Cervical cancer prevention: Feasibility of self-sampling and HPV testing in rural and urban areas of Bolivia: An observational study.

BACKGROUND: Cervical cancer is a major health problem in Latin America. In 2019, the Italian Agency for Development Cooperation (La Paz regional site) conducted a pilot study to estimate the prevalence of high-risk human papillomavirus (HPV) and the feasibility of HPV screening in Bolivia through self-sampling and portable and transportable laboratory instruments for HPV testing in urban and rural areas. METHODS: Women aged 20-65 years from La Paz (urban area), Toro Toro (rural area), and Acasio (rural area) were enrolled in local public health centers between Dec 1, 2019, and June 30, 2021. Self-sampling was carried out with the Viba-Brush system (Rovers, Oss, Netherlands) and samples were preserved in ThinPrep containers (Hologic Corporation, San Diego, CA, USA). The GeneXpert system (Cepheid, Sunnyvale, CA, USA) for high-risk HPV testing detects HPV E6 and E7 DNA via real-time PCR in a mobile system of easy execution requiring minimal manual intervention. The system provides results in about 1 h. The hr- HPV prevalence data, overall and partial genotyping, were analyzed considering the following age groups: 20-34, 35-44, and 45-65 years old. FINDINGS: 2168 women were enrolled: 614 (28.3%) in La Paz, 743 (34.3%) in Toro Toro, and 811 (37.4%) in Acasio. Only one sample was collected from each participant. 2043 (94.2%) of 2168 samples were adequate for HPV testing. 255 (12.5%) samples were positive for high-risk HPV. Comparing the urban area (La Paz) versus rural combined areas (Acasio+Toro Toro), using a logistic model, the HPV total rate was statistically significantly higher in the city of La Paz (15.0% vs 11.4%; OR:1.37;95% CI: 1.04-1.80). Furthermore, the HPV prevalence was declining by age, and the urban/rural odds ratio was 1.50; (95% IC 1.13-19). The overall HPV 16 positivity was 2.7% (55/2043) and for HPV 18/45 was 1.8% (37/2043) without any statistically significant differences between the three BHU enrolling centers. Only the prevalence of HPV group '39/56/66/68' was significantly higher in La Paz (p<0,001) in comparison to Acasio and Toro Toro. INTERPRETATION: The total and age-adjusted prevalence of high-risk HPV infection in rural and urban areas in Bolivia, as measured with a validated test for screening, is similar to that observed in Europe and the USA. Our study shows that a screening protocol for HPV testing with self-sampling would be feasible in urban and rural areas in Bolivia, and that the reported high occurrence of cervical cancer in Bolivia is not related to a higher rate of high-risk HPV infections. Carrying out HPV tests locally avoids the issues associated with transportation and storage of the collected material and allows the participant to wait in the clinic for the test result, overcoming the very long response time for screening test in Bolivia.

Epilepsy and neurocysticercosis in rural areas of the Bolivian Chaco: What has changed during the last 30 years?

OBJECTIVE: Neurocysticercosis (NCC) is considered the major cause of epilepsy in endemic regions. In the rural areas of the Bolivian Chaco prevalence of NCC among people with epilepsy (PWE) was 27.4%, according to a population-based survey carried out in 1994. The aim of the study was to estimate the prevalence of Epilepsy Associated with Tonic-Clonic Seizures (EATCS) and to evaluate the prevalence of NCC among PWE in the rural communities of the Bolivian Chaco after 30 years. METHODS: Twenty-two rural communities (total population 12 852) were involved in the study. PWE in the study area were ascertained by multiple sources and the diagnosis was confirmed by a neurologist. All PWE identified were invited to undergo brain CT scan examination and diagnosis of NCC was sought according to the revised Del Brutto criteria. RESULTS: Seventy-eight PWE (30 men, 38.4%; mean age at onset was 12.7 ± 13.2 years) with EATCS were identified giving a crude prevalence of 6.1/1000 (95% CI: 4.7-7.3). Due to the COVID-19 lockdown, the study was interrupted in 2020 and only 36 PWE (46%) of the whole sample underwent CT scan examination. Of these, 8 (22.2%) fulfilled the criteria for NCC of whom 6 (75%) presented only single or multiple calcifications. SIGNIFICANCE: This is the first study reassessing the prevalence of NCC among PWE after 30 years, in the same rural area and using a population-based design. T. solium is still endemic in the Bolivian Chaco where more than 20% of EATCS may be attributable to NCC. Our findings show a substantially unchanged prevalence of NCC over the past 30 years despite improved knowledge, underlining the need for active intervention programs to control T. solium transmission in this area. PLAIN LANGUAGE SUMMARY: Neurocysticercosis is still endemic in the Bolivian Chaco. The proportion of epilepsy attributable to neurocysticercosis is about 22%. Systematic efforts towards elimination of neurocysticercosis in these areas should be implemented.

