Prioritizing persons deprived of liberty in global guidelines for tuberculosis preventive treatment.

In this Policy Forum piece, Aditya Narayan and colleagues discuss the challenges and opportunities for tuberculosis preventive treatment in carceral settings.

Intergenerational sex and early sexual debut are associated with HIV infection among transgender women in Paraguay.

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.

Mental health issues and psychological risk factors among Paraguayan healthcare workers during the COVID-19 pandemic.

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.

Prevalencia y factores de riesgo para sífilis en población indígena masculina de Paraguay, 2017.

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 ym 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.

Prevalence of Syphilis and Related Risk Behaviors Among Women in 5 Distinct Indigenous Populations in Paraguay.

BACKGROUND: The objective of this study was to measure the prevalence of syphilis among women of reproductive age from 5 distinct indigenous populations in Paraguay. We also sought to identify the demographic profile and behaviors of women with elevated prevalence of syphilis. METHODS: We conducted a population-based, cross-sectional survey among women aged 15 to 49 years from 5 distinct language families in Paraguay in 2016. The 5 language families were Guaraní, Maskoy, Mataco, Guaicurú, and Zamuco, sampled through a probability-based, multistage cluster design. Participants completed a questionnaire on demographic characteristics and risk-related behavior. Blood samples were drawn for rapid testing for syphilis with confirmation and titers. Participants provided written informed consent; minors had written parental consent and provided their own assent. RESULTS: A total of 1732 indigenous women were enrolled. Overall syphilis prevalence was 6.8% (95% confidence interval [CI], 5.6-8.0). Syphilis prevalence varied by language family/ethnic group (P = 0.010), with Mataco having the highest prevalence (8.2%; 95% CI, 5.3-11.9) and Maskoy having the lowest (2.5%; 95% CI, 1.1-4.7). Women reporting multiple partners (11.3%; 95% CI, 6.9-17.1; P = 0.031) and transactional sex in the last year (18.7%; 95% CI, 7.2-36.4; P = 0.010) had higher prevalence of syphilis. CONCLUSIONS: Our survey found high prevalence of syphilis in indigenous women in Paraguay, in association with transactional sex and multiple partners. Interventions to reduce sexual behaviors associated with an increased risk of sexually transmitted infections (STI) in indigenous women must be carried out with programs aimed at addressing transactional sex, appropriately framed to respect interculturality and an indigenous worldview.

An evaluation of the safety and immunogenicity of MVC-COV1901: Results of an interim analysis of a phase III, parallel group, randomized, double-blind, active-controlled immunobridging study in Paraguay.

BACKGROUND: Data from previous studies of the MVC-COV1901 vaccine, a subunit vaccine against SARS-CoV-2 based on the stable prefusion spike protein (S-2P) adjuvanted with CpG 1018 adjuvant and aluminum hydroxide, suggest that the vaccine is generally safe and elicits a good immune response in healthy adults and adolescents. By comparing with AZD1222, this study adds to the findings from previous trials and further evaluates the breadth of protection offered by MVC-COV1901. METHODS: In this phase 3, parallel group, randomized, double-blind, active-controlled trial conducted in 2 sites in Paraguay, we assigned adults aged 18-91 years in a 1:1 ratio to receive intramuscular doses of MVC-COV1901 or AZD1222 administered as scheduled in the clinical trial. Serum samples were collected on the day of vaccination and 14 days after the second dose. Primary and secondary safety and immunogenicity endpoints were assessed. In addition, other outcomes investigated were cross-reactive immunity against the Omicron strain and the induction of IgG subclasses. RESULTS: A total of 1,030 participants underwent randomization. Safety data was derived from this set while primary immunogenicity data involved a per-protocol immunogenicity (PPI) subset including 225 participants. Among the participants, 58% are seropositive at baseline. When compared against AZD1222, MVC-COV1901 exhibited superiority in terms of neutralizing antibody titers and non-inferiority in terms of seroconversion rates. Reactogenicity was generally mild and no serious adverse event was attributable to MVC-COV1901. Both vaccines have a Th1-biased response predominated by the production of IgG1 and IgG3 subclasses. Omicron-neutralizing titers were 44.5 times lower compared to wildtype-neutralizing titers among seronegative individuals at baseline. This fold-reduction was 3.0 times among the seropositive. CONCLUSION: Safety and immunogenicity data of MVC-COV1901 from the study in Paraguay confirm previous results. The previous infection coupled with vaccination of this vaccine may offer protection against the Omicron strain though its durability is still unknown.

