RESUMO
ABSTRACT Background: The incidence of chronic kidney disease (CKD) is relatively high in Guyana. Estimated glomerular filtration rate (eGFR) reporting allows for early-stage CKD identification when therapeutic interventions can prevent CKD progression. Accurate creatinine measurements are essential for valid eGFR calculations. Objective: This study was undertaken to assess the accuracy of creatinine measurements in Guyana prior to implementing routine eGFR reporting. Methods: Sixteen Guyanese laboratories participated in this study. Each laboratory received a common set of blinded human serum samples (n = 3) containing clinically relevant creatinine concentrations, assigned by an international reference method (ID-GCMS). Laboratories performed repeated measurements of creatinine in each sample. These data were used to calculate bias, precision and total error (TE) for each creatinine method. Linear regression was used to compare measured creatinine results to assigned reference sample values and to post-analytically correct calibration bias, a priori, for recent patient results from each laboratory. Patient eGFR profiles were compared before and after bias correction. Results: The mean across samples CV and bias for all labs were 9% (range 2.5%-39.3%) and 11% positive (range 0.4%-29.1%), respectively. The mean TE was 28.6%. If the mean TE from a subset of the better performing laboratories (CV < 7%) was to apply nationally, an 'all stage' eGFR misclassification rate of 36% would result. Conclusion: There is a pressing need to improve the accuracy of creatinine measurements in Guyana as, at this time, routine reporting of eGFR by Guyanese laboratories cannot be recommended based on the accuracy data presented in this study.
Assuntos
Humanos , Creatinina/sangue , Insuficiência Renal Crônica/diagnóstico , Biomarcadores/sangue , Insuficiência Renal Crônica/sangue , Confiabilidade dos Dados , Laboratórios Clínicos , Taxa de Filtração Glomerular , GuianaRESUMO
ABSTRACT Objective. To determine predictors associated with physical violence during pregnancy, and to determine the relationship between exposure to intimate partner violence during pregnancy and women's health and suicide ideation in Guyana. Methods. A secondary data analysis of a cross-sectional household survey. Multivariate logistic regression models were fitted to the data to estimate the association between physical violence during pregnancy, controlling partner behavior, and other predictors. Ordered logistic regression models were fitted to estimate the association between physical violence during pregnancy and women's health, and lifetime physical partner violence and overall health. Logistic regression models were fitted to estimate associations between physical violence during pregnancy and lifetime physical partner violence and overall health and suicide ideation. Results. The prevalence of lifetime physical/sexual intimate partner violence was 38.8%, current physical/sexual intimate partner violence 11.1%, and violence during pregnancy 9.2%. Controlling partner behavior was significantly and positively associated with maternal experience of physical violence during pregnancy. Experiencing physical partner violence during pregnancy, but not lifetime physical partner violence, was associated with significantly increased odds of poor overall health. Physical violence during pregnancy and lifetime physical violence were both significantly associated with increased odds of suicide ideation. Conclusions. The prevalence of violence during pregnancy in Guyana is high and is associated with adverse health outcomes. These findings suggest the need for intimate partner violence prevention, and for integrating intimate partner violence screening and treatment into antenatal care, reproductive health services, and maternal and child health programs and services to identify and treat at-risk women.
RESUMEN Objetivo. Determinar los factores predictivos relacionados con la violencia física durante el embarazo y determinar la relación entre la exposición a la violencia de pareja durante el embarazo y la ideación suicida y la salud de las mujeres en Guyana. Métodos. Se realizó un análisis secundario de los datos obtenidos de una encuesta domiciliaria transversal. Se adaptaron modelos multifactoriales de regresión logística a los datos para calcular la asociación entre la violencia física durante embarazo, comportamiento controlador de la pareja y otros factores predictivos. Se emplearon modelos ordenados de regresión logística para calcular la asociación entre la violencia física durante el embarazo y la salud de la mujer, y la violencia de pareja a lo largo de la vida y la salud en general. Se aplicaron modelos de regresión logística para calcular la asociación entre la violencia física durante el embarazo y la violencia de pareja a lo largo de la vida y la ideación suicida y la salud en general. Resultados. La prevalencia de la violencia física o sexual infligida por la pareja a lo largo de la vida fue 38,8%, la violencia física o sexual infligida por la pareja en la actualidad fue 11,1% y la violencia durante el embarazo fue 9,2%. El comportamiento controlador de la pareja mostró una asociación positiva y significativa con una experiencia materna de violencia física durante el embarazo. Sufrir violencia física durante el embarazo, aunque no a lo largo de la vida, se asoció significativamente con mayores probabilidades de un estado de salud general deficiente. Tanto la violencia física durante el embarazo como la violencia física a lo largo de la vida se asociaron significativamente con mayores probabilidades de ideación suicida. Conclusiones. La prevalencia de la violencia durante el embarazo en Guyana es alta y está relacionada con consecuencias adversas en materia de salud. Estos resultados ponen de manifiesto la necesidad de prevenir la violencia de pareja y de integrar su detección y tratamiento en la atención prenatal, los servicios de salud reproductiva y los programas y servicios de salud maternoinfantil para detectar y tratar a las mujeres en riesgo.
