Estudio de infestación de caninos con Echinococcus granulosus en la provincia de La Rioja, Argentina / Study of infestatioon of dogs with Echinococcus granulosus in the province of La Rioja, Argentina

Este trabajo fue realizado en la provincia de La Rioja, ubicada en el noroeste argentino. El objetivo fue estimar el porcentaje de heces de caninos con presencia de antígenos de Echinococcus sp. en las distintas regiones de la provincia. Se tomaron un total de 269 muestras de materia fecal seca de caninos, que fueron analizadas por la técnica de copro-ELISA. La zona más afectada fue la zona IV, que contó con un 30,5% de muestras positivas. La zona I, que corresponde al Departamento Capital, tuvo un 12% de positividad. En el resto de las zonas, los porcentajes variaron entre el 11,4 y el 14,8%. Este es el primer estudio en la provincia sobre la existencia de la enfermedad en caninos. La falta de estrategias para el control de la equinococosis ha permitido la dispersión de la enfermedad

This work was conducted in the province of La Rioja, located in northwestern Argentina. The aim of this study was to estimate the percentage of dog feces showing the presence of antigens of Echinococcus sp. in different regions of the province. A total of 269 samples of dried canine stool were taken, which were analyzed by the copro-ELISA technique. The most affected area was zone IV, which had 30.5% of positive samples. Zone I corresponding to the Capital Department of the province had 12% of positivity. In other areas, the percentages ranged between 11.4% and 14.8%. This is the first study in the province of La Rioja on the existence of this disease in dogs. The lack of control strategies has allowed the spread of echinococcosis

[Study of infestation of dogs with Echinococcus granulosus in the province of La Rioja, Argentina]. / Estudio de infestación de caninos con Echinococcus granulosus en la provincia de La Rioja, Argentina.

This work was conducted in the province of La Rioja, located in northwestern Argentina. The aim of this study was to estimate the percentage of dog feces showing the presence of antigens of Echinococcus sp. in different regions of the province. A total of 269 samples of dried canine stool were taken, which were analyzed by the copro-ELISA technique. The most affected area was zone IV, which had 30.5% of positive samples. Zone I corresponding to the Capital Department of the province had 12% of positivity. In other areas, the percentages ranged between 11.4% and 14.8%. This is the first study in the province of La Rioja on the existence of this disease in dogs. The lack of control strategies has allowed the spread of echinococcosis.

Clinical characteristics of chronic kidney disease of nontraditional causes in Salvadoran farming communities.

INTRODUCTION: Chronic kidney disease is a serious health problem in El Salvador. Since the 1990s, there has been an increase in cases unassociated with traditional risk factors. It is the second leading cause of death in men aged >18 years. In 2009, it was the first cause of in-hospital death for men and the fifth for women. The disease has not been thoroughly studied. OBJECTIVE: Characterize clinical manifestations (including extrarenal) and pathophysiology of chronic kidney disease of nontraditional causes in Salvadoran farming communities. METHODS: A descriptive clinical study was carried out in 46 participants (36 men, 10 women), identified through chronic kidney disease population screening of 5018 persons. Inclusion criteria were age 18-59 years; chronic kidney disease at stages 2, 3a and 3b, or at 3a and 3b with diabetes or hypertension and without proteinuria; normal fundoscopic exam; no structural abnormalities on renal ultrasound; and HIV-negative. Examinations included social determinants; psychological assessment; clinical exam of organs and systems; hematological and biochemical parameters in blood and urine; urine sediment analysis; markers of renal damage; glomerular and tubular function; and liver, pancreas and lung functions. Renal, prostate and gynecological ultrasound; and Doppler echocardiography and peripheral vascular and renal Doppler ultrasound were performed. RESULTS: Patient distribution by chronic kidney disease stages: 2 (32.6%), 3a (23.9%), 3b (43.5%). Poverty was the leading social determinant observed. Risk factor prevalence: agrochemical exposure (95.7%), agricultural work (78.3%), male sex (78.3%), profuse sweating during work (76.3%), malaria (43.5%), NSAID use (41.3%), hypertension (36.9%), diabetes (4.3%). General symptoms: arthralgia (54.3%), asthenia (52.2%), cramps (45.7%), fainting (30.4). Renal symptoms: nycturia (65.2%), dysuria (39.1%), foamy urine (63%). Markers of renal damage: macroalbuminuria (80.4%), ß2 microglobulin (78.2%), NGAL (26.1%). Renal function: hypermagnesuria (100%), hyperphosphaturia (50%), hypernatriuria (45.7%), hyperkaluria (23.9%), hypercalciuria (17.4%), electrolyte polyuria (43.5%), metabolic alkalosis (45.7%), hyponatremia (47.8%), hypocalcemia (39.1%), hypokalemia (30.4%), hypomagnesemia (19.6%). Imaging: Ultrasound showed fatty liver (93.5%) and vascular Doppler showed tibial artery damage (66.7%). Neurological symptoms: abnormal tendon reflexes (45.6%), Babinski sign and myoclonus (6.5%), sensorineural hearing loss (56.5%). CONCLUSIONS: This chronic kidney disease studied behaves clinically like chronic tubulointerstitial nephropathy, but with systemic manifestations not attributable to kidney disease. While male agricultural workers predominated, women and adolescents were also affected. Findings support a hypothesis of multifactorial etiology with a key role played by nephrotoxic environmental agents.