Lesiones ocasionadas por mordeduras de perros en niños atendidos en un hospital de tercer nivel de Bolivia / Dog bite injuries in children seen at a tertiary care hospital in Bolivia

Introducción. Este estudio pretende caracterizar las lesiones provocadas por perros en niños de un hospital pediátrico de Bolivia. Población y métodos. Se realizó un estudio observacional, retrospectivo, en pacientes atendidos del 2017 al 2021. Resultados. Se estudiaron 769 pacientes. Las lesiones representaron el 5,6 % de las emergencias y el 0,8 % de las internaciones. Fueron más frecuentes en niños de hasta 5 años (55,1 %), en quienes se observó mayor gravedad de las lesiones (p = 0,008), antecedente de provocación al animal (p = 0,048), un animal agresor conocido (p <0,036), el contexto doméstico del accidente (p = 0,021), mayor frecuencia de profilaxis con suero luego de la exposición (p = 0,005) y regiones afectadas principalmente maxilofaciales (p <0,001). Observamos 3 casos de mortalidad por rabia humana y 1 por shock hipovolémico. Conclusión. Las lesiones producidas por perros son causas frecuentes de visita a emergencia y hospitalización en pediatría, y tienen características particulares en niños de hasta 5 años de edad.

Introduction. The objective of this study is to describe the characteristics of dog bite injuries in children seen at a children's hospital in Bolivia. Population and methods. This was an observational, retrospective study in patients seen between 2017 and 2021. Results. A total of 769 patients were studied. Dog bite injuries accounted for 5.6% of emergency visits and 0.8% of hospitalizations. They were more frequent in children younger than 5 years (55.1%), in whom the following were observed: greater injury severity (p = 0.008), history of animal provocation (p = 0.048), known attacking animal (p < 0.036), domestic accident (p = 0.021), greater frequency of post-exposure prophylaxis with anti-rabies serum (p = 0.005), and maxillofacial area as the main region involved (p < 0.001). There were 3 deaths due to human rabies and 1 due to hypovolemic shock. Conclusion. Dog bite injuries are a frequent cause of visit to the emergency department and hospitalization in pediatrics and have specific characteristics in children younger than 5 years.

Genetic diversity of HBV in indigenous populations on the border between Brazil and Bolivia.

Hepatitis B is considered an important public health problem worldwide because it is a chronic infection with a risk factor for cirrhosis and cellular hepatocellular carcinoma. In Brazil, the Rondônia State ranks first in the Northern region regarding the number of deaths due to hepatitis B. In the Amazon basin, genotype F is considered specific to the Americas identified in native populations. But few data on HBV genotyping and phylogenetic analysis are available. The objective of this study was to evaluate the genotypes and subgenotypes of the hepatitis B virus in indigenous people chronic carriers residing in cities of Guajará Mirim and Nova Mamoré in state of Rondônia/Brazil, on the border with Bolivia. A fragment of 417 bp (S gene) was amplified by PCR and submitted to nucleotide sequencing. The genotypes and subgenotypes of the HBV strains were determined through phylogenetic inference using genomic sequences from 197 representatives of the genotypes (A-H). Of the 41 chronic hepatitis B patients enrolled in this study, 27 were HBV-DNA positive. Of the 27 DNA-HBV positives, 39% (17/41) had individual HBV infection and 27% (10/41) were coinfected with HDV. The frequency of genotypes was 40.7% (11/27) for genotype D (HBV-D), 33.3% (9/27) for genotype F (HBV-F) and 25.9% (7/27) for genotype A (HBV-A) with circulating subgenotypes F2, F4, D2, D3, A1, and A2. We characterized the genotypes and subgenotypes of HBV circulating among in indigenous in the State of Rondônia shows for the first time the HBV/D genotype whit greater frequency circulating in nativos of state Rondônia. In conclusion, our findings showed a diversity of HBV genotypes, which is also found in other Brazilian geographical regions.

Results and evaluation of the expansion of a model of comprehensive care for Chagas disease within the National Health System: The Bolivian Chagas network.

BACKGROUND: Most people with chronic Chagas disease do not receive specific care and therefore are undiagnosed and do not receive accurate treatment. This manuscript discusses and evaluates a collaborative strategy to improve access to healthcare for patients with Chagas in Bolivia, a country with the highest prevalence of Chagas in the world. METHODS: With the aim of reinforcing the Chagas National Programme, the Bolivian Chagas Platform was born in 2009. The first stage of the project was to implement a vertical pilot program in order to introduce and consolidate a consensual protocol-based healthcare, working in seven centers (Chagas Platform Centers). From 2015 on the model was extended to 52 primary healthcare centers, through decentralized, horizontal scaling-up. To evaluate the strategy, we have used the WHO ExpandNet program. RESULTS: The strategy has significantly increased the number of patients cared for, with 181,397 people at risk of having T. cruzi infection tested and 57,871 (31·9%) new diagnostics performed. In those with treatment criteria, 79·2% completed the treatment. The program has also trained a significant number of health personnel through the specific Chagas guidelines (67% of healthcare workers in the intervention area). CONCLUSIONS: After being recognized by the Chagas National Programme as a healthcare model aligned with national laws and priorities, the Bolivian platform of Chagas as an innovation, includes attributes that they have made it possible to expand the strategy at the national level and could also be adapted in other countries.

