,768 doctors applied for the CONAREM exam. 62.12% had a female female, 34.51% from 22 to 25, and 95.30% were single. The grade point average was 3.56(0.49. The majority (69.09%) came from private universities. As for preferred specialties, medical clinic was more common (20.31%), then general surgery and pediatrics (both 14.30%). 39.14% could access preferred specialty. The average final score was 67.92 and significant differences were found according to age, university of origin and year of examination. With logistic regression model, it was shown that average grade, age, public university and first participation in the exam were associated with a higher probability of obtaining better scores. The model had an adjustment coefficient of 0.318, indicating that it only predicts 32% of outcomes. The correlation was moderate and significant between final score and overall grade point average. By type of university, the correlation was low and not significant for foreign universities, while public and private universities showed moderate but significant correlation. Discussion: The best grade point averages correlate moderately with higher probability of high scores and access to specialties of preference and are associated with recently graduated doctors from public universities and took the exam for the first time.
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Introducción: Se han desarrollado materiales bioactivos para el recubrimiento pulpar directo con el objetivo de preservar la pulpa dentaria y mantener el diente por mayor tiempo en la cavidad oral. Objetivo: El objetivo de esta revisión fue evaluar la efectividad del uso de bioceramicos como material de recubrimiento directo pulpar para mantener la vitalidad pulpar en dientes primarios y permanentes con pulpitis reversible. Metodología: Se realizó una revisión sistemática con meta análisis. Se estudió el éxito en el tratamiento del mantenimiento de la vitalidad, el dolor postoperatorio y la decoloración. Se realizó una búsqueda Electrónica en las bases de datos: MEDLINE, EMBASE, COCHRANE, SCOPUS, LILACS, BBO. Se extrajeron los datos y se analizaron con Rev Man. Resultados: Se incluyeron ensayos clínicos aleatorizados en la cual se realizaron recubrimiento pulpar directo con silicatos tricalcicos comparado con otros materiales de recubrimiento. Comparando tres biocerámicos no se encontraron diferencias significativas en el mantenimiento de la vitalidad pulpar. En cuanto a la decoloración se observaron diferencias estadísticamente significativas a favor de Biodentine (p <0,001). Discusión: la relevancia clínica de estos hallazgos es discutible debido a su pequeña magnitud general y al alto riesgo de sesgo de los estudios incluidos.
Introduction: Bioactive materials have been developed for direct pulp capping in order to preserve the dental pulp and keep the tooth longer in the oral cavity. Objective: The objective of this review was to evaluate the effectiveness of the use of bioceramics as direct pulp capping material to maintain pulp vitality in primary and permanent teeth with reversible pulpitis. Methods: A systematic review with meta-analysis was performed. Success in treating vitality maintenance, postoperative pain, and discoloration was studied. An electronic search was carried out in the databases: MEDLINE, EMBASE, COCHRANE, SCOPUS, LILACS, BBO. Data were extracted and analyzed with Rev Man. Results: Randomized clinical trials in which direct pulp capping with tricalcium silicates was performed compared with other capping materials were included. Comparing three bioceramics, no significant differences were found in the maintenance of pulp vitality. Regarding discoloration, statistically significant differences were observed in favor of Biodentine (p <0.001). Discussion: the clinical relevance of these findings is debatable due to their small overall magnitude and the high risk of bias of the included studies.
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A cross-sectional study was carried out to identify the resistance profile of Staphylococcus aureus colonizing the oral cavity of patients. Sampling was carried out with sterile swabs. Mannitol-positive colonies were cultured on blood agar, identifying S. aureus by conventional biochemical tests that included positive results for catalase, coagulase, DNAse and latex agglutination test for S. aureus. The resistance to 11 antibiotics was tested. Forty-three subjects were included; 83.7% presented oral pathologies, and 6.9% had a history of hospitalization, 18.6% mentioned having used antibiotics in the last three months. S. aureus was isolated in 3 patients; the 3 isolates presented resistance to penicillin, while 2 of the three isolates were resistant to oxacillin and cefoxitin. Resistance to erythromycin and clindamycin was also present in one patient. Two of the cases presented resistance to various drugs and didn´t report any risk factors.
Se realizó un estudio transversal para identificar el perfil de resistenia de S. aureus que se encuentra colonizando la cavidad bucal de los pacientes. La toma de muestras se realizó con hisopos estériles. Se cultivaron colonias positivas a manitol en agar sangre, identificándose S. aureus mediante pruebas bioquímicas convencionales que incluyeron resultados positivos para catalasa, coagulasa, ADNasa y aglutinación en látex para S. aureus. Se probó la resistencia a 11 antibióticos. Se incluyeron cuarenta y tres sujetos; el 83,7% presentó patología bucal y el 6,9% tenía antecedentes de hospitalización, el 18,6% mencionó haber utilizado antibióticos en los últimos tres meses. Se aisló S. aureus en 3 pacientes; los 3 aislados presentaron resistencia a penicilina, mientras que 2 de los tres aislados fueron resistentes a oxacilina y cefoxitina. Un paciente también presentó resistencia a eritromicina y clindamicina. Dos de los casos presentaron resistencia a diversos fármacos, sin haber reportado factores de riesgo.
