ABSTRACT
BACKGROUND: Dengue is a leading cause of morbidity throughout the tropics; however, accurate population-based estimates of mortality rates are not available. METHODS/PRINCIPAL FINDINGS: We established the Enhanced Fatal Acute Febrile Illness Surveillance System (EFASS) to estimate dengue mortality rates in Puerto Rico. Healthcare professionals submitted serum and tissue specimens from patients who died from a dengue-like acute febrile illness, and death certificates were reviewed to identify additional cases. Specimens were tested for markers of dengue virus (DENV) infection by molecular, immunologic, and immunohistochemical methods, and were also tested for West Nile virus, Leptospira spp., and other pathogens based on histopathologic findings. Medical records were reviewed and clinical data abstracted. A total of 311 deaths were identified, of which 58 (19%) were DENV laboratory-positive. Dengue mortality rates were 1.05 per 100,000 population in 2010, 0.16 in 2011 and 0.36 in 2012. Dengue mortality was highest among adults 19-64 years and seniors ≥65 years (1.17 and 1.66 deaths per 100,000, respectively). Other pathogens identified included 34 Leptospira spp. cases and one case of Burkholderia pseudomallei and Neisseria meningitidis. CONCLUSIONS/SIGNIFICANCE: EFASS showed that dengue mortality rates among adults were higher than reported for influenza, and identified a leptospirosis outbreak and index cases of melioidosis and meningitis.
Subject(s)
Dengue/mortality , Disease Outbreaks/statistics & numerical data , Epidemiological Monitoring , Acute Disease/epidemiology , Adolescent , Adult , Coinfection/epidemiology , Dengue/epidemiology , Dengue/virology , Dengue Virus/genetics , Dengue Virus/immunology , Dengue Virus/isolation & purification , Female , Humans , Leptospira/genetics , Leptospira/immunology , Leptospirosis/epidemiology , Leptospirosis/microbiology , Male , Medical Records , Middle Aged , Mortality , Puerto Rico/epidemiology , Time Factors , West Nile virus/genetics , West Nile virus/immunology , Young AdultABSTRACT
Se estudiaron 500 pacientes a quienes se les implanto marcapasos definitivos en el periodo comprendido entre junio de 1978 y junio de 1992, hubo predominio del sexo masculino y del grupo de edad de 61 a 80 anos. El motivo de consulta medica con mayor frecuencia fue el sincope, el bloqueo auriculoventricular de tercer grado es la causa mas frecuente que requiere este tipo de tratamiento, cuya etiologia respondio a la enfermedad esclerodegenerativa del sistema de conduccion. La vena cefalica derecha fue la via de abordaje mas utilizada, dentro de las complicaciones registradas solo 2 fueron motivo de fallecimiento (perforacion del ventriculo derecho y el neumotorax traumatico