Deterioro cognitivo en poblaciones urbanas y rurales de la mediana altura geográfica en Bolivia: prevalencia y factores asociados / Cognitive impairment in urban and rural populations of the middle altitude in Bolivia: prevalence and associated factors

RESUMEN INTRODUCCIÓN: El deterioro cognitivo es una patología importante entre los ancianos, pero pocos estudios evalúan a poblaciones en una altura geográfica importante. OBJETIVOS: Caracterizar y encontrar los factores asociados al deterioro cognitivo en poblaciones urbanas y rurales de la mediana altura geográfica. METODOLOGÍA: Estudio transversal analítico, se evaluó el deterioro cognitivo con el Test de Pfeiffer (Alpha de Cronbach: 0,69), sus resultados se combinaron versus tres variables socioeducativas y cuatro comorbilidades; se obtuvo estadísticos analíticos. RESULTADOS: De los 400 adultos mayores, el 26,5% (106) no tuvo deterioro cognitivo, el 47,5% (190) tuvo un deterioro leve, el 25,5% (102) moderado y el 0,5% (2) severo; el 60% fueron mujeres, la mediana de edades fue de 66 años (rango intercuartílico: 63-69 años), el 67% vivían en la zona rural. En el análisis multivariado se encontró que, hubo más deterioro cognitivo moderado/severo a mayor edad (RPa: 1,05; IC95%: 1,02-1,08; p<0,001), entre los que tenían diabetes (RPa: 1,23; IC95%: 1,17-1,29; p<0,001), hipertensión arterial (RPa: 1,47; IC95%: 1,33-1,61; p<0,001), enfermedad renal crónica (RPa: 2,21; IC95%: 2,01-2,43; p<0,001) e insuficiencia cardiaca (RPa: 2,25; IC95%: 1,92-2,64; p<0,001); en cambio, los que tenían grado universitario tuvieron menos deterioro cognitivo (RPa: 0,89; IC95%: 0,22-0,65; p<0,001); ajustados por el sexo y el lugar de residencia. CONCLUSIONES: Se encontró importantes asociaciones del deterioro cognitivo en una población adulta mayor que residía entre los 2500-3900 msnm, estos resultados son importantes por no ser una población muy estudiada.

INTRODUCTION: Cognitive impairment is an important pathology among the Aged, but few studies evaluate populations at an important geographical height. OBJECTIVES: To characterize and find the factors associated with cognitive deterioration in urban and rural populations of medium geographic height. METHODOLOGY: Analytical cross-sectional study, cognitive impairment was evaluated with the Pfeiffer Test (Cronbach's Alpha: 0.69), its results were combined versus three socio-educational variables and four comorbidities; analytical statistics were obtained. RESULTS: Of the 400 older adults, 26.5% (106) had no cognitive impairment, 47.5% (190) had mild impairment, 25.5% (102) moderate and 0.5% (2) severe; 60% were women, the median age was 66 years (interquartile range: 63-69 years), 67% lived in rural areas. In the multivariate analysis it was found that there was more moderate / severe cognitive impairment at older age (RPa: 1.05; 95% CI: 1.02-1.08; p <0.001), among those with diabetes (RPa: 1, 23; 95% CI: 1.17-1.29; p <0.001), arterial hypertension (RPa: 1.47; 95% CI: 1.33-1.61; p <0.001), chronic kidney disease (RPa: 2.21, 95% CI 2.01-2.43, p <0.001) and heart failure (RPa: 2.25, 95% CI 1.92-2.64, p <0.001); On the other hand, those with a university degree had less cognitive deterioration (RPa: 0.89, 95% CI: 0.22-0.65, p <0.001); adjusted for sex and place of residence. CONCLUSION: Important associations of cognitive deterioration were found in an older adult population residing between 2500-3900 msnm, these results are important as they are not a highly studied population; therefore, these data should be taken for diagnosis and treatment.

Optimizing Tobacco Advertising Bans in Seven Latin American Countries: Microsimulation Modeling of Health and Financial Impact to Inform Evidence-Based Policy.

INTRODUCTION: In Latin America, tobacco smoking prevalence is between 6.4% and 35.2%. Governments have been making efforts to support the regulation of advertising and, in many cases, banning advertising and promotion of tobacco altogether. The objective of this study was to evaluate the potential impact on health and economic outcomes of optimizing a ban on tobacco advertising and sponsorship in Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru. METHODS: We built a probabilistic microsimulation model, considering natural history, direct health system costs, and quality of life impairment associated with main tobacco-related diseases. We followed individuals in hypothetical cohorts and calculated health outcomes on an annual basis to obtain aggregated 10-year population health outcomes (deaths, events, healthy years of life) and costs. To populate the model, we performed a rapid review of literature to calculate intervention effectiveness. RESULTS: With current policies, over 10 years, in Argentina, Bolivia, Brazil, Chile, and Colombia a total of 50,000 deaths and 364,000 disease events will be averted, saving $7.2 billion. If the seven countries strengthened their policies and implemented a comprehensive ban with 100% compliance, 98,000 deaths and 648,000 events would be averted over 10 years, saving almost $15 billion in healthcare costs. CONCLUSIONS: Optimizing a ban on tobacco advertising and sponsorship would substantially reduce deaths, diseases, and health care costs attributed to smoking. Latin American countries should not delay the full implementation of this strategy.