The Chikungunya anxiety scale (CHIKAS): Development, validation, and relationship between its items and illness-related factors.

Background: Paraguay has recently experienced an exponential increase in chikungunya cases, leading to psychological distress, particularly anxiety. Aim: To develop and validate the Chikungunya Anxiety Scale (CHIKAS). Materials and Methods: An initial scale of 18 items was used, which was subjected to validation by expert judgment to obtain 14 items. To determine construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have been employed, and internal and convergent validity were determined. Demographic, socioeconomic, and health status data were also collected. Results: The study included 974 participants. The final scale consisted of 12 items with evidence of a two-factor model (psychological and physical). The internal validity was good (McDonald's omega = 0.882). The CFA showed good adjustment indices. Regarding participant characteristics, a relationship was found between anxiety due to chikungunya and gender, employment, mental diagnosis, medication use, and chikungunya infection. Conclusion: The final 12-item CHIKAS had strong psychometric properties and was a two-factor model.

Increased incarceration rates drive growing tuberculosis burden in prisons and jeopardize overall tuberculosis control in Paraguay.

Incarcerated populations are at high-risk to develop tuberculosis (TB), however their impact on the population-level tuberculosis epidemic has been scarcely studied. We aimed to describe the burden and trends of TB among incarcerated populations over time in Paraguay, its clinical and epidemiological differences and the population attributable fraction. This is an observational, descriptive study including all TB cases notified to the National TB control Program in Paraguay during the period 2009-2018. We also used case registries of prisoners diagnosed with tuberculosis from the Minister of Justice. The population attributable fraction of TB in the community due to incarcerated cases was estimated through Levin's formula. The characteristics of TB cases in and outside of prison were compared as well as the characteristics of TB in prisons were modified over time. During 2009-2018, 2764 (9.7%) of the 28,534 TB reported cases in Paraguay occurred in prisons. The number of prisoners in Paraguay increased from 6258 in 2009 to 14,627 in 2018 (incarceration rate, 101 to 207 per 100,000 persons) while the number of TB cases among prisoners increased by 250% (n = 192 in 2009 versus n = 480 in 2018). The annual TB notification rate among male prisoners was 3218 and 3459 per 100,000 inmates in 2009 and 2018, respectively. The percentage of all TB cases occurring among prisoners increased from 7.1% in 2009 to 14.5% in 2018. The relative risk of TB in prisons compared to community was 70.3 (95% CI, 67.7-73.1); the overall population attributable risk was 9.5%. Among the 16 penitentiary centers in the country, two of them-Tacumbú (39.0%) and Ciudad del Este (23.3%)-represent two thirds of all TB cases in prisons. TB among inmates is predominantly concentrated in those 20-34 years old (77.3% of all), twice the percentage of cases for the same age group outside of prison. Our findings show that the TB epidemic in prisons represents one of the most important challenges for TB control in Paraguay, especially in the country's largest cities. Appropriate TB control measures among incarcerated populations are needed and may have substantial impact on the overall TB burden in the country.

[Clinical-epidemiological characterization of patients with tuberculosis in the Department of Caaguazú, Paraguay. 2014-2017]. / Caracterización clínico-epidemiológica de pacientes con tuberculosis en el Departamento de Caaguazú, Paraguay. 2014 a 2017.

BACKGROUND: Tuberculosis (TB) is one of the ten leading causes of death worldwide. AIM: To characterize the clinical and epidemiological point of view of TB cases reported in the Department of Caaguazú-Paraguay, from 2014 to 2017. METHODS: Observational, descriptive, retrospective study; Population: 659 cases of TB registered in the National Tuberculosis Control Program (NTCP); variables: age, sex, population group, type of TB, TB/HIV coinfection. We procesed database in Excel 2016 © using Stata 14.0®. RESULTS: 63.3% were of male gender, average age: 35.8 years, 39.6% were indigenous and 85.4% were liberty deprived persons known as inmates (LDP), 89.6% had pulmonary TB and 2,4% had TB/HIV coinfection. Incidence rate exceed 21.6/100,000 inhabitants in 2014. Indigenous incidence was 76.5/100,000 inhabitants in 2017, LDP incidence was 2,272.1/ 100,000 inhabitants in 2017. CONCLUSION: The incidence of TB in the Department of Caaguazú is low, mainly affecting men, while TB incidence in indigenous people and LDP was high.