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Introducción: La transmisión viral a menudo se propaga en grupos, donde las infecciones se pueden rastrear hasta un caso índice o una ubicación geográfica, para así poder tomar medidas de prevención al respecto. Entender el perfil de transmisión del SARS-CoV-2 es esencial para desarrollar estrategias efectivas de prevención y control de la enfermedad. Objetivo: Determinar el perfil de transmisión del Sars-Cov-2, a partir de clúster con casos índices identificados, en la V región sanitaria (Caaguazu) del Paraguay, entre julio y octubre del 2020. Metodología: Se realizó un estudio observacional, descriptivo, de corte transversal, con fichas de notificación de casos de COVID-19 y resultados laboratoriales de la RT_PCR en pacientes diagnosticados con COVID-19 en la V Región Sanitaria entrejulio y octubre del 2020. Resultados: Fueron identificadas 703 personas con Sars-Cov-2 positivo. El 55,49 % de las personas no reconoció algún nexo de contagio. Con respecto al tipo de evento donde ocurrían con mayor frecuencia los contagios, ocurrieron en Eventos Sociales en 58,14 % de los casos y en el Ambiente Familiar en el 33,89 %. La transmisión secundaria se observó en el 17,40 % de los casos. Fueron identificados 58 Clústers, con una mediana de tamaño de los mismos de 3 (RIQ 2-4), y 267 personas (37,98 %) asociadas a los mismos. Discusión: La mayoría de las personas no reconocieron su nexo de contagio, sin embargo, en los que, si conocieron, se puede observar que la participación en eventos sociales fue el principal nexo, por lo que es fundamental realizar este tipo de ejercicios para hacer el seguimiento oportuno de los casos.
Introduction: Viral transmission often spreads in clusters, where infections can be traced to an index case or a geographic location, in order to take preventive measures in this regard, understanding the transmission profile of SARS-CoV-2 is essential. to develop effective disease prevention and control strategies. Objective: to determine the transmission profile of Sars-Cov-2, from clusters with identified index cases, in the V health region (Caaguazú) of Paraguay, between July and October 2020. Methodology: We carried out an observational, descriptive, cross-sectional study, with notification sheets of COVID-19 cases and laboratory results of the RT_PCR in patients diagnosed with COVID-19 in the V Sanitary Region between July and October 2020. Results: We identified 703 people with positive Sars-Cov-2. 55.49% of people did not recognize any contagion link. Regarding the type of event where infections occurred most frequently, was in Social Events in 58.14% of the cases and the Family Environment in 33.89%, secondary transmission was observed in 17.40% of the cases. 58 Clusters were identified, with a median size of 3 (IQR 2-4), and 267 people (37.98%) associated with them. Discussion: Most of the people did not recognize their contagion link, however, in those who did know, the main link was because they participated in social events, so it is essential to carry out this type of exercise to do timely follow-up. of the cases.
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Introducción: Durante la pandemia por COVID-19, factores como cierre de fronteras, recepción tardía de vacunas, limitación de circulación de la población, reubicación de enfermeros/as de áreas de vacunación a áreas de atención de pacientes con COVID-19, sumado el miedo al contagio, afectaron las coberturas de vacunación en varios países. Objetivo: Describir la percepción sobre la vacuna COVID-19 y su efecto en la cobertura de vacunación regular de pueblos indígenas del departamento de Presidente Hayes, Paraguay. 2022. Metodología: Estudio observacional descriptivo, retrospectivo de diseño cuali-cuantitativo de corte transversal. Resultados: Las características de los pueblos indígenas revela que 110(26,44 %) se ubica entre 28 a 37 años, 276(66,35 %) del sexo femenino, 133(31,97 %) son de la etnia Angaité, 290(69,71 %) poseen estudios hasta el nivel primario y 178(42,79 %) de estado civil soltero. La percepción hacia la vacunación COVID-19 fue favorable en 201 sujetos (48 %) y muy desfavorable en 148 (36 %). Existen pueblos indígenas con gran influencia de creencias culturales y religiosas en relación con las vacunas. La vacunación regular se vio afectada. Discusión: Se observó que la pandemia del COVID-19 y la aparición de la vacuna desarrolló desconfianza no solo en la vacuna COVID-19 si no también en el resto de las vacunas en algunos de los pueblos estudiados.
Introduction: During the COVID-19 pandemic, factors such as border closures, late receipt of vaccines, limitation of population circulation, relocation of nurses from vaccination areas to areas of care for patients with COVID-19, added to the fear of contagion affected vaccination coverage in several countries. Objective: Describe the perception of the COVID-19 vaccine and its effect on the regular vaccination coverage of indigenous peoples in the department of Presidente Hayes, Paraguay 2022. Methods: Descriptive, retrospective, observational study with a qualitative-quantitative cross-sectional design. Results: The characteristics of the indigenous peoples reveals that 110 (26.44%) are between 28 and 37 years old, 276 (66.35%) are female, 133 (31.97%) are of the Angaité ethnic group, 290 (69.71%) have studies up to the primary level and 178 (42.79%) have single marital status. The perception towards the COVID-19 vaccination was favorable in 201 subjects (48%) and very unfavorable in 148 (36%). There are indigenous peoples with great influence of cultural and religious beliefs in relation to vaccines. Regular vaccination was affected. Discussion: It was observed that the COVID-19 pandemic and the appearance of the vaccine developed distrust not only in the COVID-19 vaccine but also in the rest of the vaccines in some of the towns studied.