RESUMO Objetivo. Determinar as variáveis preditivas associadas à violência física contra mulheres na gravidez e avaliar a relação entre exposição à violência por parceiro íntimo na gravidez e saúde e ideação suicida em mulheres na Guiana. Métodos. Foi realizada uma análise dos dados secundários de uma pesquisa transversal domiciliar. Modelos de regressão logística multivariada foram ajustados ao conjunto de dados para estimar a associação entre violência física na gravidez, controlando-se o efeito do comportamento do parceiro e outras variáveis preditivas. Modelos de regressão logística ordinal foram ajustados para estimar a associação entre violência física na gravidez e saúde das mulheres e violência física por parceiro íntimo ao longo da vida e saúde geral. Modelos de regressão logística foram ajustados para estimar a associação entre violência física na gravidez e violência física por parceiro íntimo ao longo da vida e saúde geral e ideação suicida. Resultados. Observou-se uma prevalência de 38,8% de violência física/sexual por parceiro íntimo ao longo da vida, 11,1% de violência física/sexual por parceiro íntimo no momento presente e 9,2% de violência física/sexual na gravidez. Controlando-se o efeito do comportamento do parceiro, verificou-se uma associação positiva significativa com experiência materna de violência física na gravidez. Sofrer violência física por parceiro íntimo na gravidez, mas não violência física por parceiro íntimo ao longo da vida, foi associado a uma chance significativamente maior de saúde geral ruim. Verificou-se uma associação significativa entre violência física na gravidez e violência física ao longo da vida e uma maior chance de ideação suicida. Conclusões. A prevalência da violência contra mulheres na gravidez na Guiana é alta e está associada a desfechos de saúde adversos. Esses resultados apontam para a necessidade de prevenir a violência por parceiro íntimo e integrar a avaliação da violência por parceiro íntimo e o tratamento das mulheres aos serviços de assistência pré-natal e de saúde reprodutiva e programas e serviços de saúde materno-infantil para identificar e tratar as mulheres em risco.
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Pessoa de Meia-Idade , Gestantes/psicologia , Ideação Suicida , Violência por Parceiro Íntimo/estatística & dados numéricos , Prevalência , Estudos Transversais , Inquéritos e Questionários , Guiana/epidemiologiaRESUMO
ABSTRACT Objective: To determine the specialty preferences and the reasons for those choices among medical interns and junior medical doctors at the Georgetown Public Hospital Corporation (GPHC), Guyana. Methods: A cross-sectional study of recent medical graduates at GPHC using anonymous self-administered questionnaires was used. Results: Of the study population of 66, 60 of the questionnaires that were filled were returned (response rate of 91.5%). The females comprised 60% of the respondents and 98% of the respondents were interested in Postgraduate Medical Education (PGME). Paediatrics was the most popular programme (25% of the respondents) followed by internal medicine (21%), and the main reason among the respondents for their choice of training programme was personal interest (69%). Gender differences occurred in paediatrics and ophthalmology where the females were predominant, and in orthopaedics and anaesthesia, where the males were predominant. Conclusion: To ensure an adequate and balanced medical specialists workforce for the future, information on medical graduates' perceptions and preferences of PGME and the factors influencing their choices is important to policy planners and medical educators and efforts must be made to correct any of the maldistributions noted.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Programas de Pós-Graduação em Saúde , Internato e Residência , Estudos Transversais , Inquéritos e Questionários , Guiana , Hospitais PúblicosRESUMO
ABSTRACT Objective: To determine the knowledge attitude and practice (KAP) and prevalence of syphilis and to investigate the sexual health practices and constraints among commercial sex workers (CSWs) in Guyana. Methods: The participants were randomly selected from CSWs participating in support group meetings held in Georgetown and Berbice. The survey was cross-sectional, and SPSS 20.0 was used to perform the data analysis. Results: The majority (92.9%) of CSWs tested negative for syphilis, whereas two (2.9%) of the five (7.1%) reactive Venereal Disease Research Laboratory cases indicated prior history of syphilis infection. In the study, 54.3% of participants always used condoms, whereas 74.3% did not use drugs and only 2.9% consumed alcohol every day. The participants had a fair KAP towards syphilis but few misconceptions exist. Stigma and discrimination was identified as the major constraint faced by male sex workers, and 97.1% of CSWs indicated that they preferred giving up sex work. Conclusion: Syphilis was not prevalent among the selected CSWs in Georgetown and Berbice. Prevention programmes should be continued through the support groups to maintain and increase safe sexual practices among female sex workers. Strategies should also be tailored to provide rehabilitation to the CSWs, especially for those willing to give up sex work.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Sífilis/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Profissionais do Sexo , Fatores Socioeconômicos , Prevalência , Estudos Transversais , Fatores de Risco , Guiana/epidemiologiaRESUMO
BACKGROUND The number of malaria cases in Roraima nearly tripled from 2016 to 2018. The capital, Boa Vista, considered a low-risk area for malaria transmission, reported an increasing number of autochthonous and imported cases. OBJECTIVES This study describes a spatial analysis on malaria cases in an urban region of Boa Vista, which sought to identify the autochthonous and imported cases and associated them with Anopheles habitats and the potential risk of local transmission. METHODS In a cross-sectional study at the Polyclinic Cosme e Silva, 520 individuals were interviewed and diagnosed with malaria by microscopic examination. Using a global positional system, the locations of malaria cases by type and origin and the breeding sites of anopheline vectors were mapped and the risk of malaria transmission was evaluated by spatial point pattern analysis. FINDINGS Malaria was detected in 57.5% of the individuals and there was a disproportionate number of imported cases (90.6%) linked to Brazilian coming from gold mining sites in Venezuela and Guyana. MAIN CONCLUSIONS The increase in imported malaria cases circulating in the west region of Boa Vista, where there are positive breeding sites for the main vectors, may represent a potential condition for increased autochthonous malaria transmission in this space.