Prevención de Infecciones Respiratorias por VSR: Consenso Interinstitucional

Las infecciones por el VSR en constituyen una causa importante de morbilidad, hospitalización, ausentismo escolar y laboral, así como de mortalidad, en el mundo, así como en el Paraguay.En la actualidad, existen herramientas para la prevención del VSR. En el año 2012, el Paraguay, ha incorporado el palivizumab (MedImmune, EE. UU.), anticuerpo monoclonal, producido por tecnología de DNA recombinante. Este anticuerpo se administra en 5 dosis, cada 30 días y está indicado en lactantes nacidos prematuros y aquellos con trastornos cardiopulmonares. Por otro lado, actualmente se cuenta con una nueva herramienta para la prevención del VSR. El anticuerpo monoclonal de vida media prolongada Nirsevimab, específico para la conformación de prefusión de la proteína F, aprobado por EMA y FDA. Este monoclonal, está indicado para la prevención de las Infecciones respiratorias agudas bajas, causada por VSR en recién nacidos y lactantes nacidos durante o al ingresar a su primera temporada de VSR, en prematuros y lactantes hasta los 24 meses de edad que siguen siendo vulnerables a la enfermedad grave por VSR durante su segunda temporada de VSR. Luego de analizar la situación epidemiológica del VSR en el país así como la evidencia de eficacia, eficiencia y efectividad de este monoclonal; instituciones académicas, sociedades científicas, organizaciones no gubernamentales y gubernamentales se reunieron y elaboraron un consenso interinstitucional para la prevención de las infecciones por VSR, sugiriendo la incorporación del Nirsevimab, en menores de 12 meses de edad antes de su primera temporada de VSR y en reemplazo del Palivizumab, debido a que el nuevo monoclonal tiene el potencial de cambiar el panorama de las infecciones por VSR en el lactante y producir un impacto en la reducción la mortalidad y morbilidad infantil; reduciendo la carga al sistema de salud, en lo que se refiere a la disminución de la ocupación de camas hospitalarias tanto en sala como en unidades de cuidados intensivos, así como la disminución de la carga para los cuidadores, médicos y proveedores de atención médica y la mortalidad infantil.

Respiratory syncytial virus (RSV) infections constitute a significant cause of morbidity, hospitalization, school and work absenteeism, as well as mortality worldwide, including in Paraguay. Currently, tools for RSV prevention are available. In 2012, Paraguay approved the use of palivizumab (MedImmune, USA), a monoclonal antibody produced through recombinant DNA technology. This antibody is administered in 5 doses, every 30 days and is indicated in infants born prematurely and those with cardiopulmonary disorders. Furthermore, a novel tool for RSV prevention has recently become available. Nirsevimab, a long-acting monoclonal antibody specific to the prefusion conformation of the F protein, has been approved by both the European Medicines Agency (EMA) and the Food and Drug Administration (FDA). This monoclonal antibody is indicated for the prevention of acute lower respiratory tract infections caused by RSV in newborns and infants born during or entering their first RSV season, as well as in premature infants and infants up to 24 months of age who remain vulnerable to severe RSV disease during their second RSV season. After analyzing the epidemiological situation of RSV in our country and evaluating the evidence of efficacy, efficiency, and effectiveness of this monoclonal antibody, academic institutions, scientific societies, and non-governmental and governmental organizations developed consensus guidelines on a new prevention alternative for the prevention of RSV infections, suggesting the incorporation of Nirsevimab in children under 12 months of age before their first RSV season and replacing Palivizumab. The new monoclonal has the potential to change the panorama of RSV infections in infants and produce an impact on the reduction of infant mortality and morbidity reducing the burden on the health system by decreasing hospital bed occupancy both in wards and in intensive care units, as well as the decrease in the burden on caregivers, physicians and health care providers.

Tuberculosis burden in indigenous population of Paraguay from 2018 to 2022

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.

Perfil de transmisión del SARS-COV-2 en una región sanitaria del Paraguay

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.