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Introduction: the in vitro study compared the dynamic cyclic fatigue resistance of 3 reciprocating NiTi files with heat treatment. Methods: we distributed 30 new endodontic files in three groups. The endodontic files selected for this experiment were: AF Blue R3 25/06 (AFB) (Fanta Dental, Shanghai, China), X1 Blue File 25/06 (X1B) (MK Life, Porto Alegre, RS, Brazil), and Reciproc Blue 08/25 (RB) (VDW, Munich, Germany. We measured the time to file fractureand the length of the fractured fragment. ANOVA analysis was used, followed by the Tukey test for multiple comparisons, with a significance level of 5% (P < 0,05). Results: the mean time in seconds until the file fractured was 170.7 ±15,1 for AFB files, 110,4 ±26,8 for X1B, and 163,3 ±22,9 for RB files. This difference was statistically significant when comparing X1B to AFB (p: 0,000) and X1B to RB (p: 0,000). However, there are no statistically significant differences between RB and AFB (p:0,739). Conclussions: this study found that RB and AFB files exhibit similar resistance to cyclic fatigue.
Introducción: el estudio in vitro comparó la resistencia a la fatiga cíclica dinámica de 3 limas NiTi recíprocas con tratamiento térmico. Métodos: distribuimos 30 limas endodónticas nuevas en tres grupos. Las limas endodónticas seleccionadas para este experimento fueron: AF Blue R3 25/06 (AFB) (Fanta Dental, Shanghai, China), X1 Blue File 25/06 (X1B) (MK Life, Porto Alegre, RS, Brasil), y Reciproc Blue 08/25 (RB) (VDW, Munich, Alemania. Se midió el tiempo transcurrido hasta la fractura de la lima y la longitud del fragmento fracturado. Se utilizó el análisis ANOVA, seguido de la prueba de Tukey para comparaciones múltiples, con un nivel de significación del 5% (P < 0.05). Resultados: el tiempo medio en segundos hasta la fractura de la lima fue de 170.7 ±15.1 para las limas AFB, 110.4 ±26.8 para las X1B y 163.3 ±22.9 para las RB. Esta diferencia fue estadísticamente significativa al comparar X1B con AFB (p: 0.000) y X1B con RB (p: 0.000). Sin embargo, no hay diferencias estadísticamente significativas entre RB y AFB (p:0.739). Conclusiones: en este estudio se ha comprobado que las limas RB y AFB presentan una resistencia similar a la fatiga cíclica.
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INTRODUCTION: HIV prevalence among transgender women is high worldwide. The objectives of the present study were to estimate the current prevalence of HIV and identify factors associated with high HIV burden among transgender women in Paraguay. METHODS: Transgender women aged ≥15 years in four regions of Paraguay were recruited by Starfish sampling between February and March 2021. RESULTS: In total, 322 transgender women were included. Mean age was 31 years (range 15-67), and 102 had positive HIV test results (31.7%, 95% confidence interval [CI] 26.6-37.1). In multivariable analysis, factors associated with HIV infection were age at first intercourse ≤17 years (adjusted odds ratio [aOR] 5.47; 95% CI 1.05-28.42), >10 years difference in age with the last sexual partner (aOR 1.60; 95% CI 1.04-2.46), substance use (mostly cocaine) (aOR 3.00; 95% CI 1.47-6.12), higher risk perception (aOR 3.08; 95% CI 1.53-6.17), not testing for HIV (aOR 1.23; 95% CI 1.09-1.39), and accessed by a peer educator (aOR 3.86; 95% CI 1.77-8.38). CONCLUSIONS: Sexual debut as a minor and a large age difference with sexual partners are associated with high burden of HIV among transgender women in Paraguay. Our study corroborates the finding of cocaine use during sex as a risk factor for HIV. Prevention programmes must address structural and social vulnerabilities to stem the tragically high burden of HIV among transgender women.
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Infecções por HIV , Soropositividade para HIV , HIV-1 , Pessoas Transgênero , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Infecções por HIV/epidemiologia , Paraguai/epidemiologia , Comportamento Sexual , Fatores de Risco , PrevalênciaRESUMO
Recent rises in incident tuberculosis (TB) cases in Paraguay and the increasing concentration of TB within prisons highlight the urgency of targeting strategies to interrupt transmission and prevent new infections. However, whether specific cities or carceral institutions play a disproportionate role in transmission remains unknown. We conducted prospective genomic surveillance, sequencing 471 Mycobacterium tuberculosis complex genomes, from inside and outside prisons in Paraguay's two largest urban areas, Asunción and Ciudad del Este, from 2016 to 2021. We found genomic evidence of frequent recent transmission within prisons and transmission linkages spanning prisons and surrounding populations. We identified a signal of frequent M. tuberculosis spread between urban areas and marked recent population size expansion of the three largest genomic transmission clusters. Together, our findings highlight the urgency of strengthening TB control programs to reduce transmission risk within prisons in Paraguay, where incidence was 70 times that outside prisons in 2021.