Assuntos
Humanos , Animais , Masculino , Feminino , Adulto , Plasmodium/isolamento & purificação , Viagem , Mineradores/estatística & dados numéricos , Mosquitos Vetores/parasitologia , Malária/diagnóstico , Malária/transmissão , Anopheles/parasitologia , Plasmodium/classificação , População Urbana , Venezuela , Brasil/epidemiologia , Estudos Transversais , Sistemas de Informação Geográfica , Análise Espacial , Ouro , Guiana , Malária/parasitologia , Malária/epidemiologia , Anopheles/classificação , Pessoa de Meia-IdadeRESUMO
Se presentó el caso de un neonato en el Hospital Regional Suddie, de Guyana, con tumoración de cuello, diagnosticado como higroma quístico, malformación no frecuente y cuyo diagnóstico se realiza al principio del embarazo por ecografía prenatal con evaluación de la región de la nuca del feto. La ampliación excesiva o aumento de la translucencia nucal puede estar relacionado con un higroma quístico. Las malformaciones congénitas son defectos estructurales presentes al nacimiento ocasionadas por un trastorno prenatal durante la morfogénesis. La ecografía prenatal realizada en el primer y segundo trimestre del embarazo por personal capacitado es un medio diagnóstico económico y no invasivo que permite el diagnóstico precoz y tomar conducta temprano en países de pocos recursos(AU)
The case of a neonate in Regional Hospital Suddie of Guyana with neck tumor, was presented and diagnosed as cystic lymphangioma, rare malformation and whose diagnosis is made early in pregnancy by prenatal ultrasound evaluation of the region of the neck of the fetus. Excessive expansion or increased translucency in the hindhead may be related to a cystic lymphangioma. Congenital malformations are structural defects present at birth caused by a prenatal disorder during morphogenesis. Prenatal ultrasound performed in the first and second trimester of pregnancy by trained personnel is an average economic diagnosis and non-invasive allowing early diagnosis and taking behavior early in resource-poor countries(AU)
O caso de um neonato em Hospital Regional Suddie na Guiana foi apresentado com um tumor no pescoço, diagnosticado como higroma cístico, malformação freqüente e cujo diagnóstico é feito no início da gestação por ultrassonografia pré-natal com avaliação da região da nuca do feto. O aumento excessivo ou aumento da translucência nucal pode estar relacionado a um higroma cístico. Malformações congênitas são defeitos estruturais presentes no nascimento causados por um distúrbio pré-natal durante a morfogênese. A ultrassonografia pré-natal realizada no primeiro e segundo trimestres da gravidez por pessoal treinado é um meio de diagnóstico barato e não invasivo que permite o diagnóstico precoce e a conduta precoce em países com poucos recursos(AU)
Assuntos
Recém-Nascido , Recém-Nascido , Linfangioma Cístico/diagnóstico , GuianaRESUMO
Map of Guyana utilizes a colour key to identify the number of locations where malaria microscopy is done; the main malaria hot spots; and the main health facilities.
Assuntos
Humanos , Masculino , Feminino , Malária , Área Programática de Saúde , Localização Geográfica de Risco , Localizações Geográficas , Guiana/epidemiologiaRESUMO
ABSTRACT Objective To assess scale-up of recommended tuberculosis (TB)/HIV activities in Guyana and to identify specific strategies for further expansion. Methods Medical records and clinic registers were reviewed at nine TB clinics and 10 HIV clinics. At TB clinics, data were collected on HIV testing and antiretroviral therapy (ART) for patients with TB/HIV; at HIV clinics, data were collected on intensified case finding (ICF), tuberculin skin test (TST) results, and provision of isoniazid preventive therapy (IPT). Results At TB clinics, among 461 patients newly diagnosed with TB, 419 (90.9%) had a known HIV status and 121 (28.9%) were HIV-infected. Among the 63 patients with TB/HIV, 33 (52.4%) received ART. Among the 45 patients with TB/HIV for whom dates of HIV diagnosis were available, 38 (84.4%) individuals knew their HIV status prior to TB diagnosis. At HIV clinics, among 127 patients eligible to receive a TST, 87 (68.5%) received a TST, 66 (75.9%) had a TST result, seven (10.6%) had a newly positive result, two had a previously positive result, and six of nine patients with positive results (66.7%) received IPT. ICF could not be assessed because of incomplete or discrepant documentation. Conclusions An in-depth evaluation of TB/HIV activities successfully identified areas of success and remaining challenges. At TB clinics, HIV testing rates are high; further scale-up of ART for persons with TB/HIV is needed. At HIV clinics, use of TST to focus IPT is a feasible and efficient strategy; improving rates of annual TST screening will allow for further expansion of IPT.