Deficiencias de cobre, hierro y zinc en niños menores de 5 años

Introducción: La determinación de niveles séricos de micronutrientes de los niños menores de 5 años, es un requerimiento básico para establecer la prevalencia de deficiencias nutricionales de la población infantil y es una estrategia útil para incentivar a Salud Pública para que tome medidas en cuanto a aplicación y/o modificación de las Políticas Alimentarias Nacionales. Objetivo: Determinar los niveles séricos de cobre, hierro y zinc en niños paraguayos menores de 5 años. Materiales y Métodos: Estudio observacional, descriptivo y de corte transversal. Se procesaron las muestras de sangre de 1.441 niños menores de 5 años de edad que provenían de los Departamentos de Alto Paraná, Caaguazú, Central y de la capital de Paraguay. Se realizaron hemogramas y se determinaron las concentraciones séricas de albúmina, cobre, ferritina y zinc, de todas las muestras. Resultados: Los niños tuvieron una edad promedio de 3 años y 3 meses, fueron 52,74% de sexo masculino y 47,26% de sexo femenino. La prevalencia de anemia fue de 45,25% y la prevalencia de hipoalbuminemia fue de 20,65%. Se detectaron deficiencias de cobre en 14,03%, de ferritina en 6,98% y de zinc en 43,62%, de los niños. Conclusión: Los resultados de este estudio avalan la necesidad de ampliar la cobertura del Programa Alimentario Nutricional Integral (PANI), de plantearse si se deben ajustar las cantidades de minerales y vitaminas de la fórmula nutricional del Programa y de mejorar el seguimiento de los controles prenatales de las madres.

Introduction: The determination of serum levels of micronutrients in children under 5 years of age is a basic requirement to establish the prevalence of nutritional deficiencies in the child population and is a useful strategy to encourage Public Health agencies to take steps regarding application. and/or modification of National Food Policies. Objective: To determine the serum levels of copper, iron and zinc in Paraguayan children under 5 years of age. Materials and Methods: This was an observational, descriptive and cross-sectional study. Blood samples from 1,441 children under 5 years of age who came from the Departments of Alto Paraná, Caaguazú, Central and the capital of Paraguay were processed. Complete blood counts were performed and the serum concentrations of albumin, copper, ferritin and zinc were determined in all samples. Results: The children in this study had an average age of 3 years and 3 months, they were 52.74% male and 47.26% female. The prevalence of anemia was 45.25% and the prevalence of hypoalbuminemia was 20.65%. Copper deficiencies were detected in 14.03%, ferritin in 6.98% and zinc in 43.62% of the children. Conclusion: The results of this study support the need to expand the coverage of the Comprehensive Nutritional Food Program (PANI program), to consider whether the amounts of minerals and vitamins in the Program's nutritional formula should be adjusted, and to improve prenatal care.

Factores asociados a la mortalidad por tuberculosis en indígenas en Paraguay, 2014 a 2019 / Factors associated with tuberculosis mortality in indigenous people in Paraguay, 2014 to 2019

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.

Vigilancia de la resistencia del Mycobacterium tuberculosis a los fármacos en Paraguay, 2014 a 2017 / Surveillance of drug resistance of Mycobacterium tuberculosis in Paraguay, 2014 to 2017

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

Calidad microbiológica de las fórmulas enterales y las superficies de una unidad de cuidados intensivos

RESUMEN El objetivo de este estudio fue evaluar la calidad microbiológica de fórmulas enterales y superficies, que pudiesen generar contaminación, en una Unidad de Cuidados Intensivos. Se recolectaron 300 muestras (129 fórmulas enterales, 80 superficie ambiental, 66 superficies inertes y 25 superficies vivas). Se utilizaron placas con medios rehidratables y convencionales para inoculación y pruebas bioquímicas (Citrato, LIA, MIO, ONPG, Fenilalanina, SIM, TSI, VP y Ureasa) para identificación. Al valorar recuento bacteriano y presencia de patógenos; las fórmulas enterales fueron 80,6% aceptables y fueron 19,4% inaceptables. El ambiente fue 85% seguro y fue 15% contaminado. Las superficies inertes estuvieron 83,3% limpias y estuvieron 16,7% contaminadas. Las superficies vivas poseían 92% higiene satisfactoria y poseían 8% higiene deficiente. Se aislaron patógenos en los cuatro tipos de muestras y las especies fueron: Acinetobacter baumanii, Klebsiella aerogenes, Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli, Pseudomonas aeruginosa y Staphylococcus aureus. En conclusión, aunque la mayoría de las muestras fue de calidad microbiológica favorable, como se constató presencia de patógenos, se aconseja que se apliquen medidas correctivas, como la priorización del uso de fórmulas de sistema cerrado, la correcta capacitación del personal encargado de manipular la nutrición y la estandarización de un protocolo de desinfección de superficies.