Past and present of cystic echinococcosis in Bolivia.

Viable eggs of the canine intestinal tapeworm Echinococcus granulosus sensu lato (s.l.) infect various intermediate hosts causing cystic echinococcosis (CE). Furthermore, CE represents a serious zoonosis causing a significant global burden of disease. CE is highly endemic in South America, including Argentina, Brazil, Chile, Uruguay, and Peru. For Bolivia, no official data concerning the incidence in humans or the number of livestock and dogs infected are available. However, it is well known that CE occurs in Bolivia. We aim here to fill the gap in the current knowledge of the epidemiological situation of CE in Bolivia, providing a historical overview of documents published within the country, which have never been comprehensively reviewed. The very first documentation of E. granulosus infection in animals dates in 1910, while the first human case was reported in 1913. In total, 876 human CE cases have been reported in the scientific literature, with an apparent increase since the 1970s. In the absence of other epidemiological studies, the highest prevalence in human comes from Tupiza, Potosí Department, where 4.1% (51/1,268) of the population showed signs of CE at mass ultrasound screening in 2011. In the same report, 24% of dog faecal samples were positive for coproantigens of E. granulosus s.l. in ELISA. The highest prevalence in intermediate hosts reported at abattoir reached 37.5% in cattle from Potosí, followed by 26.9% in llamas from Oruro, 2.4% in pigs and 1.4% in sheep from La Paz. Finally, Echinococcus granulosus sensu stricto (s.s.), Echinococcus ortleppi (G5), and Echinococcus intermedius (G7) have been identified in Bolivia. Data reviewed here confirm that E. granulosus s.l. is circulating in Bolivia and that a proper prospective nationwide epidemiological study of CE is urgently needed to define transmission patterns as a basis for the planning and implementation of future control measurements.

El covid-19 y sus consecuencias en la vida y el trabajo de médicos residentes de La Paz, Bolivia / Covid-19 and its consequences in the life and the work of medical residents of La Paz, Bolivia

Este artículo es un apretado resumen de los principales resultados de una investigación mayor realizada por MEDICON, cuantitativa y cualitativa, en línea, a médicos residentes de 2º año del Sistema Departamental de Salud La Paz, en Bolivia. Los datos y relatos recogidos tienen que ver con la pandemia, el cumplimiento de las medidas de bioseguridad, la afectación experimentada por la cuarentena, la donación de plasma, el desempeño del personal de salud, entre otros. En el 55% la enfermedad fue confirmada por laboratorio. No hubo hospitalizados y la mayoría se automedicó. No recibieron soporte psicológico, por lo que es factible que algunos hubieran desarrollado el síndrome de burnout. Los que se enfermaron o tuvieron allegados con covid-19 dieron a conocer sus vivencias sobre la manera en que ellos y sus familiares enfrentaron el problema. (AU)

This article is a tight summary of the main results of a major investigation conducted by MEDICON, quantitative and qualitative, online, to second-year resident physicians of the La Paz Departmental Health System, in Bolivia. The data and reports collected have to do with the pandemic, compliance with biosecurity measures, the impact experienced by quarantine, plasma donation, the performance of health personnel, among others. In 55% the disease was confirmed by laboratory. There were no hospitalized and most self-medicated. They did not receive psychological support, so it is possible that some had developed ­ burnout syndrome. Those who became ill or had relatives with covid-19 shared their experiences about the way that they and their relatives faced the problem. (AU)

Relevance of screening for Chagas and viral hepatitis in Bolivian migrants.

OBJECTIVES: Given the scarcity of data regarding prevalence of various infectious diseases in Latin-American countries, our study aims to assess the burden of T. cruzi, S. stercoralis, HIV and viral hepatitis in Latin-American migrants, with a focus on Bolivian migrants. METHODS: We performed a retrospective observational study of 565 screening evaluations in adults (≥18 years) carried out at our International Healthcare referral service in Barcelona. We reviewed structured clinical records and microbiological results of patients attended between February 2012 and April 2015. RESULTS: The median age was 35 years and 74% were women. Of the population screened, 87% were of Bolivian origin. We found a 48% prevalence of T. cruzi, 16% of S. stercoralis, 0.2% of HIV, 0.2% HBV and 0.2% HCV. CONCLUSIONS: These results support the relevance of screening for T. cruzi and S. stercoralis in Bolivian migrants but challenge the pertinence of systematic screening for HBV in this population.

