Prevalence of Hb S (HHB: c.20A > T) in a Honduran population of African descent.

Sickle cell disease is the most common hemoglobinopathy worldwide, particularly in Africa and among people of African descent. Serious clinical consequences characterize the homozygous condition. To determine the prevalence of Hb S (HBB: c.20A > T) and anemia in a community of people of African descent from Honduras, 202 individuals were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The high prevalence found indicates that it is necessary to implement a program to prevent the consequences of this disease in vulnerable populations of Honduras.

Early identification and linkage to care of persons with chronic hepatitis B virus infection--three U.S. sites, 2012-2014.

In the United States, an estimated 0.8-1.4 million persons are living with chronic hepatitis B virus (HBV) infection. Among these persons, as many as 70% were born in countries of Asia, Africa, or other regions where HBV is moderately or highly endemic (hepatitis B surface antigen [HBsAg] prevalence ≥2%). HBV-associated cirrhosis and liver cancer are major health problems for these populations. Most persons with HBV were infected at birth or during early childhood and are asymptomatic until advanced liver disease develops. To address these concerns, CDC recommends HBsAg testing for all persons born in these areas and linkage to medical care and preventive services for those who are infected. In 2012, CDC awarded funds to nine sites to implement this recommendation. This report describes programs at three sites (New York, New York; Minneapolis-St. Paul, Minnesota; and San Diego, California) that conducted HBV testing, in clinical or community settings, and referred for medical evaluation and care those persons whose HBsAg test results were positive. During October 2012-March 2014, the three sites tested 4,727 persons for HBV infection; 310 (6.6%) were HBsAg-positive. Among the HBsAg-positive persons, 94% were informed of their results, 90% were counseled, 86% were referred for care, and 66% attended their scheduled first medical visit. These projects demonstrate that community-based programs can identify infected persons among populations with a high prevalence of HBV infection and refer HBsAg-positive persons for care. Individualized efforts to assist patients with accessing and receiving health-care services ("patient navigation services") can increase the number of persons who follow up on referrals and receive recommended care.

Changes in the Bone Mineral Density after Sleeve Gastrectomy vs. Roux-En-Y Gastric Bypass 2 Years after Surgery.

The aim of this study was to compare the analytical and densitometric changes 2 years after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). A retrospective study of a prospectively collected database was performed. Morbidly obese patients undergoing RYGB or SG, as primary bariatric procedures, were included. Weight loss; analytical levels of parathormone (PTH), vitamin D, and calcium; and densitometric parameters were investigated. In total, 650 patients were included in the study, and 523 patients (80.5%) underwent RYGB and 127 (19.5%) SG. There were no significant differences in excess weight loss at 24 months between both groups. When comparing preoperative and postoperative values, a significantly greater increase in PTH values was observed in the RYGB group, whereas there were no significant differences in calcium and vitamin D levels. The mean t-score values decreased after surgery at all the locations and in both groups. The reduction in the t-score was significantly greater in the RYGB group at the femoral trochanter and lumbar spine. A decrease in bone mineral density (BMD) was observed after both techniques. The mean BMD decrease was significantly greater in the femoral trochanter and lumbar spine after RYGB.

Impact of Biliopancreatic Limb Length (70 cm vs 120 cm), with Constant 150 cm Alimentary Limb, on Long-Term Weight Loss, Remission of Comorbidities and Supplementation Needs After Roux-En-Y Gastric Bypass: a Prospective Randomized Clinical Trial.

BACKGROUND: The best alimentary and biliopancreatic limb (BPL) lengths in the Roux-en-Y gastric bypass (RYGB) still remain unclear. The aim of this study was to compare the effect of a BPL of 70 vs 120 cm, with a constant AL of 150 cm on long-term weight loss, remission of comorbidities, and supplementation needs after RYGB. PATIENTS AND METHODS: A prospective randomized study of morbidly obese patients undergoing RYGB was performed. Patients were randomized into two groups: those patients undergoing RYGB with a BPL of 70 cm (BPL 70 cm) and those ones undergoing RYGB with a BPL of 120 cm (BPL 120 cm). BMI, excess BMI loss (EBMIL), remission of comorbidities and specific vitamin and mineral supplementation needs at 1, 2, and 5 years were analyzed. RESULTS: Two hundred fifty-three patients were included in each group. There were no significant differences in BMI, EBMIL and the remission of diabetes mellitus, hypertension, and dyslipidemia between groups at 1, 2, and 5 years after surgery. Patients from group BPL 120 cm required greater specific supplementation of vitamin B12, folic acid, and vitamin A during all the follow-up. CONCLUSION: A RYGB with 120 cm BPL does not achieve greater weight loss or remission of comorbidities than a RYGB with 70 cm BPL but is associated with greater deficiencies of vitamin B12, vitamin A, and folic acid. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03607305. https://clinicaltrials.gov/.