RESUMEN Objetivo Evaluar la ampliación de las actividades recomendadas contra la tuberculosis (TB) y la infección por el VIH en Guyana y definir estrategias específicas para nuevas expansiones. Métodos Se examinaron los expedientes médicos y registros clínicos de nueve consultorios de atención de la TB y diez consultorios de atención de la infección por el VIH. En los consultorios de atención de la tuberculosis, se recopilaron datos sobre las pruebas de detección del VIH y el tratamiento antirretroviral (TAR) para pacientes con TB e infección por el VIH; en los consultorios de atención de la infección por VIH, se recopilaron datos a partir de una búsqueda intensiva de casos, los resultados de la prueba de la tuberculina y la provisión de tratamiento preventivo con isoniazida. Resultados En los consultorios de atención de la tuberculosis, de 461 pacientes recién diagnosticados con tuberculosis, 419 (90,9%) conocían su estado con respecto a la infección por el VIH y 121 (28,9%) estaban infectados por el virus. De los 63 pacientes con TB e infección por el VIH, 33 (52,4%) recibieron TAR. De los 45 pacientes con TB e infección por el VIH cuya fecha de diagnóstico de la infección por el VIH se conocía, 38 (84,4%) supieron de su estado con respecto a la infección por el VIH antes de recibir el diagnóstico de la tuberculosis. En los consultorios de atención de la infección por el VIH, de 127 pacientes que reunían los requisitos para la prueba de la tuberculina, 87 (68,5%) recibieron la prueba, 66 (75,9%) tuvieron un resultado, siete (10,6%) tuvieron un resultado positivo nuevo, dos habían tenido un resultado positivo anteriormente, y seis de nueve pacientes con resultados positivos (66,7%) recibieron tratamiento preventivo con isoniazida. No pudo evaluarse la búsqueda intensiva de casos debido a que la documentación estaba incompleta o era discrepante. Conclusiones Una evaluación exhaustiva de las actividades contra la TB y la infección por el VIH permitió determinar las áreas donde se había tenido éxito y los retos pendientes. En los consultorios de atención de la tuberculosis, las tasas de realización de pruebas de detección del VIH son elevadas; se necesita ampliar el alcance del TAR para llegar a las personas con TB e infección por el VIH. En los consultorios de atención de la infección por el VIH, el uso de la prueba de la tuberculina para focalizar la búsqueda intensiva de casos es una estrategia factible y eficaz; el mejoramiento de las tasas de tamizaje anual con la prueba de la tuberculina permitirá ampliar la búsqueda intensiva de casos.
Assuntos
Tuberculose/prevenção & controle , Infecções por HIV/prevenção & controle , Infecções por HIV/epidemiologia , Guiana/epidemiologiaRESUMO
The document highlights the achievements made in the public health system in Guyana as well as the challenges faced during the past fifty years. It provides an analysis of the country context, the health systems and services, the epidemiological profile, the achievements and challenges, and the health targets for the next fifty years. The Epidemiological profile addresses diseases surveillance and disease profile, including measles, malaria, tuberculosis, HIV/AIDS, dengue, cardiovascular, hypertension, diabetes and cancer.
Assuntos
Humanos , Masculino , Feminino , Saúde Pública , Serviços de Saúde , Guiana/epidemiologiaRESUMO
Malaria remains a public health problem in Guyana, particularly in the hinterlands. Malaria prevention centers on control and treatment options provided by the National Malaria Program through the Ministry of Public Health. This makes communication an essential tool for positive outcomes of all options offered in malaria prevention and control by the National Malaria Program. The National Malaria Communication Strategy is to guide the development, implementation, and monitoring of the communication and behavior change component of malaria prevention and control. The National Malaria Communication Strategy is aligned to support the National Malaria Strategic Plan for 2015-2020. It is our hope that all actors who use this strategy will find it useful in their interventions and most importantly in the promotion of interventions that are meant to eliminate malaria in this country.