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Mycobacterium tuberculosis , Tuberculose , Humanos , Mycobacterium tuberculosis/genética , Prisões , Paraguai/epidemiologia , Filogeografia , Estudos Prospectivos , Tuberculose/epidemiologia , Tuberculose/prevenção & controleRESUMO
Introducción. La falta del cumplimiento terapéutico es un problema en el control de la hipertensión arterial. Objetivo. Caracterizar los pacientes no adherentes al tratamiento de hipertensión arterial en pobladores de la V Región Sanitaria del Paraguay. Material y Métodos: Estudio transversal que incluyó pacientes hipertensos conocidos que se encontraban en tratamiento para la hipertensión arterial. Se utilizó la Escala de adherencia a la medicación de Morisky 8 ítems que mide comportamientos de adherencia específicos asociados a la ingesta de medicamentos. Resultados. Se incluyeron163 pacientes, todos considerados no adherentes al tratamiento según la Escala Morinsky MMAS-8. El 52,2% tenía más de 40 años, 66,3% del sexo femenino, 40,5% de nivel universitario, 57,1% casado y el 87,7% vive con la familia. El 66,9% informó trabajar hasta 8 horas por día y el 58,3% con ingresos mayores a 2 salarios mínimos. En cuanto al conocimiento el 53,9% fue alto. El 50% de los pacientes declaró utilizar plantas medicinales para su tratamiento, el 7,4% con depresión frecuentemente o casi siempre y el 22,1% ansiedad frecuentemente o casi siempre. En cuanto a las preguntas de no adherencia, el 53,4% olvidó tomar alguna vez su medicación o dejar de tomarla cuando siente que está bajo control (53,3%),el 44,2% deja de tomar su medicación porque se siente peor con ella y el 46,5% la olvida cuando viaja. Conclusión. La no adherencia en los pacientes de la V Región fue alarmante, por tanto, se deben de realizar medidas de acción respecto a las mismas. Palabras Clave: hipertensión; presión arterial; cumplimiento y adherencia al tratamiento; epidemiologia
Introduction. The lack of therapeutic compliance is a problemto control high blood pressure.Objective. To characterize patients who do not adhere to the treatment of arterial hypertension in the Vsanitary region of Paraguay. Material and Methods: A cross-sectional study was carried out in known hypertensive patients who were undergoing treatment for high blood pressure. The 8-item Morisky Medication Adherence Scale was used, which measures specific adherence behaviors associated with medication intake. Results.163 patients were included, all considered non-adherent to treatment according to the Morinsky MMAS-8 Scale. 52.2% were over 40 years old, 66.3% female, 40.5% with university level, 57.1% married, and 87.7% lived with their family. 66.9% reported working up to 8 hours per day and 58.3% with income greater than 2 minimum wages. Regarding knowledge, 53.9% was high. 50% of the patients declared using medicinal plants for their treatment, 7.4% with depression frequently or almost always and 22.1% with anxiety frequently or almost always. Regarding the non-adherence questions, 53.4% ever forgot to take their medication or stopped taking it when they feel they are under control (53.3%), 44.2% stop taking their medication because they feel worse with it and 46.5% forget it when traveling. Conclusion. The non-adherence in patients from Region V was alarming, therefore, action measures must be taken regarding them. Key words:hypertension; blood pressure; treatment adherence and compliance; epidemiology
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Humanos , Masculino , Feminino , Hipertensão , Epidemiologia , Pressão ArterialRESUMO
BACKGROUND: There is an increasing concern regarding the mental health of healthcare workers during the COVID-19 pandemic. AIMS: This study aimed to assess the psychological impact of the COVID-19 exposure among Paraguayan healthcare workers. METHODS: A cross-sectional descriptive study has been carried out in five hospitals of Paraguay. Demographic and occupational exposure to COVID-19 were collected through a short questionnaire. Mental health status was assessed with the GAD-7, the PHQ-9, and the PCL-C. Logistic regression was used to determine psychological risk factors. RESULTS: 432 participants were surveyed. 218 (50.46%) were physicians. The prevalence of symptoms of anxiety, depression and PTSD was 48.15, 41.90, and 5.79%, respectively. There were no significant differences in anxiety (128 [29.63%] vs. 80 [18.52%]; p = 0.3303), depression (102 [23.61%] vs. 79 [18.29%]; p = 0.6703), or PTSD (14 [3.24%] vs. 11 [2.55%]; p = 0.8074) between frontline versus second-line workers. Main risk factors associated with psychological distress included work experience <5 years for depression and a COVID-19 positive diagnosis or having family/friends with a COVID-19 positive diagnosis for PTSD. CONCLUSIONS: Paraguayan healthcare workers reported high prevalence of anxiety, depression, and a low prevalence of PTSD. A positive diagnosis of COVID-19 and work experience <5 years are important psychological risk factors.