ABSTRACT The aim of this study was to evaluate the microbiological quality of enteral formulas and surfaces, which could generate contamination, in an Intensive Care Unit. Three hundred samples were collected (129 enteral formulas, 80 environmental surfaces, 66 inert surfaces and 25 from hands of health staff). Plates with rehydratable and conventional media were used for inoculation and biochemical tests (Citrate, LIA, MIO, ONPG, Phenylalanine, SIM, TSI, VP and Urease) for identification. When assessing bacterial count and presence of pathogens; enteral formulas were 80.6% acceptable and 19.4% unacceptable. The environment was 85% safe, 15% polluted. Inert surfaces were 83.3% clean, 16.7% contaminated. The hands of health staff had 92% satisfactory hygiene, 8% had poor hygiene. Pathogens were isolated in the four types of samples and the species were: Acinetobacter baumanii, Klebsiella aerogenes, Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. To conclude, although the majority of the samples were of favorable microbiological quality, as the presence of pathogens was confirmed, it is advisable to apply corrective measures, such as prioritizing the use of closed system formulas, the correct training of the personnel in charge of handling the nutrition and standardization of a surface disinfection protocol.

Prevalencia y factores de riesgo para sífilis en población indígena masculina de Paraguay, 2017 / Prevalence and risk factors for syphilis in male indigenous population of Paraguay, 2017

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.

Características clínico-epidemiológicas de leishmaniasis visceral canina en un área endémica de Paraguay / Clinical-epidemiological characteristics of visceral leishmaniasis in dogs from an endemic area in Paraguay

RESUMEN Objetivo Describir las características clínico-epidemiológicas asociadas a la transmisión de leishmaniosis visceral canina en un área endémica del departamento de Caaguazú, Paraguay. Materiales y Métodos El estudio fue descriptivo observacional, de corte transversal. Se evaluaron 324 caninos seleccionados de 110 viviendas. Se realizó el examen clínico; se obtuvo aspirado de ganglio para el examen directo y muestra de sangre para la posterior detección de anticuerpos anti-Leishmania revelados en tiras inmunocromatográfias. Resultados El 4,9% de la población canina dio positivo con antígeno recombinante rK39. Por la técnica de tinción con Giemsa, se obtuvo 4,3% de canes positivos, de los cuales 37,5% presentaron signos clínicos evidentes. Los signos más frecuentes encontrados en los perros infectados fueron adelgazamiento, onicogrifosis y alopecia (25%). La seroprevalencia fue mayor en perros entre 2 y 4 años de raza mestiza. Conclusiones Los signos clínicos presentes confirmaron la infección parasitaria y el hallazgo indica el rol de los caninos en la epidemiologia de la leishmaniosis en Caaguazú, así como el riesgo que representan para la transmisión. Los resultados obtenidos podrían ayudar a formular un sistema de monitoreo y contribuir con la vigilancia de la leishmaniosis canina en la zona.

ABSTRACT Objective To describe the clinical-epidemiological characteristics associated with the transmission of visceral leishmaniasis in dogs in an endemic area from Caaguazú department, Paraguay. Materials and Methods Cross-sectional study that included 324 dogs from 110 houses. Clinical examination was performed; ganglion aspirate was obtained for direct exa-mination and blood sample for further detection of anti-Leishmania antibodies by rk39 recombinant antigen immunochromatographic strips. Results 4.9% of the canine population resulted positive for rk39 recombinant antigen. By the Giemsa staining technique, 4.3% of positive dogs were obtained, of which 37.5% presented evident clinical signs. The most frequent signs found in infected dogs were thinning, onychogryphosis and alopecia (25%). Seroprevalence was higher in mixed breed dogs between 2 and 4 years old. Conclusion The clinical signs confirmed the parasitic infection, and the finding indicates the role of canines in the epidemiology of leishmaniasis in Caaguazú as well as the risk that they represent for transmission. These results may help to formulate a monitoring system and contribute to the surveillance of canine leishmaniasis in the zone.