Assuntos
Humanos , Masculino , Feminino , Comunicação , Malária/prevenção & controle , Guiana/epidemiologiaRESUMO
The global emergence of Plasmodium vivax strains resistant to chloroquine (CQ) since the late 1980s is complicating the current international efforts for malaria control and elimination. Furthermore, CQ-resistant vivax malaria has already reached an alarming prevalence in Indonesia, East Timor and Papua New Guinea. More recently, in vivo studies have documented CQ-resistant P. vivax infections in Guyana, Peru and Brazil. Here, we summarise the available data on CQ resistance across P. vivax-endemic areas of Latin America by combining published in vivo and in vitro studies. We also review the current knowledge regarding the molecular mechanisms of CQ resistance in P. vivax and the prospects for developing and standardising reliable molecular markers of drug resistance. Finally, we discuss how the Worldwide Antimalarial Resistance Network, an international collaborative effort involving malaria experts from all continents, might contribute to the current regional efforts to map CQ-resistant vivax malaria in South America.
Assuntos
Humanos , Antimaláricos/administração & dosagem , Cloroquina/administração & dosagem , Resistência a Medicamentos , Malária Vivax/tratamento farmacológico , Plasmodium vivax/efeitos dos fármacos , Bolívia/epidemiologia , Brasil/epidemiologia , Colômbia/epidemiologia , Guiana/epidemiologia , Malária Vivax/epidemiologia , Malária Vivax/parasitologia , América do Sul/epidemiologiaRESUMO
The preparation of Health Vision 2020 reflects the collaborative work of a number of governmental agencies, programmes and stakeholders under the leadership of the Ministry of Health. The technical drafting and coordination of the strategy development was completed by the Planning Unit of the Ministry, led by my office and facilitated with assistance from PanAmerican Health Organization/ World Health Organization Consultant. We are grateful for the considered support and technical cooperation given by the PAHO/WHO, whose assistance made possible the successful completion of this critical document. I wish to recognize the invaluable contribution by the Honourable Minister Dr. Bheri Ramsaran in providing guidance on the overall vision and general strategic direction aligned to the government's health commitment to the people of Guyana. The insight of the Parliamentary Secretary, Mr. Joseph Hamilton, Permanent Secretary, Mr. Leslie Cadogan and Deputy Permanent Secretary, Mr. Trevor Thomas in supporting the development of the strategic framework, defining the polices for Health Vision 2020 and ensuring wide stakeholder contribution added tremendous value to the multifaceted inputs into the strategy. I, on behalf of the Ministry, take this opportunity to acknowledge the contributions made by stakeholders within and outside the health sector of Guyana, in particular our programme directors and health workers, regional officers and other managers in the health system, clinicians in the private and public sectors, counterparts in other sectors and government agencies, civil society organizations, faith based organizations, the media and other partners in health. Sincerest thanks are extended to members of the general public and all people of Guyana for who this strategy was developed. The ministry looks forward to your full support and thanks you in advance for your feedback as we all strive to ensure that all persons in Guyana enjoy good health
Assuntos
Estratégias de Saúde Nacionais , Gestão da Qualidade Total , Promoção da Saúde , Programas Nacionais de Saúde/normas , Assistência Centrada no Paciente , Parcerias Público-Privadas , GuianaRESUMO
OBJECTIVE: To analyse the sensitivity of Mycobacterium tuberculosis by nitrate reductase assay (NRA) and the Hain molecular line probe assay (LPA) in sputa of tuberculosis (TB)/HIV co-infected patients in Guyana. DESIGN: Sputum samples were collected from known TB patients at Georgetown Chest Clinic and were analysed at the Reference Laboratory, Guyana, over the period April 2010 to April 2011. RESULTS: Both methods recorded greater sensitivity for rifampin (RIF) than of isoniazid (INH). Both methods detected four RIF resistant, two INH resistant and two multi-drug resistant (MDR) strains and they had greater negative agreement indices than positive agreement indices. CONCLUSION: It was established that the sensitivity of Mycobacterium tuberculosis by the NRA and Hain LPA in TB/HIV co-infected patients has acceptable correlation and that HIV infection does not affect drug susceptibility testing.
OBJETIVO: Analizar la sensibilidad de Mycobacterium tuberculosis por medio del ensayo de nitrato reductasa (NRA) y el ensayo de sonda lineal (LPA) molecular de Hain en esputos de pacientes co-infectados TB/VIH en Guyana. DISEÑO: Muestras de esputo de pacientes de la Clínica del Tórax en Georgetown diagnosticados con tuberculosis, fueron analizadas en el Laboratorio de Referencias, en Guyana, en el período de abril de 2010 a abril de 2011. RESULTADOS: Ambos métodos registraron una mayor sensibilidad a la rifampicina (RIF) que a la isoniacida (INH). Ambos métodos detectaron cuatro cepas resistentes a RIF, dos resistentes a INH, y dos resistentes a mútiples medicamentos (RMM). Asimismo, presentaban mayores índices de concordancia negativa que de concordancia positiva. CONCLUSIÓN: Se estableció que la sensibilidad de Mycobacterium tuberculosis por medio del ensayo de NRA y el LPA de Hain en pacientes co-infectados TB/VIH, guarda una correlación aceptable, y que la infección por VIH no afecta la prueba de susceptibilidad a los medicamentos.