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COVID-19 , Humanos , COVID-19/epidemiologia , Saúde Mental , SARS-CoV-2 , Pandemias , Estudos Transversais , Paraguai/epidemiologia , Depressão/epidemiologia , Depressão/etiologia , Pessoal de Saúde/psicologia , Ansiedade/epidemiologia , Ansiedade/etiologia , Fatores de RiscoRESUMO
This study aims to report the epidemiological characterization, incidence, mortality and prognostic factors of tuberculosis in indigenous patients of Paraguay from 2018 to 2022. A retrospective cohort study was carried out with data extracted from the National Tuberculosis Program from January 2018 to June 2022. The clinical records of 1659 indigenous patients were included in the study. The indigenous population with tuberculosis in the period 2018-2022 was between 0 and 20 years old (25.4%), mostly female (54.6%), residing in Presidente Hayes (22.4%), and was from the rural area (74.3%), of the Mbya ethnic group (20.4%). The diagnosis was bacteriological in 69.2%, 96.1% had pulmonary location, 94.5% of the study population started treatment and 1.1% presented drug-resistance, while 88.3% corresponded to new cases. The highest number of new cases of tuberculosis in indigenous people was 336 in 2019. The incidence of tuberculosis was associated with age and area of residence, being more incident in the youngest and in the Presidente Hayes area. A total of 11.2% died, and the highest number of deaths occurred in 2019 with 47 cases (14%). We observed that the elderly, who did not start treatment, and who were coinfected with HIV were more likely to die from tuberculosis. The number of new cases and mortality from tuberculosis is high in the Paraguayan indigenous population. Age and coinfection with HIV continue to be risk factors for mortality.
Este estudio tiene como objetivo reportar la caracterización epidemiológica, incidencia, la mortalidad y los factores pronósticos de la tuberculosis en pacientes indígenas en Paraguay de 2018 a 2022. Se realizó un estudio de cohorte retrospectivo con datos extraídos del Programa Nacional de Tuberculosis desde enero 2018 hasta junio de 2022. Se incluyeron en el estudio las historias clínicas de 1.659 pacientes indígenas. La población indígena con tuberculosis en el período 2018-2022 presentaba las siguientes características: entre 0 y 20 años (25,4%), sexo femenino (54,5%), residente en Presidente Hayes (22,4%), del área rural (74,3%), y de la etnia Mbya (20,4%). El diagnóstico fue bacteriológico en el 69,2% y el 96,1% era de localización pulmonar, el 94,5% de la población estudiada inició tratamiento y el 1,1% presentó resistencia, el 88,3% correspondió a casos nuevos. El mayor número de casos nuevos de tuberculosis entre indígenas fue de 336 en 2019. La incidencia de tuberculosis estuvo asociada a la edad y zona de residencia, siendo más frecuente entre los más jóvenes y en la zona de Presidente Hayes. Murió un total del 11,2%, y el mayor número de muertes se produjo en 2019 con 47 casos (14%). Se constató que las personas mayores que no habían iniciado el tratamiento y que estaban coinfectadas con el VIH tenían más probabilidades de morir de tuberculosis. El número de casos nuevos y mortalidad por tuberculosis es alto en la población indígena paraguaya. La edad y la coinfección por el VIH siguen siendo factores de riesgo de mortalidad.
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El objetivo del estudio fue identificar la resistencia del Mycobacterium tuberculosis a los fármacos en Paraguay, 2014 a 2017. Se realizó un estudio observacional retrospectivo. Se utilizaron los datos del Programa Nacional de Tuberculosis del Paraguay comprendidos entre los años 2014 a 2017. Se incluyeron todos los pacientes con diagnóstico de Tuberculosis que se realizaron un test de resistencia. Se extrajeron los datos en Excel y fueron analizados con Stata 17.0. Se incluyeron 3429 pacientes con tuberculosis que contaban con resultado de al menos una prueba de sensibilidad. La resistencia se encontró en 2.1% de los pacientes. La resistencia a la Rifampicina estuvo presente en el 0.3% de los casos mientras que a la Izionazida en el 0.6% de los casos. La prevalencia de resistencia fue más alta en hombres 3.4 (IC 95% 2.2 - 4.8) p=0.003, que residían en el chaco 6.0 (IC 95% 3.4 - 9.7) p=0.000, previamente tratados 2.7 (IC 95% 1.1 - 5.1) p=0.010. En el modelo se pudo observar que un paciente previamente tratado tiene mayores posibilidades de tener resistencia OR 2.62 (IC 95% 1.1 - 6.24). La prevalencia de resistencia del Mycobacterium tuberculosis a fármacos estuvo relacionada con haber sido previamente tratado
The objective of the study was to identify the resistance of Mycobacterium tuberculosis to drugs in Paraguay, 2014 to 2017. A retrospective observational study was carried out. The data from the National Tuberculosis Program of Paraguay between the years 2014 to 2017 were used. All patients with a diagnosis of Tuberculosis who underwent a resistance test were included. Data were extracted in Excel and analyzed with Stata 17.0. 3429 tuberculosis patients who had a result of at least one sensitivity test were included. Resistance was found in 2.1% of patients. Resistance to Rifampicin was present in 0.3% of cases while to Izionazide in 0.6% of cases. The prevalence of resistance was higher in men 3.4 (95% CI 2.2 - 4.8) p = 0.003, who resided in the Chaco 6.0 (95% CI 3.4 - 9.7) p = 0.000, previously treated 2.7 (95% CI 1.1 - 5.1) p = 0.010. In the model, it was observed that a previously treated patient has a greater chance of having resistance OR 2.62 (95% CI 1.1 - 6.24). The prevalence of resistance of Mycobacterium tuberculosis to drugs was related to having been previously treated