A 5-Year Follow-up in Children and Adolescents Undergoing One-Anastomosis Gastric Bypass (OAGB) at a European IFSO Excellence Center (EAC-BS).

BACKGROUND: The children and adolescent population with obesity has increased worldwide, both in developing areas and in developed countries. Consequently, the prevalence of morbid obesity among this population has also increased, leading to an exponential growth of bariatric approaches in this population. Many surgeons fear eventual nutritional sequelae after malabsorptive approaches and prefer restrictive or mixed procedures. METHODS: A retrospective review of all the morbidly obese patients between 13 and 19 years, undergoing a one-anastomosis gastric bypass (OAGB) as bariatric procedure between 2004 and 2012, was performed. RESULTS: A total of 39 patients were included, 8 males (20.5%) and 31 females (79.5%), with a mean age of 17.8 ± 2 years (range 13-19 years). Mean preoperative weight was 114.3 ± 20.4 kg and mean BMI 42.2 ± 5.9 kg/m2. Preoperative comorbidities include only type 2 diabetes mellitus (T2DM) in 7.9% of the patients, hypertension in 10.3%, and dyslipidemia in 23.1%. Five years after surgery, mean BMI was 25.9 ± 5.3 kg/m2 and total weight loss 32.1 ± 15.7%. Remission rate of T2DM, hypertension and dyslipidemia was 100%. All the patients received multivitamin and vitamin D supplementation. Anemia secondary to iron deficiency occurred in one female, requiring intravenous iron supplementation during 1 year and later on oral supplementation. CONCLUSIONS: OAGB is a valid alternative for long-term weight loss and remission of comorbidities in childhood and adolescence. No cases of malnutrition or growth disorders were observed.

Testing and Linking Foreign-Born People with Chronic Hepatitis B Virus Infection to Care at Nine U.S. Programs, 2012-2014.

OBJECTIVE: Hepatitis B virus (HBV) infection continues to be a public health threat in the United States. As many as 2.2 million people are infected, approximately 70% of whom are foreign-born, and fewer than one-third are aware of their infection. We launched an HBV testing and linkage-to-care initiative among foreign-born people. METHODS: As part of the Hepatitis Testing and Linkage to Care (HepTLC) initiative, which promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites, nine U.S. programs in seven states conducted HBV screening from October 2012 to September 2014. The nine programs partnered with health-care centers and community-based organizations to recruit foreign-born people recommended for HBV testing. We assessed patient characteristics, region of origin, risk factors, hepatitis B surface antigen (HBsAg) status, and referral to medical care. RESULTS: Of 23,144 participants tested for HBV, 1,317 (5.7%) were HBsAg positive. Of these, the median age was 47 years, 1,205 (91%) had at least one risk factor for HBV infection, 1,117 (85%) received posttest counseling, 1,098 (83%) were referred to care, and 606 (46%) attended a first medical appointment. The proportion of HBsAg-positive participants by region of origin included Africa (10%, 206/2,129), Western Pacific (6%, 616/9,673), Eastern Mediterranean (5%, 174/3,337), Southeast Asia (5%, 191/3,891), South America (2%, 6/252), Eastern Europe (2%, 6/262), and North America (1%, 17/1,936). CONCLUSION: Community-based HBV testing initiatives can identify substantial numbers of people with chronic HBV infection, inform them of their infection status, and provide posttest counseling and linkage to care. However, strategies are needed to improve linkage to HBV-directed medical care for foreign-born individuals living with chronic HBV infection.

