ABSTRACT
Cryptosporidium is a leading cause of pediatric diarrhea in resource-limited settings; yet, few studies report the health care costs or societal impacts of this protozoan parasite. Our study examined direct and indirect costs associated with symptomatic cryptosporidiosis in infants younger than 12 months in Kenya, Peru and Bangladesh. Inputs to the economic burden model, such as disease incidence, population size, health care seeking behaviour, hospital costs, travel costs, were extracted from peer-reviewed literature, government documents, and internationally validated statistical tools for each country. Indirect losses (i.e. caregiver income loss, mortality, and growth faltering) were also estimated. Our findings suggest that direct treatment costs per symptomatic cryptosporidiosis episode were highest in Kenya ($59.01), followed by Peru ($23.32), and Bangladesh ($7.62). The total annual economic impacts for the 0-11 month cohorts were highest in Peru ($41.5M; range $0.88-$599.3M), followed by Kenya ($37.4M; range $1.6-$804.5M) and Bangladesh ($9.6M, range $0.28-$91.5M). For all scenarios, indirect societal costs far outweighed direct treatment costs. These results highlight the critical need for innovative improvements to current prevention, diagnostic and treatment strategies available in resource poor settings, as well as the need for solutions that span multiple disciplines including food and water safety, sanitation and livestock production.
Subject(s)
Cryptosporidiosis/epidemiology , Bangladesh/epidemiology , Humans , Infant , Kenya/epidemiology , Peru/epidemiologyABSTRACT
INTRODUCTION: Psoas abscess is a rare clinical entity with vague symptomatology. We report a psoas abscess that simulated symptoms of acute appendicitis. PRESENTATION OF CASE: A twenty-five year old male presented pain irradiating to the right iliac fossa and lumbar region associated with thigh flexion. Laboratorial exams revealed leukocytosis with a neutrophil shift to the left. Abdominal Ultrasound showed significant intestinal distension and a small quantity of free fluid at the right iliac fossa. Laparotomy and an appendectomy were performed. During immediate post-operative, the patient evolved with worsening of the pain and the leukocytosis, therefore, we chose to maintain his antalgic posture. An abdominal Computerized Tomography scan with contrast was solicited, revealing an increase of the iliac and psoas muscles of the right side, and multiple bacterial focuses. A retroperitoneal access was performed and 300ml of purulent secretion was drained. Afterwards, we implanted a Penrose Drain. The patient had a good post-op evolution, being discharged 7days after the drainage. DISCUSSION: The psoas muscle is a flexor of the thigh. Psoas abscess is an underdiagnosed condition, its main treatment is surgery associated with antibiotic therapy. CT scan seems to be the best choice of diagnostic image exam, although some authors prefer the nuclear magnetic resonance. CONCLUSION: The psoas muscle abscess is uncommon and poorly characterized in its etiology, clinical associations, and its therapeutic approach. On the other hand, acute appendicitis is the most common abdominal emergency, with a 7% death rate, and surgery is its main treatment.
ABSTRACT
Se evaluaron las características clínicas y la escala económico funcional 8prolo) en un estudio retrospectivo de 207 pacientes con hernia de núcleo pulposo lumbar tratados quirúrgicamente (69 pacientes), comparándolos con los tratados médicamente (138 pacientes) y con seguimiento de dos años, en el Hospital de la Fuerza Aérea Peruana situado en Lima. No hubo diferencia estadísticamente significativa entre ambos grupos respecto a edad, sexo, ocupación, grado de esfuerzo habitual, obesidad, tabaquismo y trastornos psicosociales. Hubo diferencia estadística en la sintomatología presente en el tiempo del diagnóstico: lumbociatalgia, signo de Lasègue, trastorno moto y herniación del disco L4-L5 que fueron más frecuentes en los tratados quirúrgicamente; y la lumbalgia y herniación del disco L5-S1, que fueron más frecuentes en los tratados médicamente. Se empleó la técnica de Love modificada y las complicaciones posoperatorias sumaron 29%. Hubo mayor alivio sintomatológico en el primer año con la terapia cruenta, pero en el segundo año dicho alivio no fue estadísticamente diferente con ambas terapias. La mejoría en la escala económico-funcional de Prolo fue similar en el primer año con ambos tratamientos pero en el segundo año el tratamiento médico mostró mejor evolución que el quirúrgico. También se observó que los trastornos motores son de recuperación lenta y muy posteriores a la recuperación de los síntomas. La tendencia moderna es que el tratamiento quirúrgico no es un método curativo, no detiene el proceso patológico que permitió la herniación y solamente proporciona alivio sintomático y funcional. En nuestro medio no tenemos estudios comparativos de tratamiento quirúrgico vs. médico a corto plazo que nos muestre este tipo de evaluación. Recomendamos realizar estudios prospectivos para tal efecto.
