ABSTRACT
Soil-transmitted helminths (STH) are a significant public health problem in impoverished communities of tropical and subtropical areas. Improved diagnostic methods are crucial for Neglected Tropical Diseases programs, particularly for S. stercoralis, as traditional methods are inadequate. Thus, it is important to identify the most accurate and efficient methods for the diagnosis of STH. We performed a retrospective study analyzing laboratory data at the Instituto de Investigaciones de Enfermedades Tropicales from 2010 to 2019. The study included data from outpatients referred for stool analysis and public health interventions from urban and rural communities in northern Salta province, Argentina. Samples were included in this analysis if processed through sedimentation/concentration, Baermann, Harada-Mori and McMaster's, with a subgroup that also included Agar plate culture method (APC). Sensitivity was calculated against a composite reference standard. Of the 5625 samples collected, 944 qualified for this analysis, with a prevalence of 11.14% for A. lumbricoides, 8.16% for hookworm, 1.38% for T. trichiura, and 6.36% for S. stercoralis. The sedimentation/concentration method was the most sensitive for A. lumbricoides (96%), compared to the McMaster method, with a sensitivity of 62%. Similarly, for hookworms, sedimentation/concentration was more sensitive than McMaster's, Harada-Mori, and Baermann with sensitivities of 87%, 70%, 43%, and 13%, respectively. Most of these infections were of light intensity. For S. stercoralis, Baermann and sedimentation/concentration methods were the most sensitive, with 70% and 62% respectively, while Harada-Mori was the least sensitive. In a subset of 389 samples also analyzed by the APC, Baermann was more sensitive than APC for detecting S. stercoralis, and both methods were superior to Harada-Mori. Parasitological methods, mostly when used combined, offer adequate opportunities for the diagnosis of STH in clinical and public health laboratories. The incorporation of S. stercoralis into the control strategies of the World Health Organization requires rethinking the current diagnostic approach used for surveys. With sedimentation/concentration and Baermann appearing as the most sensitive methods for this species. Further studies, including implementation assessments, should help in identifying the most adequate and feasible all-STH diagnostic approach.
ABSTRACT
Resumen Objetivo: Determinar las características epidemiológicas, el tratamiento, las estrategias de reperfusión y los eventos adversos intrahospitalarios de pacientes con infarto de miocardio con elevación del segmento ST en Perú. Métodos: Estudio observacional, prospectivo, multicéntrico a nivel nacional, en pacientes mayores de 18 años hospitalizados con diagnóstico de infarto de miocardio con elevación del segmento ST. Resultados: Desde febrero de 2016 a febrero de 2017, 396 pacientes fueron enrolados; la edad promedio fue de 64.9 ± 12 años y el 21% eran mujeres. En las primeras 12 h de evolución un 38% fueron fibrinolisados, en un 29% se realizó PCI primaria y un 33% no recibieron reperfusión. En el 12.9% se usó estrategia farmacoinvasiva. La tasa de éxito de la fibrinólisis fue de un 65% y la de la PCI primaria fue de un 82%. La estancia hospitalaria fue de 6 días (RIQ 5-10). La mortalidad intrahospitalaria llegó a un 10.1%, siendo la principal causa de muerte el choque cardiogénico. La tasa de reinfarto intrahospitalario fue de 2.2% y de falla cardiaca postinfarto, de 25%. La edad > 75 años, grandes tamaños de infarto, la fracción de eyección de ventrículo izquierdo < 40% y la ausencia de ondas T negativas en el electrocardiograma posreperfusión fueron variables relacionadas de manera independiente con una mayor mortalidad intrahospitalaria. Conclusiones: El infarto de miocardio con elevación del segmento ST en Perú afecta con más frecuencia a varones de entre 60 y 70 años. El tratamiento de reperfusión inicial más frecuente es la fibrinólisis, seguida por la angioplastia primaria y la estrategia farmacoinvasiva. El motivo principal de la falta de administración de tratamiento de reperfusión fue la demora desde el inicio de los síntomas hasta el primer contacto médico. La causa más frecuente de muerte intrahospitalaria es el choque cardiogénico.
Abstract Objective: To determine the epidemiological characteristics, treatment, reperfusion strategies and in-hospital adverse events of patients with ST elevation myocardial infarction in Peru. Methods: Observational, prospective multicentre study in patients over 18 years admitted to hospital with a diagnosis of ST elevation myocardial infarction. Results: A total of 396 patients were enrolled in the registry during February 2016 to February 2017. The mean age was 64.9 ± 12 years, and 21% were women. In the first 12 h of onset 38% of patients were fibrinolysed, 29% underwent primary PCI, and 33% did not receive any reperfusion. Pharmaco-invasive strategy was used in 12.9% of cases. The fibrinolysis was successful in 65% of patients, and primary PCI success was 82%. The hospital stay was 6 days (IQR 5-10). In-hospital mortality was 10.1%, with the first cause of death being due to cardiogenic shock. The rate of in-hospital re-infarction was 2.2%, and the rate of acute heart failure was 25%. Age > 75 years, large infarct size, left ventricular ejection fraction < 40%, and absence of negative T waves on post-reperfusion electrocardiogram were independently related to higher in-hospital mortality. Conclusions: In Peru, ST elevation myocardial infarction most frequently affects men between 60-70 years. The most frequent initial reperfusion treatment is fibrinolysis, followed by primary angioplasty, and pharmaco-invasive strategy. The main reason for the lack of administration of reperfusion treatment was the delay from symptoms onset to first medical contact. The most common cause of in-hospital death was cardiogenic shock.