Vigilancia seroepidemiológica de la circulación del SARS-CoV-2 en 41 municipios de Honduras sin reporte de casos activos, COVID-19, del 16- 23 junio 2020 / Seroepidemiological surveillance of SARS-CoV-2 circulation in 41 municipalities in Honduras with no report of active cases, COVID-19, June 16-23, 2020

Resumen Introducción: el 12 de marzo del 2020 Honduras reporto el primer caso de COVID-19 producida por el SARS-CoV-2. A partir de ese momento, se adoptan medidas para ralentizar el contagio. Para junio 2020, se reportan casos en la mayoría de los municipios. Con el objetivo de identificar la presencia y circulación del SARS-CoV-2 y caracterizar e identificar sintomatología sugerente de COVID-19 en la población se realiza el presente estudio. Metodología: Se trató de un estudio descriptivo tipo transversal, bajo enfoque cuantitativo y cualitativo utilizando el método de muestreo por lote. La población de estudio fueron los habitantes de municipios en los cuales no se reportaban oficialmente casos activos de COVID-19. Se recolectaron datos mediante encuesta electrónica y se aplicaron pruebas rápidas de detección de anticuerpos (IgG e IgM). Resultados: se encuestó y realizó pruebas a 792 personas de 41 municipios del país. La positividad de contacto se encontró en el 6.2 % (49/792). De estos, el 55.1 % (27/49) son hombres. Los grupos de edad con menor cantidad de pruebas de contacto positivo por COVID-19 fueron entre los 10-19 años (3/49) y mayores de 60 años (6/49). El cuadro clínico consistió en fiebre, disminución del apetito, dificultad respiratoria y pérdida del gusto y olfato. El 49.2 % (32/49) fueron asintomáticos. Conclusiones: Se demostró que hubo circulación del virus en la población de municipios en donde no se notificaron casos activos, 96 días después del primer caso confirmado en el país. La detección de anticuerpos específicos del virus podría ser importante en encuestas para infección asintomática en zonas donde el contacto es esperado.

Abstract Introduction: In Honduras on March 12, 2020, the first case of COVID-19 caused by the SARS-CoV-2 was reported. From that moment on, a series of measures were adopted to slow down contact throughout the country. By June 2020, cases are reported across the whole country. With the objective of identifying the presence and circulation of SARS-CoV-2, characterizing and identifying suggestive symptoms of COVID-19 in the population, the present study was carried out. Methodology: A descriptive cross-sectional study was carried out, using a quantitative and qualitative approach, using the LQAS sampling method. The study population was the inhabitants of the identified municipalities, with no current circulation data for SARS-CoV-2 or the municipalities whose last confirmed case was 21 days ago. The data was collected through an electronic survey, it was possible to apply rapid antibody detection tests (IgG and IgM). Results: 792 people from 41 municipalities of the country were surveyed and tested. Positivity of contact was found in 6.2% (49/792). Of these, 55.1% (27/49) are men. 61.2% (30/49) are between 20 and 49 years old. The clinical symptoms found were fever, decreased appetite, respiratory distress, and loss of taste and smell, the 49.2% (32/49) without symptoms. Conclusions: virus circulation was demonstrated in the population of municipalities in which no cases were officially reported and after 96 days of the first confirmed case in the country. Detection of virus-specific antibodies could be important in surveys for asymptomatic infection in areas where contact is expected.

Early Identification and Linkage to Care for People with Chronic HBV and HCV Infection: The HepTLC Initiative.

OBJECTIVE: In 2012, CDC's Division of Viral Hepatitis launched a public health initiative to increase hepatitis B virus (HBV) and hepatitis C virus (HCV) infection testing for those at risk and to improve linkage to medical care for those infected. We describe testing outcomes of previously unidentified people at risk for HBV and HCV infection and the lessons learned while linking patients to care. METHODS: CDC's Hepatitis Testing and Linkage to Care (HepTLC) initiative provided 34 financial awards to U.S. organizations that serve people at risk for viral hepatitis, 25 of which focused on HCV and nine of which focused on HBV. Grantees offered testing and test result notification to people at risk for HBV and/or HCV infection, as well as counseling, referral, and verification or notification of linkage to care for people with positive test results. We entered demographic data, self-reported risk factors, country of origin (for HBV), and testing outcomes into a confidential database. RESULTS: The 34 grantees tested 87,860 people at more than 260 sites in 17 states. Of the 23,144 people tested for HBV, 1,317 (6%) were positive. Of the 64,716 people tested for HCV, 57,570 (89%) received an HCV antibody (anti-HCV) test, of whom 7,580 (13%) tested anti-HCV positive. Of the 4,765 people who received an HCV RNA test, 3,449 (72%) tested positive. Of the 4,766 people who tested positive for either HBV or HCV infection, 2,116 (44%) were linked to care. CONCLUSION: Interventions targeting people at risk for HBV and HCV infection reached a substantial number of people for whom testing is recommended and identified a large proportion of those who had previously unrecognized infection. Patient navigation was critical for follow-up and linkage to care.