Chronic kidney disease and associated risk factors in the Bajo Lempa region of El Salvador: Nefrolempa study, 2009.

INTRODUCTION: In El Salvador, end-stage renal disease is the leading cause of hospital deaths in adults, the second cause of death in men and the fifth leading cause of death in adults of both sexes in the general population. OBJECTIVE: Identify risk factors for chronic kidney disease and urinary markers of renal and vascular damage, measure kidney function and characterize prevalence of chronic kidney disease in persons aged ≥18 years in the Bajo Lempa region of El Salvador. METHODS: A cross-sectional analytical epidemiological study was carried out using active screening for chronic kidney disease and associated risk factors in individuals aged ≥18 years in the Bajo Lempa Region, a rural, coastal area in El Salvador. Door-to-door visits and clinical examinations were conducted. Epidemiological and clinical data were collected including: family and personal clinical history of disease; biological, behavioral, social and environmental risk factors; physical measurements; urinalysis for markers of renal and vascular damage; and blood tests (serum creatinine, serum glucose, lipid profile). Glomerular filtration rate was calculated using the Modification of Diet in Renal Disease formula. Chronic kidney disease case confirmation was done three months later. Multiple logistic regression was used for data analysis. RESULTS: A total of 375 families and 775 individuals (343 men, 432 women) were studied-88.3% of the total resident population in the region. Elevated prevalence of risk factors was observed: diabetes mellitus, 10.3%; hypertension,16.9%; family history of chronic kidney disease, 21.6%; dyslipidemias, 63.1%; overweight, 34%; obesity, 22.4%; metabolic syndrome, 28.8%; use of non-steroidal anti-inflammatory drugs, 74.8%; infectious diseases, 86.9%; agricultural occupation, 40.6% (80.6% in men); and contact with agrochemicals, 50.3% (82.5% in men). Prevalence renal damage markers was 15.8% (greater in men): microalbuminuria 6.3%; proteinuria 5.7%; hematuria 3.5%; proteinuria-hematuria 0.3%. Proteinuria of <1 g/L predominated. Prevalence of chronic kidney disease was 17.9% (25.7% in men; 11.8% in women). Distribution by stages: stage 1, 4.6%; stage 2, 3.5%; stage 3, 6.2%; stage 4, 3.0%; stage 5, 0.6%. In patients with chronic kidney disease, most common was non-diabetic chronic kidney disease (86.3%), followed by chronic kidney disease associated with neither diabetes nor hypertension (54.7%). Prevalence of chronic renal failure was 9.8% (17% in men; 4.1% in women). Multiple logistic regression showed significant association with increasing age, male sex, hypertension and family history of chronic kidney disease. CONCLUSIONS: Elevated prevalence of chronic kidney disease, chronic renal failure and risk factors was found, compared to international reports. Most common was chronic kidney disease of unknown cause, associated with neither diabetes nor hypertension. Associations were found with age, male sex, hypertension and family history of chronic kidney disease, with decline in kidney function beginning at early ages. Male farmers have a dual burden of non traditional (occupational, toxic environmental) and traditional (vascular) risk factors that could act in synergy, contributing to kidney damage.