Guía de vigilancia de eventos supuestamente atribuibles a la vacunación e inmunización: Bolivia 2021 / Surveillance guide for events supposedly attributable to vaccination and immunization: Bolivia 2021

El presente documento establece los lineamientos técnicos para la vigilancia integrada de los Eventos Supuestamente Atribuibles a la Vacunación e Inmunización (ESAVI) El documento se estructura en seis capítulos: en el Capítulo I se enfatiza el impacto de las vacunas en el perfil epidemiológico de la salud infantil y se establecen los objetivos del manual y de la vigilancia integrada de los Eventos Supuestamente Atribuibles a la Vacunación e Inmunización, ESAVI. En el Capítulo II se describen los componentes de la vacunación segura como la Calidad e inocuidad, Transporte y almacenamiento seguro, Inyecciones seguras, Disposición final y la Vigilancia de ESAVI como elemento importante en la vacunación segura. En el Capítulo III se describe el marco conceptual de los ESAVI y los parámetros de clasificación final de los mismos. En el Capítulo IV se describen cada uno de los pasos de la vigilancia epidemiológica de los ESAVI desde la detección, la evaluación inicial, notificación, investigación, reporte, plan de acción, seguimiento y retroalimentación. Además, se establece las responsabilidades compartidas entre el personal operativo, el Programa Ampliado de Inmunización (PAI) y la Agencia Estatal de Medicamentos y Tecnología en salud, (AGEMED). En el capítulo V se expone el protocolo de investigación de los ESAVI desde la definición de que se va a investigar, como recolectar la información, el análisis de la información, planificar, ejecutar, evaluar acciones y el Informe de investigación del ESAVI. En el Capítulo VI se describe todos los elementos de la gestión de crisis que incluye líneas de acción estratégica que se deben adoptar al interior del Programa para evitar, prevenir o contener la aparición y desarrollo de amenazas que puedan poner en riesgo la implementación adecuada y oportuna de sus procesos

HIV/AIDS em região de tríplice fronteira: subsídios para reflexões sobre políticas públicas / VIH / SIDA en una región fronteriza triple: subvenciones para reflexiones sobre políticas públicas / HIV / AIDS in a triple border region: subsidies for reflections on public policies

RESUMO Objetivo analisar a tendência dos casos de HIV/Aids por sexo e faixa etária nas cidades gêmeas de Mato Grosso do Sul. Método estudo ecológico de série histórica. Foram utilizadas as fichas de notificação de HIV/Aids, do período de 2009 a 2018, disponibilizadas pela Secretaria de Estado de Saúde e analisadas segundo estatística descritiva, regressão polinomial e geoespacialização dos casos. Resultados foram registradas 734 notificações, sendo 57,9% em homens, e com maior incidência no biênio 2017-2018 em ambos os sexos. A tendência de crescimento das notificações apresenta-se com aceleração positiva nas cidades gêmeas (r2=0,91; p<0,001). Os maiores coeficientes de determinação foram observados em mulheres, na faixa etária de 35 a 49 anos (r2=0,98; p<0,001), e em homens de 15 a 19 anos (r2=0,96; p<0,002). Conclusão os resultados desafiam profissionais e gestores no combate à pandemia de HIV/Aids, carecendo de reflexões contínuas diante as estratégias/políticas públicas adotadas até o momento, em especial na região de fronteira. Implicações para a prática: o profissional enfermeiro, ao conhecer o perfil da sua população e a distribuição dos casos, consegue traçar estratégias capazes de atingir o público de forma eficaz e efetiva.

RESUMEN Objetivo analizar la tendencia de los casos de VIH/SIDA por género y grupo de edad en las ciudades gemelas de Mato Grosso do Sul. Método estudio ecológico de series históricas. Se utilizaron formularios de notificación del VIH/SIDA de 2009 a 2018, puestos a disposición por el Departamento de Salud del Estado y analizados de acuerdo con estadísticas descriptivas, regresión polinómica y geospatialización de los casos. Resultados se registraron 734 notificaciones, un 57,9% en hombres y una mayor incidencia en el bienio 2017-2018 en ambos sexos. La tendencia de crecimiento de las notificaciones se acelera positivamente en las ciudades gemelas (r2-0,91; p<0,001). Los coeficientes de determinación más altos se incluyeron en las mujeres de 35 a 49 años (r2-0,98; p<0,001), y en los hombres de 15 a 19 años (r2-0,96; p<0,002). Conclusión los resultados desafían a profesionales y directivos en la lucha contra la pandemia del VIH/SIDA, carentes de reflexiones continuas frente a las estrategias/políticas públicas adoptadas hasta ahora, especialmente en la región fronteriza. Implicaciones para la práctica: el enfermero profesional, conociendo el perfil de su población y la distribución de los casos, puede diseñar estrategias capaces de llegar al público de manera efectiva y efectiva.