Assuntos
Humanos , Escarro/microbiologia , Testes de Sensibilidade Microbiana , Infecções por HIV , Mycobacterium tuberculosis/efeitos dos fármacos , Antituberculosos/farmacologia , Rifampina/farmacologia , População Rural , Tuberculose Pulmonar/microbiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Farmacorresistência Bacteriana Múltipla , Coinfecção/microbiologia , Guiana , Isoniazida/farmacologia , NitratosRESUMO
INTRODUCTION: Blood transfusion is an important transmission route of Trypanosoma cruzi (T cruzi), a major parasitic infection in Central and South America. The limited treatment options are most effective in acute Chagas' infection. At present, there is no current data on the prevalence of T cruzi in the blood donor population of Guyana. This information is necessary to protect the supply of the blood donation programme. This study sought to determine the prevalence of T cruzi in the blood supply at the National Blood Transfusion Services of Guyana with the hope of providing knowledge to the on-going surveillance for Chagas' disease worldwide and therefore address the risk of its spread by blood transfusion. METHODS: Two commercialized ELISAs utilizing crude or recombinant T cruzi antigens were used to study 2000 blood samples voluntarily donated for the purpose of altruistic or family replacement donation retrospectively. RESULTS: The results showed that approximately 1 in 286 donations tested positive for antibodies to T cruzi. CONCLUSION: These results indicate that T cruzi continues to be a risk in Guyana and there is a need to continue screening donated blood. Trypanosoma cruzi is a life-long infection and infected persons may be asymptomatic chronic carriers of the disease. Education, housing improvement, and controlled use of insecticides should be introduced to contain Chagas' disease.
INTRODUCCIÓN: La transfusión de Sangre es una vía de transmisión importante del Trypanosoma cruzi (T cruzi), una infección parasitaria mayor en América Central y América del Sur. Las opciones de tratamiento limitadas son más eficaces en los casos de la enfermedad de Chagas aguda. En el presente, no existen datos actualizados acerca de la prevalencia del T cruzi en la población de donantes de sangre en Guyana. Esta información es necesaria para proteger el suministro del programa de donación de sangre. Este estudio se propuso determinar la prevalencia de T cruzi en el suministro de sangre de los Servicios Nacionales de Transfusión de Sangre en Guyana, con la esperanza de aportar conocimientos a la vigilancia que tiene lugar en relación con la enfermedad de Chagas a nivel mundial, y por consiguiente aborda el riesgo de la difusión de esta última mediante la transfusión de sangre. MÉTODOS: Dos inmunoensayos ELISA con antígenos de T cruzi crudos o recombinantes, fueron utilizados a fin de estudiar 2000 muestras de sangre donadas voluntariamente a modo de donaciones altruistas o de reposición familiar, retrospectivamente. RESULTADOS: Los resultados mostraron que aproximadamente 1 de 286 donaciones daban positivo a anticuerpos frente al T cruzi. CONCLUSIÓN: Estos resultados indican que el T cruzi sigue siendo un riesgo en Guyana, y hay necesidad de continuar tamizando la sangre donada. El Trypanosoma cruzi es una infección crónica, y las personas infectadas pueden ser portadores asintomáticos crónicos de la enfermedad. Deben introducirse medidas en cuanto a educación, mejoramiento de las viviendas, y uso controlado de insecticidas, a fin de detener la enfermedad de Chagas.
Assuntos
Humanos , Anticorpos Antiprotozoários/sangue , Segurança do Sangue , Doença de Chagas/epidemiologia , Doença de Chagas/imunologia , Trypanosoma cruzi/imunologia , Guiana/epidemiologia , Prevalência , Estudos SoroepidemiológicosRESUMO
The countries and territories comprising the English-speaking Caribbean (ESC) have made some strides in the development of mental health policy, services and systems with the expenditure in mental health as a percentage of health budgets ranging from 1% to 7%. The ESC countries have well developed primary healthcare systems. However, mental health legislations in many countries are in need of reform. Some countries have developed an innovative community based, secondary care treatment model: treatment in the medical wards of general hospitals. These countries have made progress in integrating mental health into primary healthcare and have made psychotropic medication widely available at the primary care level. Notwithstanding the progress in some countries, greater effort is required in phasing out mental hospitals and integrating mental health into primary care in other ESC countries.
Los países y territorios que comprenden el Caribe Anglófono (CAF) han dado pasos extraordinarios en relación con el desarrollo de políticas, servicios y sistemas de salud mental, de modo tal que los gastos en salud mental en término del porcentaje de presupuestos de salud fluctúan entre el 1% y el 7%. Los países del CAF poseen sistemas de atención primaria de la salud bien desarrollados. Sin embargo, las legislaciones con respecto a la salud mental en muchos países necesitan reformas. Algunos países han desarrollado un modelo innovador comunitario para tratamientos de atención secundaria: tratamiento en las salas de los hospitales generales. Estos países han tenido progresos en cuanto a integrar la salud mental a la atención primaria de la salud, y han puesto la medicación psicotrópica ampliamente a la disposición del nivel de atención primaria. A pesar del progreso en algunos países, se requiere un mayor esfuerzo en cuanto a reducir gradualmente los hospitales psiquiátricos y acelerar la integración de la atención a la salud mental con la atención primaria en otros países anglófonos.