INTRODUCCIÓN En El Salvador, la enfermedad renal crónica terminal es la causa principal de muerte hospitalaria en adultos, la segunda causa de muerte en los hombres y la quinta causa principal de muerte entre adultos de ambos sexos en la población general. OBJETIVO Identificar los factores de riesgo de la enfermedad renal crónica y los marcadores de daño renovascular en orina, medir la función renal y caracterizar la prevalencia de enfermedad renal crónica en personas X18 años de edad en la región del Bajo Lempa en El Salvador. METODOS Se realizó un estudio epidemiológico transversal y analítico de la enfermedad renal crónica y los factores de riesgo asociados en individuos con edades X18 años por medio de pesquisa activa en la Región del Bajo Lempa, una zona costera rural en El Salvador. Se efectuaron visitas casa por casa y consultas médicas. Se recolectaron datos epidemiológicos y clínicos que incluían: historia clínica personal y familiar para la enfermedad; factores de riesgo biológicos, de conducta, sociales y ambientales; mediciones físicas; análisis de orina buscando marcadores de daño renovascular y exámenes de sangre (creatinina y glucosa en suero, lipidograma). La tasa de filtración glomerular se calculó usando la fórmula de MDRD (sigla en inglés de Modificación de la Dieta en la Enfermedad Renal). La confirmación de casos de enfermedad renal crónica se realizó en un período de tres meses. Se utilizó la regresión logística múltiple para analizar los datos. RESULTADOS Se estudiaron un total de 375 familias y 775 individuos (343 hombres, 432 mujeres), el 88,3% del total de la población residente en la región. Se observó una elevada prevalencia de factores de riesgo: diabetes mellitus en 10,3%; hipertensión en 16,9%; antecedentes familiares de enfermedad renal crónica en 21,6%; dislipidemias en 63,1%; sobrepeso en 34%; obesidad en 22,4%; síndrome metabólico en 28,8%; uso de medicamentos anti-inZ amatorios no esteroideos en 74,8%, enfermedades infecciosas en 86,9%, 40,6 % eran agricultores (80,6% de los hombres) y 50,3% tenían contacto con agroquímicos (82,5% de los hombres). La prevalencia de marcadores de daño renal fue de 15,8% (mayor en los hombres): microalbuminuria de 6,3%; proteinuria de 5,7%; hematuria de 3,5%; proteinuria-hematuria de 0,3%. Predominó la proteinuria <1 g/L. La prevalencia de enfermedad renal crónica fue de 17,9% (25,7 en los hombres; 11,8% en las mujeres). La distribución por estadios fue la siguiente: estadio 1, un 4,6%; estadio 2, un 3,5%' estadio 3, un 6,2%; estadio 4, un 3,0% y en estadio 5, un 0,6%. En pacientes con enfermedad renal crónica, la más común fue la enfermedad renal crónica no diabética (86,3%), seguida de la enfermedad renal crónica no asociada a diabetes ni a hipertensión (54,7%). La prevalencia de la insuficiencia renal crónica fue de 9,8% (17% en los hombres y 4,1% en mujeres). La regresión logística múltiple mostro una asociación significativa con el aumento de la edad, sexo masculino, hipertensión y antecedentes familiares de enfermedad renal crónica. CONCLUSIONES Se halló una elevada prevalencia de enfermedad renal crónica, insuficiencia renal crónica y factores de riesgo en comparación con lo reportado internacionalmente. La más frecuente fue la enfermedad renal crónica de causa desconocida, no asociada con diabetes ni hipertensión. Se encontraron asociaciones con la edad, sexo masculino, hipertensión e historia familiar de enfermedad renal crónica, con una disminución de la función renal que comienza a edades tempranas. Los agricultores hombres tienen la doble carga de riesgos no tradicionales (ocupacionales, toxico-ambientales) y tradicionales (vasculares) que podrían actuar de manera sinérgica, contribuyendo al daño renal. PALABRAS CLAVE Enfermedad renal crónica/epidemiologia, factores de riesgo, prevalencia, salud ocupacional, salud ambiental, plaguicidas, agroquímicos, El Salvador