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Tuberculose , Mycobacterium tuberculosis , Rifampina , Preparações Farmacêuticas , Vigilância em DesastresRESUMO
BACKGROUND: Our study aimed to measure HIV prevalence and associated risk factors among men who have sex with men (MSM) in three regions of Paraguay in 2020. METHODS: MSM were recruited for cross-sectional surveys in three regions of Paraguay using respondent-driven sampling. Interview were conducted face-to-face to collect demographic characteristics and risk and preventive behaviors. The analysis assessed HIV prevalence and associated risk factors in the three samples of MSM within each region. RESULTS: A total of 1,207 MSM were recruited, including 559 in Asunción-Central, 245 in Alto Paraná, and 403 in Caaguazú. HIV prevalence was 24.2% (95% CI 20.6-27.9) in Asunción-Central, 10.2% (95% CI 6.7-14.6) in Alto Paraná, and 3.2% (95% CI 1.7-5.4) in Caaguazú. In Asunción-Central, associations with HIV were age ≥25 years (1.86, 95% CI 1.15-3.00), being employed (1.82, 95% CI 1.07-3.11), self-reporting as homosexual (1.90, 95% CI 1.06-3.43), having sex with a known HIV-positive partner acquisition (4.19, 95% CI 2.37-7.43), self-perceived as being at higher risk for HIV acquisition (4.15, 95% CI 2.54-6.77), and able to access condoms and lubricants (1.82, 95% CI 1.08-3.05). In Alto Paraná, associations with HIV were self-reporting as homosexual (4.33, 95% CI 1.19-15.65) and having higher HIV knowledge (2.53, 95% CI 0.97-6.61). In Caaguazú, associations with HIV were self-reporting as homosexual (7.06, 95% CI 1.53-32.46) and being diagnosed with depression (4.68, 95% CI 0.89-24.43). CONCLUSIONS: HIV prevalence among MSM in Paraguay varied by region, being highest in the capital and major metropolitan area of Asunción-Central, followed by the border area of Alto Paraná. While being self-identified as homosexual was associated with HIV in all three regions, other associations differed, indicating prevention programs need to be tailored to the locale.
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Infecções por HIV , Minorias Sexuais e de Gênero , Masculino , Humanos , Adulto , Homossexualidade Masculina , Comportamento Sexual , Prevalência , Estudos Transversais , Paraguai/epidemiologia , Infecções por HIV/diagnóstico , Fatores de Risco , Inquéritos e Questionários , Assunção de RiscosRESUMO
RESUMEN El objetivo del estudio fue identificar los hábitos alimentarios relacionados al nivel de estrés de los estudiantes de la Universidad Nacional de Caaguazú durante la pandemia del COVID-19. Se realizó un estudio descriptivo, observacional, de corte transversal donde se seleccionaron 353 estudiantes de las diferentes facultades. Se estudiaron las variables demográficas, los hábitos alimentarios y el estrés académico. Se incluyeron en el estudio 353 estudiantes universitarios, 64,9% del sexo femenino, 59,5% menores de 23 años. El 36,5% pertenecía a la facultad de ciencias de la producción mientras que el 29,7% fue del tercer año. En total el 64,8% (229 estudiantes) tuvieron nivel de estrés alto. El nivel de estrés alto estuvo relacionado a un alto consumo de dulces (AOR= 2,94, 1,57-5,51), alto consumo de comida rápida (AOR= 2,23, 1,14-4,32), bajo consumo de frutas (AOR= 1,66, 0,99-2,79), saltarse el almuerzo (AOR= 2,94, 1,55-5,60) y el aumento de las colaciones diarias (AOR= 3,36, 1,74- 6,47). Los resultados de nuestro estudio visibilizaron la problemática de que el estrés académico durante la pandemia del COVID-19 influyó en la adquisición de malos hábitos alimentarios.
ABSTRACT The objective of the study was to identify the eating habits related to the level of stress among students of the National University of Caaguazú during the COVID-19 pandemic. A descriptive, observational, cross-sectional study was carried out with 353 students selected from different faculties. Demographic variables, eating habits and academic stress were studied. A total of 353 university students were included in the study, 64.9% female, and 59.5% under 23 years of age. 36.5% belonged to the Faculty of Production Sciences while 30% were from the third year. In total, 64.8% (229 students) had a high level of stress. High stress level was related to high consumption of sweets (AOR= 2.94, 1.57-5.51), high consumption of fast food (AOR= 2.23, 1.14-4.32), low consumption of fruits (AOR= 1.66, 0.99-2.79), skipping lunch (AOR= 2.94, 1.55-5.60), and increased daily snacks (AOR= 3.36, 1.74-6.47). The results of our study made visible the problem that academic stress during the Covid-19 pandemic influenced the acquisition of bad eating habits.