Assuntos
Humanos , Política de Saúde , Serviços de Saúde Mental/organização & administração , Belize , Educação em Enfermagem , Guiana , Serviços de Saúde Mental , Psiquiatria/educação , Índias OcidentaisRESUMO
OBJECTIVE: To describe the process used to implement a comprehensive, standardized, and reliable national system for data collection for HIV care and treatment in Guyana; to provide examples of the program-level data resulting from implementation; and to highlight the monitoring benefits for national programs. METHODS: In 2007, Guyana's Ministry of Health and other key stakeholders adapted the World Health Organization's generic HIV care and antiretroviral therapy (ART) patient monitoring guidelines to fit the Guyana context, which included modifying the patient chart, patient registers, and cross-sectional and cohort reports. Following initial training and feedback from clinical staff, a national patient monitoring system (PMS) was finalized, piloted, and implemented at all care and treatment sites. Thereafter, sites received monthly supportive supervisory visits to review data collection and validate reports. RESULTS: Implementation of the PMS enabled analysis of cohort data for patients on ART. After 12 months, 79 percent of a combined national cohort of all 50 patients who started ART in June 2007 were alive and on first-line ART regimens. After six years, 58 percent of the first (April 2002) cohort of ART patients in the country were alive and on ART, with only two (8 percent) patients on second-line regimens. CONCLUSIONS: Implementation of a national PMS for standardized data collection and reporting across multiple clinical sites ultimately provided important and reliable information on utilization of services, patient outcomes, and survival rates on treatment. These data are used at the national level to monitor the efficacy of the HIV care and treatment program. Successful implementation requires early inclusion of all committed stakeholders and a dedicated human resource team to ensure sustainability of the system.
OBJETIVO: Describir el proceso utilizado con el objeto de poner en práctica un sistema nacional integral, estandarizado y confiable de recopilación de datos sobre la atención y el tratamiento de la infección por el VIH en Guyana; suministrar ejemplos de los datos que se obtuvieron mediante el programa durante la ejecución; y subrayar las ventajas de la vigilancia para los programas nacionales. MÉTODOS: En el 2007, el Ministerio de Salud de Guyana y otros actores claves adaptaron al contexto de Guyana las directrices básicas de la Organización Mundial de la Salud sobre el seguimiento de los pacientes con VIH que reciben atención y tratamiento antirretrovírico; la adaptación implicó modificaciones en el expediente clínico, el registro de los pacientes, los informes transversales y los informes de cohortes. Después de una capacitación inicial y la retroalimentación por parte del personal médico, se finalizó un sistema nacional de seguimiento de los pacientes, que se puso a prueba y se puso en marcha en todos los centros de atención y tratamiento. Posteriormente, se realizaron visitas mensuales de supervisión y apoyo a los centros, con el fin de examinar la recopilación de los datos y validar los informes. RESULTADOS: La ejecución del programa de vigilancia de los pacientes permitió el análisis de los datos de las cohortes de pacientes en tratamiento antirretrovírico. Después de 12 meses, se encontró que 79 por ciento de una cohorte nacional combinada de los 50 pacientes que comenzaron tratamiento antirretrovírico en junio del 2007 estaban vivos y recibían tratamiento con antirretrovíricos de primera línea. Después de seis años, 58 por ciento de la primera cohorte de pacientes tratados con antirretrovíricos en el país (abril del 2002) estaban vivos, continuaban el tratamiento y solo dos pacientes (8 por ciento) recibían medicamentos de segunda línea. CONCLUSIONES: La ejecución de un programa nacional de supervisión de los pacientes con recopilación y notificación estandarizada de los datos en múltiples centros clínicos suministró en último término información importante y confiable sobre la utilización de los servicios, el desenlace clínico de los pacientes y las tasas de supervivencia con el tratamiento. Estos datos se usan a escala nacional con el fin de vigilar la eficacia del programa de atención y tratamiento de la infección por el VIH. La ejecución eficaz del programa exige la participación temprana de todos los actores claves comprometidos y un equipo de recursos humanos dedicado a velar por la sostenibilidad del sistema.