Características dentales y óseas en un grupo de escolares del área urbana de Manizales según género y tipo de dentición / Dental and Bone Featuresin a Group of School Children in the Urban Area of ManizalesRegarding Gender and Dentition Type

Resumen Introducción y objetivo: El control del crecimiento facial requiere un conocimiento profundo de los cambios óseos, dentales y musculares que se producen a nivel del sistema Estomatognático. Describir las características óseas y dentales de un grupo de escolares entre 5 y 6 años. Materiales y métodos: Estudio descriptivo que utilizó una base de datos epidemiológica de un posgrado de ortodoncia, de acuerdo a los criterios de inclusión, se consideraron 107 escolares. La información se obtuvo a través de radiografías de perfil y modelos de estudio. Se realizó un análisis descriptivo de medidas de tendencia central y un análisis de correspondencias. Resultados: Las sobremordidas, los planos terminales rectos y las relaciones caninas clase I se presentaron entre el 41 y 60%. Los maxilares con respecto a la base del cráneo presentaron posición media 64%(superior) 65% (inferior), las alturas faciales anteriores se encontraron por encima del 60% en un tamaño medio. En el análisis multivariado se observaron cuatro clases, la tercera de mayor porcentaje (45%), compuesta por escolares con características dentales y óseas ideales en la dentición temporal completa. Se realizaron análisis de tendencia central y análisis multivariado para caracterizar grupos. Conclusión: 45% de los escolares presentaron características ideales en dentición temporal. Las relaciones de los maxilares con la base de cráneo registraron valores mayores en las mujeres, las medidas ejeY, SNmandibular, maxilomandibular y goníaco fueron mayores en los hombres.

Introduction and objective: Control of facial growth requires an in-depth knowledge of dental, bone and muscle changes produced in the stomatognathic system. The aim of this study was to describe dental and bone features of a group of school children between 5 and 6 years old. Materials and methods: This descriptive study used the epidemiological database of a Postgraduate Orthodontics program, and base on the inclusion criteria, 107 school children were selected. Data was obtained through profile radiography and study models. A descriptive analysis of central tendency measures and a correspondence analysis was made. Results: Overbites, straight terminal planes and Class I canine relationships were found between 41% and 60%. Maxillary structures in relation to the cranial base showed a median position 64% (upper) and 65% (lower). Anterior facial heights were found over 60% in a median size. Four classes were observed with the multivariate analysis. The third class showed the highest percentage (45%) and was formed by school children with ideal dental and bone features in the complete primary dentition. A central tendency analysis and a multivariate analysis were made in order to characterize groups. Conclusions: 45% of school children showed ideal features in primary dentition. The relations of the maxillary structures to cranium showed higher values in women. Measurements such as Y axis, SN-mandibular plane, maxillomandibular plane and goniac angle were higher in men.

Representaciones sociales sobre salud oral y su relación con los discursos y prácticas profesionales / Representacões sociais sobre saúde oral e sua relacão com os discursos e praticas profissional / Social representations on dental health and its relation to professional discourse and practices

Este estudio pretendió reconocer las representaciones sociales sobre salud oral, que tienen los niños, las niñas y sus familias que asisten a los servicios de ortopedia maxilar en la Universidad Autónoma de Manizales y la relación con los discursos y prácticas de los profesionales. De acuerdo con su pregunta de investigación obedece a un estudio de corte cualitativo, que puso de manifiesto un rompimiento de diálogos entre los(as) niños(as), las familias y los profesionales, luego de establecer que las familias reconocen a la salud oral como un componente de la salud general, al igual que la salud oclusal como un componente de la salud oral pero no reconocen la salud oclusal como un componente de la salud general, pero al mismo tiempo hacen una transversalización de los tres niveles de salud por la funcionalidad y el tratamiento ortopédico. De otro lado los(as) niños(as), reconocen la salud oral como igual a la salud oclusal, considerando aparte la salud general; mientras que los profesionales le dan a la salud oral y a la salud oclusal alguna independencia con la salud general en el momento de realizar los tratamientos de ortopedia maxilar. Con el fin de presentar a partir de un modelo que pudiera dar cuenta de la interpretación realizada, se asume la teoría general de sistemas, entendiendo el ser humano como un sistema.