ABSTRACT Objective Analyze the trend of HIV/AIDS cases by sex and age in the twin cities of Mato Grosso do Sul. Method ecological study of historical series. The HIV/AIDS notification forms, from 2009 to 2018, made available by the Secretary of State for Health and analyzed according to descriptive statistics, polynomial regression and geospatialization of the cases were used. Results 734 notifications were registered, 57.9% of them in men, and with a higher incidence in the biennium 2017-2018 in both sexes. The trend of growth of notifications shows a positive acceleration in twin cities (r2=0.91; p<0.001). The highest coefficients of determination were observed in women, in the age group 35 to 49 years (r2=0.98; p<0.001), and in men from 15 to 19 years (r2=0.96; p<0.002). Conclusion The results challenge professionals and managers in the fight against the HIV/AIDS pandemic, requiring continuous reflection on the strategies/public policies adopted so far, especially in the border region. Implications for the practice: the nurse professional, by knowing the profile of its population and the distribution of cases, is able to draw strategies capable of reaching the public effectively and efficiently.

Arritmias cardíacas en habitantes de gran altura con diagnóstico de corazón pulmonar crónico / Cardiac arrhythmias in highlanders with a diagnosis of chronic cor pulmonale

Resumen Antecedentes: El corazón pulmonar crónico (CPC) muestra un incremento en habitantes que viven en grandes altitudes. Objetivo: Investigar la frecuencia de arritmias cardíacas y factores de riesgo para su desarrollo. Métodos: Estudio descriptivo y transversal; se revisó el registro de pacientes internados del Departamento de Cardiología del Instituto Nacional de Tórax, La Paz, Bolivia, entre enero de 2017 y junio de 2018; se incorporó a todos los individuos con diagnóstico de CPC, definido por criterios clínicos, electrocardiográficos y ecocardiográficos; se incluyó a 162 pacientes que cumplieron los criterios en el análisis; se utilizaron la t de Student y ANOVA. Resultados: Arritmias: fibrilación auricular (FA), 125 (75%); aleteo auricular (AA), 17 (10.5%); taquicardia auricular (TA), 17 (10.5%); extrasístoles, 3 (1.9%). Según el análisis univariado, los factores relacionados con el desarrollo de arritmias fueron: eritrocitosis: FA, RR: 1.33, otras arritmias (RR: 1.67), p = 0.0001; hipertensión arterial pulmonar: FA, RR: 3.10, otras arritmias (RR: 3.21), p = 0.0001; dilatación de aurícula derecha (AD): FA, RR: 1.92, otras arritmias (RR: 2.13), p = 0.0001; obesidad: FA, RR: 3.47, p = 0.001, otras arritmias (RR: 3.70), p = 0.001; hipertensión arterial sistémica: FA, RR: 3.10, p = 0.001, otras arritmias (RR: 3.21), p = 0.001. Según el análisis multivariado: eritrocitosis (RR: 2.2), dilatación de AD (RR: 1.2), p = 0.0001. Conclusiones: Se encontró FA con mayor frecuencia en los pacientes con CPC; los factores de riesgo con mayor significancia estadística para su presentación fueron la eritrocitosis y la dilatación de la AD.

Abstract Background: Chronic cor pulmonale (CPC), with increased presentation in high-altitude inhabitants. Objectives: Investigating the frequency of cardiac arrhythmias, and risk factors for its development. Methods: Descriptive, cross-sectional study, the inpatient registry of the Department of Cardiology of the National Institute of Torax, La Paz-Bolivia, from January 2017 to June 2018 was reviewed, all were incorporated with the diagnosis of CPC, defined by clinical criteria, electrocardiographic and echocardiographic, 162 patients who met the criteria were taken, the student's t-test and ANOVA were used for the analysis. Results: Arrhythmias: atrial fibrillation (AF) 125 (75%), atrial flutter (AA) 17 (10.5%), atrial tachycardia (AT) 17 (10.5%), extrasystoles 3 (1.9%). Univariate analysis of factors related to the development of arrhythmias: erythrocytosis: FA, RR: 1.33, other arrhythmias RR: 1.67, p = 0.0001, pulmonary arterial hypertension: FA, RR: 3.10, other arrhythmias RR: 3.21, p = 0.0001, right atrial dilation (AD): FA, RR: 1.92, other arrhythmias RR: 2.13, p = 0.0001, obesity: FA, RR: 3.47, p = 0.001, other arrhythmias RR: 3.70, p = 0.001, systemic arterial hypertension: FA: RR: 3.10, p = 0.001, other arrhythmias RR: 3.21, p = 0.001. Multivariate analysis: erythrocytosis (RR: 2.2), AD dilation (RR: 1.2), p = 0.0001. Conclusions: AF was found more frequently in patients with CPC, the risk factors with the greatest statistical significance for presentation were: erythrocytosis and AD dilation.