Assuntos
Humanos , Infecções por HIV/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde/organização & administração , Vigilância da População/métodos , Estudos de Coortes , Estudos Transversais , Coleta de Dados , Controle de Formulários e Registros , Guiana/epidemiologia , Infecções por HIV/terapia , Política de Saúde , Prioridades em Saúde , Prontuários Médicos/normas , Programas Nacionais de Saúde/organização & administração , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Organização Pan-Americana da Saúde , Organização Mundial da SaúdeRESUMO
Como una contribución al conocimiento florístico de la cuenca del Río Caroní se realizaron colecciones botánicas en varios ambientes de la cuenca baja del Río Cucurital, que incluyen formaciones boscosas, tanto en penillanura como ribereñas, morichales, sabanas, arbustales y ambientes perturbados; en los bosques se hicieron colecciones en parcelas de 0,1 ha y fuera de ellas. De manera general, las familias con mayor cantidad de especies fueron Melastomataceae (46), Rubiaceae (33), Euphorbiaceae (23), Cyperaceae (19), Myrtaceae (18), Fabaceae (18), Clusiaceae (15), Arecaceae (15), Caesalpiniaceae (14), Chrysobalanaceae (14), Lauraceae (14), Poaceae (13) y Burseraceae (12), siendo las más representativas de la cuenca baja. Los géneros con mayor cantidad de especies fueron Miconia (17), Psychotria (13), Ocotea (10), Myrcia (8), Protium (7), Licania (7) y Rhynchospora (7). Melastomataceae y Rubiaceae predominaron en todos los ambientes con excepción de la sabana; Lauraceae, Burseraceae, Arecaceae, Chrysobalanaceae y Euphorbiaceae fueron las de mayor importancia en los bosques, y Myrtaceae y Cyperaceae en los bosques ribereños, esta última junto con las Poaceae predominaron en morichal y sabana. Se encontraron 19 especies restringidas a la Guayana venezolana, de las cuales 12 se conocen sólo del estado Bolívar, evidenciando que las condiciones ecológicas, topográficas y edáficas determinan la presencia de elementos florísticos particulares. Las actividades humanas son escasas, lo que se ha reflejado en poca alteración de las comunidades vegetales y en el mantenimiento del carácter prístino de los ambientes. Los escasos ambientes intervenidos han sido colonizados por especies herbáceas y arbustivas típicas de la región.
As a contribution to the floristic knowledge of the Caroní river basin, botanical collections were made in several environments of the lower Cucurital river basin, including forests, riverine forests, palm swamp forests (morichal), savanna, scrublands and altered areas. In middle and tall forests additional collections were made in plots of 0.1 ha. In general, the families with the highest number of species were Melastomataceae (46), Rubiaceae (33), Euphorbiaceae (23), Cyperaceae (19), Myrtaceae (18), Fabaceae (18), Clusiaceae (15), Arecaceae (15), Caesalpiniaceae (14), Chrysobalanaceae (14), Lauraceae (14), Poaceae (13) and Burseraceae (12), being the most representative of the low river basin. The genera with highest number of species are Miconia (17), Psychotria (13), Ocotea (10), Myrcia (8), Protium (7), Licania (7) and Rhynchospora (7). Melastomataceae and Rubiaceae families predominated in all environments with exception of the savanna. In the forest, Lauraceae, Burseraceae, Arecaceae, Chrysobalanaceae and Euphorbiaceae were the most abundant, as such as Myrtaceae and Cyperaceae in the riverine forests. Cyperaceae and Poaceae predominated in morichal and savanna. Nineteen species were previously reported only to the Venezuelan Guayana. Twelve of these are only known to the Bolivar state, reinforcing the idea that ecological, topographic and edaphic conditions can determine the presence of particular floristic elements. Human activities are scarce, which is reflected in unaltered vegetal communities and environments. The few altered communities have been colonized by native herbaceous and scrub species.
Assuntos
Árvores , Venezuela , Agricultura Florestal , Pradaria , GuianaRESUMO
IgA nephropathy can be considered the most common cause of primary glomerulopathy in developed countries. There has been no report of cases of IgA nephropathy from Caribbean countries. The authors report five cases of IgA nephropathy from Trinidad and Tobago, and Guyana, diagnosed from biopsy studies. No cases were of African origin and some did not have the typical presentation associated with IgA nephropathy. Caribbean nephrologists are reminded that this entity can be seen in Caribbean patients and can only be diagnosed through immunofluorescence staining of renal biopsy specimen. This diagnosis is required for the proper management of patients with glomerular disease, particularly when there may be progression to end stage renal failure as can occur in up to twenty per cent of patients with IgA nephropathy. Accurate diagnosis is important, since disease recurrence can be seen in the transplanted kidney, but this does not often lead to graft failure.
La nefropatía IgA puede considerarse la causa más común de glomerulopatía primaria en los países desarrollados. No ha habido reportes de casos de nefropatía IgA de los países del Caribe. Los autores reportan cinco casos de nefropatía IgA de Trinidad y Tobago, y Guyana, diagnosticados a partir de estudios de biopsia. Ninguno de los casos fue de origen africano y algunos no presentaron las características típicas asociadas con la nefropatía IgA. Se les recuerda a los nefrólogos del Caribe que esta entidad puede ser observada en pacientes del Caribe y puede ser diagnosticada sólo mediante tinción por inmunofluorescencia de un espécimen de biopsia renal. Este diagnóstico es un requisito para el tratamiento adecuado de pacientes con la enfermedad glomerular, en particular cuando puede haber progresión al fallo renal en etapa terminal, como puede ocurrir hasta en el veinte por ciento de los casos con nefropatía IgA. El diagnóstico exacto es importante, ya que la recurrencia de la enfermedad puede verse en el riñón trasplantado, pero esto no conduce a menudo al fallo del injerto.