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INTRODUCCIÓN: La tasa de mortalidad estimada de tuberculosis (TBC) en Paraguay en 2019 fue de 3,9 por 100.000 habs. Las comunidades indígenas presentan un elevado riesgo de padecer TBC. OBJETIVO: Determinar los factores asociados a la mortalidad en personas de origen indígena con diagnóstico de TBC en Paraguay, 2014-2019. MÉTODOS : Se realizó un estudio observacional retrospectivo. Se utilizaron los datos del Programa Nacional de Control de la TBC del Paraguay comprendidos entre los años 2014 y 2019. Se registraron los datos sociodemográficos y factores de riesgo. RESULTADOS: Se incluyeron 2.210 personas de origen indígena con diagnóstico de TBC, el 53,8% fue de sexo masculino, entre 20 y 39 años (32,3%) y 0 a 19 años de edad (30,2%), la localización de la TBC fue mayoritariamente pulmonar (92,3%). Durante el 2014 a 2019 se observaron 217 muertes (9,8%). Los factores asociados a mortalidad en pacientes con TBC fueron la edad (adOR = 13,95; CI: 7,07-27,55 mayor a 80 años), (adOR = 4,20; CI: 2,59-6,82 mayor a 60 años) y (adOR = 3,30; CI: 2,06-5,28 para 40 a 59 años), la co-infección VIH (adOR =), y la localización de la TBC (adOR = 3,60; CI: 1,88-6,90 para TBC diseminada). CONCLUSIÓN: La mayor edad, el diagnóstico de co-infección VIH y localización de la TBC diseminada, están asociados a un mayor riesgo de muerte en población indígena con TBC.
BACKGROUND: The estimated tuberculosis (TB) mortality rate in Paraguay in 2019 was 3.9 per 100,000 people. Indigenous communities are at high risk for TB. AIM: To determine the factors associated with mortality in indigenous people with a diagnosis of TB in Paraguay, 2014-2019. METHODS: A retrospective observational study was done. sociodemographic data and risk factors data from the National TB Program of Paraguay between the years 2014 to 2019 were used. RESULTS: A total of 2,210 indigenous people with a diagnosis of TB were included, 53,8% were male, between 20 to 39 (32.3%) and 0 to 19 years old (30.2%), the localization of TBC was majority pulmonary (92.3%). During 2014 to 2019 the were 217 deaths (9.8%). The factors associated to mortality in TB patients were the age (adOR = 13.95; CI: 7.07-27.55 older than 80 years), (adOR = 4.20; CI: 2.59-6.82 older than 60 years), and (adOR = 3.30; CI: 2.06 - 5.2840 to 59 years), HIV co-infection (adOR = 7.07; CI 3.74-13.87), and localization of TB (adOR = 3.60; CI: 1.88-6.90 for disseminated TB). CONCLUSION: Older age, HIV co-infection and disseminated localization of TBC are associated with a higher risk of death in indigenous people with TB.
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Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Tuberculose/mortalidade , Indígenas Sul-Americanos , Paraguai/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores SociodemográficosRESUMO
PURPOSE: To evaluate the effect of Carica papaya mouthrinse as an inhibitor of Streptococcus mutans. METHODS: This was a double blind (subject and evaluator) randomized controlled trial in 40 subjects distributed in two groups: Carica papaya mouthrinse intervention (n= 20) or chlorhexidine (n= 20). The antibacterial effect was determined by counting colony-forming units per milliliter (CFU/ml) of S. mutans in saliva sample cultures; taken both before mouthrinse, immediately after 10 minutes mouthrinsing, and 8 days after mouthrinsing. The data was statistically analyzed with Student's t-test (P ≤ 0.05). RESULTS: The difference before and immediately after (10 minutes) use of Carica papaya mouthrinse was of 764 CFUs. After 8 days use the difference was 212 CFUs. For the control group (0.12% chlorhexidine) the difference before and immediately after use (10 minutes) was 683 CFUs. After 8 days use the difference was 455 CFU. When comparing between groups applying t-test, no statistical differences were found in the (CFU/ml) of S. mutans before and after 10 minutes mouthrinse (P= 0.8060), 10 minutes and 8 days after mouthrinsing (P= 0.7104) before and 8 days after mouthrinsing (P= 0.4419). CLINICAL SIGNIFICANCE: Carica papaya could be an alternative mouthrinse for the inhibition of Streptococcus mutans.