Epidemiología de la covid-19 en Bolivia / Epidemiology of covid-19 in Bolivia

Estudio descriptivo retrospectivo sobre la magnitud, evolución e impacto de la pandemia covid-19 en Bolivia, basado en los reportes diarios del Ministerio de Salud que incluyen datos sobre: casos nuevos, defunciones, casos acumulados, casos confirmados, sospechosos, descartados y recuperados. Los indicadores utilizados son: tasa de incidencia por 100.000 habitantes, tasa de letalidad, porcentaje de pacientes recuperados y diferencia entre descartados y confirmados. Los datos han sido organizados por períodos arbitrarios y por semanas epidemiológicas, y presentados por departamento sumado a la cifra promedio nacional. La información revela que en Bolivia la covid-19 está en plena actividad, y que no hay una manera segura de establecer cuándo los casos acumulados llegarán a su pico. (AU)

Retrospective descriptive study on the magnitude, evolution and impact of the covid-19 pandemic in Bolivia, based on daily reports from the Ministry of Health, which include data on: new cases, new deaths, accumulated cases, confirmed cases, suspects, discarded and recovered. The indicators used are: incidence rate per 100,000 habitants, case fatality rate, percentage of recovered patients and, difference between discarded and confirmed. The data has been organized by arbitrary periods and epidemiological weeks, and presented by department plus the national average figure. The information reveals that in Bolivia, covid-19 is in full swing, and that there is no sure way to establish when cumulative cases will peak. (AU)

Evaluation of the effectiveness of high-risk human papilloma self-sampling test for cervical cancer screening in Bolivia.

BACKGROUND: In Bolivia the incidence and mortality rates of uterine cervix cancer are the highest in America. The main factor contributing to this situation is the difficulty of establishing and maintaining quality prevention programs based on cytology. We aimed to evaluate the effectiveness of HR-HPV testing on self-collected samples to detect cervical intra-epithelial neoplasia and identify the best combination of screening tests. METHODS: A total of 469 women, divided in two groups, were included in this study. The first group included 362 women that underwent three consecutively primary screening tests: self-collected sampling for HR-HPV detection, conventional cervical cytology and visual inspection under acetic acid (VIA). The second group included 107 women referred with a positive HR-HPV test that underwent conventional cervical cytology and VIA. The presence of high grade intraepithelial lesion (CIN 2+) or invasive cancer was verified by colposcopy and biopsy. RESULT: In the screening group the sensitivity to detect high grade intraepithelial lesion (CIN 2+) or invasive cancer were 100, 76, 44% for the VIA, HR-HPV test and cytology, respectively. In the referred group, the sensitivity to detect high grade intraepithelial lesion (CIN 2+) or invasive cancer by VIA and cytology were 100 and 81%, respectively. CONCLUSIONS: VIA and HR-HPV self-sampling were the best combination to detect CIN2+ lesions. Cytology analysis gave the poorest performance.

Prevalence of viral sexually transmitted infections and HPV high-risk genotypes in women in rural communities in the Department of La Paz, Bolivia.

BACKGROUND: Bolivia has the highest prevalence of cervical cancer in South America and the prevalence of viral sexually transmitted infections (STIs) among people in urban cities is increasing. Little is known about the prevalence of viral STIs in rural communities, which generally have limited access to health care. In order to study the prevalence of viral STIs in rural Bolivia, we recruited women from villages and towns in the Department of La Paz in Bolivia. METHODS: Three hundred ninety-four female participants were assessed for IgG-antibodies to herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV) and hepatitis B virus (HBV, anti-HBc), as well as for the presence of HBV surface antigen (HBsAg) in dried blood spots. The prevalence of 12 high-risk types of human papillomavirus (HPV) was assessed by qPCR in dried cervicovaginal cell spots from 376 of these women. χ2 test was used to compare variables between the populations and binary logistic regression was used to identify risk factors associated with the positivity of the tests. RESULTS: The seroprevalence of HSV-2 was 53% and of HBV 10.3%. HBAg was detected in 15.8% of women with anti-HBV antibodies indicating chronic infection. The frequency of high-risk HPV infection was 27%, with the most prevalent high-risk HPV types being HPV 56, 39 and 31 followed by HPV 16 and 18. Finally, none of the 394 women were seropositive for HIV, and about 64% of the studied population was positive for at least one of the viral infections. CONCLUSIONS: Women in Bolivian rural communities in La Paz show a high prevalence of HBV, HPV and, in particular, HSV-2. In contrast, none of the women were HIV positive, suggesting that the HIV prevalence in this population is low. The pattern of high-risk HPV types differed from many other countries with a predominance of HPV-types not included in the Gardasil vaccine which was officially introduced in Bolivia in April 2017.

Prevalence of double burden on malnutrition at household level in four Latin America countries / Prevalência de dupla carga de má nutrição em nível domiciliar em quatro países da América Latina

Abstract Objectives: to estimate the prevalence of maternal overweight and short stature in children at household level in Brazil, Bolivia, Colombia and Peru. Methods: a cross-sectional descriptive study. Population-based studies on children (0-5 years old) and women (15 to 49 years old) who participated in the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher(National Survey on Children and Women Demography and Health) in Brazil and the Encuesta Nacional de Demografía y Salud, (National Survey on Demography and Health), in Bolivia, Colombia and Peru. Variables of interest: overweight mother and child with short stature, a double burden when both outcomes are present. Global prevalence and stratification, according to rural and urban areas and 95% confidence intervals, were estimated. Results: the global sample consisted of 26,506 households. The prevalence of double burden was 9.3% in Bolivia (CI95%= 8.3-10.4), 6.7% in Peru (CI95%=5.9-7.5), Colombia (3.2%; CI95%=2.8-3.6) and Brazil (2.2%; CI95%=1.4-3.2). The highest prevalence were observed in the rural areas in Bolivia (13% vs 6.5%; p<0.001) and Peru (11.9% vs 4.1%; p<0.001). Conclusions: the highest prevalence were registered in Peru and Bolivia, and the lowest in Brazil and Colombia.