Prevalencia de anemia en niños de 1 a 4 años de edad en Asunción y Central, Paraguay 2017

RESUMEN Introducción: Los niños constituyen el grupo más afectado por la anemia. En Paraguay no existen datos actualizados sobre prevalencia de anemia en menores de 5 años. Objetivos: Determinar la prevalencia de anemia en niños previamente sanos de 1 a 4 años que acuden a consultorios de servicios de salud y guarderías de Asunción y Central de Paraguay, durante el año 2017. Materiales y Métodos: Estudio prospectivo, de corte transverso, observacional, descriptivo. Muestreo aleatorio, estratificado. Nivel de confianza: 95% Error de muestra: 5%. Variables: edad, sexo, hemoglobina, índices hematimétricos, ferritina, Proteína C reactiva (PCR), albúmina, zPeso/Edad, zPeso/Talla, zTalla/Edad, peso al nacer. Fueron analizadas medidas paramétricas y no paramétricas, χ2. La anemia se definió por criterios OMS para el grupo de 1 a 5 años de edad: Hemoglobina Hb<11 g/dL y Volumen Corpuscular Medio VCM< 72 fL Se utilizó el Programa Anthro v 3.2.2 y SPSS 16.0. Aprobado por Comité de Ética del Instituto de Medicina Tropical, se obtuvo consentimiento informado. Nivel de significancia<0,05. Resultados: Fueron reclutados 806 pacientes. Se determinó Hb, VCM y ferritina en 706 pacientes.327 (46,3%) fueron varones. El promedio de Hb fue 11,9±1,03 g/dL. Volumen corpuscular medio promedio 71,2±26 fL. Se encontraron 83/706 pacientes con anemia (11,8%), 44/83 (53%) fueron microcíticas (VMC<72 fL). PCR negativa 640/706 (90,7%) pacientes. El promedio de albuminemia fue 4,5±0,2 g/dL. El promedio de z Peso/Edad fue 0,29±1,33, z Peso/Talla -0,38±1,52 y el z Talla/Edad fue 0,92±1,64. Ferritina < 12µg/L fue del 17,6 %. No se encontró relación entre el peso al nacer y la anemia [p=0,11. RR: 1,45 (0,6- 2,3)]. La prevalencia de anemia en el grupo de 12 a 23 meses fue del 39 % vs el 6,9 % en preescolares (χ2 p<0,05). Conclusiones: La prevalencia de anemia en lactantes de Asunción y Central constituye un problema de salud pública.

ABSTRACT Introduction: Children are the group most affected by anemia. In Paraguay there are no updated data on the prevalence of anemia in children under 5 years of age. Objectives: To determine the prevalence of anemia in previously healthy children aged 1 to 4 years who presented to health services clinics and nurseries in Asunción and the Central Department, Paraguay, during the year 2017. Materials and Methods: This was a prospective, cross-sectional, observational descriptive study. We used random, stratified sampling. Confidence level: 95% Sample error: 5%. Variables: age, sex, hemoglobin, hematometric indices, ferritin, C-reactive protein (CRP), albumin, z Weight / Age, z Weight / Height, z Height / Age, birth weight. Parametric and non-parametric measures, χ2, were analyzed. Anemia was defined by WHO criteria for the 1 to 5 year-old group: Hemoglobin Hb <11 g / dL and Mean Corpuscular Volume MCV <72 fL The Anthro Program v 3.2.2 and SPSS 16.0 were used. The study was approved by the Ethics Committee of the Institute of Tropical Medicine, and informed consent was obtained. Significance level <0.05. Results: 806 patients were recruited. Hgb, MCV and ferritin were determined in 706 patients. 327 (46.3%) were male. The mean Hgb was 11.9 ± 1.03 g / dL. Mean corpuscular volume 71.2 ± 26 fL. 83/706 patients with anemia (11.8%) were found, 44/83 (53%) were microcytic (MCV <72 fL). Negative CRP 640/706 (90.7%) patients. Average albuminemia was 4.5 ± 0.2 g / dL. The mean of z Weight / Age was 0.29 ± 1.33, z Weight / Height -0.38 ± 1.52 and the z Height / Age was 0.92 ± 1.64. Ferritin <12µg / L was 17.6%. No relationship was found between birth weight and anemia [p = 0.11. RR: 1.45 (0.6-2.3)]. The prevalence of anemia in the 12 to 23 month group was 39% vs 6.9% in preschool children (χ2 p <0.05). Conclusions: The prevalence of anemia in infants from Asunción and the Central Department constitutes a public health problem.