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Carica , Streptococcus mutans , Clorexidina/farmacologia , Humanos , Antissépticos Bucais/farmacologia , SalivaRESUMO
The objective of this study was to evaluate the antibacterial effect of a green tea infusion used as a mouthwash. In this double-blind, randomized controlled study, simple randomization was used to divide 28 students, 18 to 40 years of age, into 2 groups (n = 14): green tea (intervention) or distilled water (placebo). A 13% green tea infusion was prepared with 13 g of green tea (commercially fractionated) in 100 mL of saline solution at a temperature of approximately 90°C. The liquid was poured into sterile glass containers, as was the distilled water for the control group. The antibacterial effect was determined by counting the colony-forming units in cultures of plaque and saliva samples, which were obtained before and immediately after the students rinsed their mouth once with 10 mL of the green tea or control solution. The data were subjected to t tests to analyze differences before and after the intervention and between groups (green tea versus distilled water) (P < 0.05). The analysis showed statistically significant differences between the groups (P < 0.05), with participants in the green tea group demonstrating greater reductions in the numbers of colony-forming units. Green tea mouthwash had an antibacterial effect on saliva and bacterial plaque, suggesting that green tea mouthwash could be a beneficial addition to standard oral hygiene measures. Trial registration: ClinicalTrials.gov Identifier NCT04410666.
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Placa Dentária , Antissépticos Bucais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Placa Dentária/tratamento farmacológico , Placa Dentária/prevenção & controle , Humanos , Saliva , CháRESUMO
Resumen La leishmaniasis es la tercera de las enfermedades de transmisión vectorial a humanos en importancia por el número de casos y la población en riesgo. En Paraguay la leishmaniasis cutánea es una enfermedad endémica atribuida en casi todos los casos a Leishmania (Viannia) braziliensis. El objetivo del artículo es describir las características demográficas y clínicas de una serie de casos de pacientes con leishmaniasis en el V departamento de Caaguazú y departamentos cercanos, epidemiológicamente endémicos. Se reportan casos diagnosticados en los meses enero a diciembre del año 2019. Los casos se presentaron en el departamento de Caaguazú, abarcando los diferentes distritos que componen y departamentos cercanos como Canindeyú, Alto Paraná y Guaira. De los casos registrados (9 casos) fueron hombres y (6 casos) tuvieron entre 50 a 70 años de edad. La lesión estuvo situada mayormente en el tabique nasal en 8 casos, con una evolución de menos de 10 años (6 casos) y en 4 casos dejo cicatriz. Solo 3 casos completaron su tratamiento. Se sugiere realizar el reporte de casos para tener un panorama de los casos de leishmaniasis en Paraguay como vigilancia sanitaria de la enfermedad y localizar focos de contagio.
Abstract Leishmaniasis is the third most important vector-borne diseases in humans due to the number of cases and the population at risk. In Paraguay, cutaneous leishmaniasis is an endemic disease attributed in almost all cases to Leishmania (Viannia) braziliensis. The objective of the article was to describe the demographic and clinical characteristics of a series of cases of patients with leishmaniasis in the V department of Caaguazú and nearby departments, epidemiologically endemic. Cases diagnosed in the months of January to December of the year 2019 are reported. The cases occurred in the department of Caaguazú, covering the different districts that make up and nearby departments such as Canindeyú, Alto Paraná and Guaira. Of the registered cases (9 cases) were men and (6 cases) were between 50 and 70 years of age. The lesion was located mainly in the nasal septum in 8 cases, with an evolution of less than 10 years (6 cases) and in 4 cases it left a scar. Only 3 cases completed their treatment. It is suggested to carry out the case report to have an overview of Leishmania cases in Paraguay as a health surveillance of the disease and to locate sources of contagion.
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Resumen: Objetivo: Determinar la prevalencia y los factores de riesgo para sífilis en población indígena masculina de Paraguay durante el año 2017. Material y métodos: Se realizó un estudio observacional, descriptivo, con muestro probabilístico, estratificado y multietápico. Fueron incluidos indígenas de sexo masculino, mayores de 15 años de edad, de cinco familias lingüísticas residentes en Paraguay durante el periodo de estudio. Resultados: La prevalencia de sífilis en hombres de la población indígena de Paraguay fue de 4.50%. Los indígenas que tenían entre 15 y 20 años tuvieron 2.70 probabilidades de presentar sífilis. Asimismo, los participantes que reportaron múltiples parejas en el último año, sexo transaccional y consumir alcohol en la última relación sexual tuvieron 2.69, 3.06 y 2.16 veces la probabilidad de presentar sífilis, respectivamente. Conclusiones: Se encontró una prevalencia moderada de sífilis en la población indígena masculina. La prevalencia fue de dos veces más para aquéllos que tenían más de dos parejas sexuales, sexo transaccional y que involucraban alcohol durante la práctica sexual.
Abstract: Objective: To determine the prevalence and risk factors for syphilis transmission of the male indigenous population of Paraguay during 2017. Materials and methods: An observational, descriptive cross-sectional study was conducted with multi-epic stratified probabilistic sampling. They were included in the study indigenous male, over 15 years of age, of five linguistic families resident in Paraguay during the study period. Results: The prevalence of syphilis in men of the indigenous population of Paraguay was 4.50%. Indigenous people who were 15 to 20 years old had 2.70 times the probability of presenting syphilis, as well as the participants who reported multiple partners in the last year, transaccional sex and consumed alcohol in the last sexual intercourse had 2.69, 3.06 and 2.16 times the probability of presenting syphilis. Conclusions: A moderate prevalence of syphilis was found in the male indigenous population. In turn, an opportunity was found twice more to acquire syphilis infection for those who had more than two sexual partners, transactional sex and those who involved alcohol during sexual practice.