This paper presents a study aimed at recognizing the social representations on dental health had by children and their families, who attend the maxillary orthopedic services in Universidad Autonoma of Manizales and their relation to the professional discourse and practices. This is a qualitative research, manifesting a dialogue rupture among children, families and professionals. The families recognized dental health as part of general health, and occlusal health as a part of dental health. However, they do not recognize occlusal health as part of general health, but at the same time they transversalize the above mentioned three health levels by their functionality and orthopedic treatment. On the other hand, children recognized dental health and being the same as occlusal health, considering general health as a separate matter. Instead, professionals consider dental health and occlusal health an independent area in respect to general health when performing maxillary orthopedics treatments. Based on a model that could account for the interpretation presented, the general system theory is used, understanding human beings as a whole system.

Esta pesquisa pretendeu reconhecer as representações sociais sobre saúde oral, que têm as crianças, as meninas e suas famílias que assistem aos serviços de ortopedia maxilar na Universidade Autônoma de Manizales e a relação com os discursos e práticas de os Profissionais. De acordo com a pergunta de investigação obedece a um estudo de corte qualitativo, que pôs de manifesto um rompimento de diálogos entre os garotos e meninas, as famílias e os profissionais, logo de estabelecer que as famílias reconheçam à saúde oral como um componente da saúde geral, ao igual oclusal como um componente da saúde oral, mas não reconhecem a saúde oclusal como componente da saúde geral, mais ao mesmo tempo fazem uma transversalizacão dos três niveles da saúde por a funcionalidade e o tratamento ortopédico. De outro lado as menina (as) e garoto (os), reconhecem a saúde oral como igual à oclusal, considerando aparte a saúde geral; mientras que os profissionais dão à saúde oral e à saúde oclusal alguma independência com a saúde geral no momento de realizar os tratamentos de ortopedia maxilar. Com o fim de apresentar a partir dum modelo que poderia dar conta da interpretação realizada, se assume a teoria geral de sistemas, entendendo o ser humano como um sistema.

Tuberculosis del lactante: reevaluación de los criterios diagnósticos, quimioprofilaxis y alternativas en el desnutrido / Infancy Tuberculosis: reevaluation of the diagnosis criteria, chemoprophylaxis and alternatives with malnutrition infants

Se presenta la experiencia en cuanto al diagnóstico y manejo de 54 pacientes menores de 2 años de edad, portadores de diferentes formas clínicas de TBC, poniéndo énfasis en los criterios diagnóstico que en esta edad tienen diferente connotación en relación al niño mayor y al adulto. El hallazgo del alto porcentaje de PPD negativo, guarda relación con el alto porcentaje de Desnutridos de II§ grado y III§ grado, lo que obliga a ampliar el uso de la Quimioprofilaxis a pacientes desnutridos y eutróficos no becegeizados, aún con PPD negativo, en presencia de un contacto referido o demostrado.Por su efectividad, bajo costo en relación a dosis y facilidad de administración, se recomienda el uso de la Rifampicina en reemplazo de la Estreptomicina para la quimioterapia de pacientes con formas moderadas o graves de TBC, enfatizando que debe continuar la Isoniazida como base de todo esquema terapéutico antituberculoso.

Factores de riesgo asociados a la hipertension durante el embarazo / Risk factors associated to hypertension during pregnancy

La importancia de la búsqueda exhaustiva de factores de riesgo relacionados con la hipertensión durante el embarazo condiciona un nuevo enfoque clínico epidemiológico acerca de las baterias necesarias para el estudio de una materna a través del embarazo. De importancia fundamental factores como edad, nivel socioeconómico, enfermedades renovasculares presentes o pasadas, aborto, paridad, estado nutricional y grupo étnico, que el médico debe conocer para así poder establecer a tiempo el riesgo de dicho embarazo con respecto a una futura hipertension durante el embarazo. Este estudio pretende mostrar la frecuencia de presentación de dichos factores mediante un estudio descriptivo realizado en el Centro de salud de Horizontes en un periodo de dos y medio años. Se estudiaron 124 pacientes que asistieron a control prenatal, encontrándose un predominio de maternas menores de 29 años de nivel socioeconómico bajo, multíparas, y en mínima proporción con alteraciones renovasculares; solo una paciente presentó enfermedad hipertensiva durante el embarazo, cuyo parto llego a feliz término gracias a la oportuna remisión al Hospital Regional Simón Bolivar para su seguimiento y atención