Resumo Objetivos: estimar a prevalência de excesso de peso materno e baixa estatura infantil em nível domiciliar no Brasil, Bolívia, Colômbia e Peru. Métodos: estudo descritivo transversal. Utilizou-se estudos de base populacional de crianças (0-5 anos) e mulheres (15 a 49 anos) que participaram da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher, no Brasil, e da Encuesta Nacional de Demografía y Salud, na Bolívia, Colômbia e Peru. Variáveis de interesse: mãe com excesso de peso e filho com baixa estatura, sendo dupla carga quando presentes ambos os desfechos. Foi estimada a prevalência global e estratificada por área rural e urbana e os intervalos de confiança de 95%. Resultados: a amostra global foi composta de 26.506 domicílios. As prevalências de dupla carga foram na Bolívia 9,3% (IC95%= 8,3 - 10,4), no Peru 6,7% (IC95%= 5,9 - 7,5), Colômbia (3,2%; IC95%= 2,8 - 3,6) e Brasil (2,2%; IC95%= 1,4 - 3,2). As maiores prevalências foram mostradas nas áreas rurais da Bolívia (13% vs 6,5%; p < 0,001) e do Peru (11,9% vs 4,1%; p < 0,001). Conclusões: as mais altas prevalências foram registradas no Peru e Bolívia, e as menores no Brasil e Colômbia.

Decline in Total Serum IgE and Soluble CD30 in the Context of Soil-Transmitted Helminth Decline in Bolivia.

In the Bolivian Chaco, recent surveys documented a dramatic decrease in the prevalence of soil-transmitted helminth (STH) infections as compared with the 1980s after thirty years of preventive chemotherapy (PC). Concomitant immunological rearrangements are expected. Because nematode infections are associated with increased levels of circulating IgE and glycoprotein CD30 soluble form (sCD30), this study aims to evaluate changes in serological markers of T helper (Th)2-cells activity between 1987 (high STH prevalence) and 2013 (low STH prevalence) in rural communities in the Bolivian Chaco area. We collected 151 sera during two different surveys in 1987 (n = 65) and 2013 (n = 86) and measured the concentration of total IgE and sCD30 by immunoassays. We found a statistically significant age-independent decrease in the total IgE (P < 0.0001) and sCD30 (P < 0.0001) from 1987 to 2013. The significant decrease in serological Th2 markers (IgE and sCD30) between 1987 and 2013 is consistent with the drop in STH prevalence in this geographical area during the same period of time. Further studies might elucidate the clinical and epidemiological impact of these serological rearrangements.

Visceral Leishmaniasis in Bolivia: Current Status

Abstract INTRODUCTION In Bolivia, before 1982 there were no records of visceral leishmaniasis (VL) cases that would allow us to review and describe the temporospatial occurrence of VL by ecoregions in provinces and departments of Bolivia to evaluate its impact on public health, risk of outbreaks, or dispersion. METHODS This update on VL in Bolivia is based on research, reviews, and retrospective literature analyses of online data and libraries and institutional reports, from 1939 to the present. RESULTS In Bolivia, 56 cases of VL have been reported. Until 2014, only three endemic departments had been identified (La Paz, Santa Cruz, and Tarija). Since then, further cases have been recorded in Pando, Cochabamba, and Beni, and in Chuquisaca in 2015. In Yungas, a VL focus was confirmed by isolating and comparing parasites from human and dog cases, and from the Lu. longipalpis vector. VL cases from seven departments, involving 12 different ecoregions were located within the Amazon and Plata basins. CONCLUSIONS We confirmed that dogs are its primary reservoir, and Lutzomyia longipalpis is its main vector (currently dispersed in six departments). The primary vectors in areas where Lutzomyia longipalpis is absent are Migonemyia migonei and Lutzomyia cruzi.

Chagas disease in the Bolivian Chaco: Persistent transmission indicated by childhood seroscreening study.

BACKGROUND: Screening for Trypanosoma cruzi infection was performed amongst children in a rural community in the Bolivian Chaco, an area known for high prevalence. The force of infection (FOI) was estimated. METHODS: A total of 423 children attending the local school were screened using the Chagas Detect Plus (CDP) rapid test (InBios International, Inc.). CDP-positive specimens were further tested by indirect haemagglutination assay (IHA) and Wiener Recombinante v3.0 ELISA. A catalytic model was used to estimate FOI. RESULTS: Confirmed seroprevalence was 0.22, rising steeply with age. The mean age of seropositive individuals was 13 years. The calculated specificity of the rapid test was 91.9%. The annual incidence estimated from the FOI was 0.021. CONCLUSIONS: This study demonstrates persistent transmission and continuing high levels of T. cruzi infection in the Bolivian Chaco, and highlights the practicality of school-based screening.