The clinical characteristics and the economic-functional Prolo Scale were evaluated in a comparative and retrospective study of 207 patients with herniated lumbar nucleus pulpous, in which 69 patients underwent surgery and 138 patients had medical treatment for 2 years art he Fuerza Aerea Peruana Hospital, in Lima. There was significant statistical difference between both groups regarding age, sex, occupation, regular effort degree, obesity, smoking and psychosocial disorders. However, there were differences in the present symptomatology of the diagnostic: lumbosciatic pain, Lasègues sign, motor disorders and herniated L4-L5 disc, which were more often in those underwent surgery; and low back pain and herniated L5-S1 disc, which were more often in those who had medical treatment. The modified Love technique was employed in the surgery group and the postoperative complications were 29%. The surgical treatment gave more symptomatological relief in the first year, but in the second year that relief was not statically different with both treatments, but in the second year, the medical treatment had better evolution than the surgical treatment. In addition, it was observed that the motor disorders had, a slow recovery and very long after the recovery of the symptoms. The modern tendency is that the surgical treatment is not curative method, because it doesnt stop the pathological process which allowed the origin of the hernia, it only gives symptomatic and functional relief. In our country there are not any studies about surgical versus medical treatment in short and long term which show us the kind of evaluation. For this reason, we recommend to make prospective studies.
Subject(s)
Male , Female , Humans , Intervertebral Disc Displacement , Intervertebral Disc Displacement/surgery , Intervertebral Disc Displacement/therapy , Lumbosacral Region , Epidemiology, DescriptiveABSTRACT
We have purified a cytotoxic L-amino acid oxidase (LAO) from Agkistrodon contortrix laticinctus snake venom by means of Superdex-200 gel filtration, followed by phenyl-Sepharose CL-4B chromatography. The purified enzyme (ACL LAO) is a dimer on gel filtration, with a M(r) of 60,000 for the monomer as estimated by SDS-PAGE. LAO activity was tested against 15 amino acids, but only 9 were oxidized by the enzyme, suggesting that it presents some degree of specificity. ACL LAO has apoptosis-inducing activity in an HL-60 cell culture assay. After 24 h treatment with 25 micrograms/ml of ACL LAO, the typical DNA fragmentation pattern of apoptotic cells was observed on agarose gel electrophoresis. NMR analysis showed the presence of a flavin mononucleotide prosthetic group. To solve its 3-D structure, crystals of the purified protein were grown in 0.1 M Tris-HCl, pH 8.5, and 2 M (NH(4))(2)SO(4). Diffraction data collected to 3.5 A showed that the protein crystallized in the tetragonal system, with unit cell a = b = 103.22 A, c = 183.45 A. This is the first report of preliminary crystallization data for a snake venom L-amino acid oxidase.
Subject(s)
Amino Acid Oxidoreductases/isolation & purification , Crotalid Venoms/enzymology , Agkistrodon , Amino Acid Oxidoreductases/chemistry , Amino Acid Oxidoreductases/toxicity , Animals , Apoptosis/drug effects , DNA Fragmentation/drug effects , HL-60 Cells , Humans , L-Amino Acid Oxidase , Protein ConformationABSTRACT
Se informa el caso de un recién nacido con aneurisma de la aorta abdominal secundaria a cateterismo de la arteria umbilical e infección sistémica. Se analizan el cuadro clínico, los estudios diagnósticos y el abordaje quirúrgico
Subject(s)
Infant, Newborn , Humans , Male , Aortic Aneurysm/etiology , Catheterization/adverse effects , Aortic Aneurysm/diagnosis , Aorta, AbdominalABSTRACT
La obstruccióninfundibular o de la cámara de salida del ventrículo derecho es una malformación sumamente rara que con frecuencia se confunde con estenosis valvular pulmonar. Se presenta el caso de un escolar con dicha cardiopatía que se operó con buen resultado. Se discuten las características anatómicas y fisiopathológicas de la enfermedad. Se muestran los resultados y la utilidad de los exámenes de gabinete que ayudan al diagnóstico, así como las modalidades del tratamiento quirúrgico y su resultado
Subject(s)
Child , Humans , Male , Pulmonary Valve Stenosis/diagnosis , Pulmonary Valve Stenosis/surgery , Heart Ventricles/physiopathologyABSTRACT
Es muy frecuente la persistencia del conducto arterial en prematuros con insuficiencia respiratoria. Esto causa un compromiso cardiopulmonar que obliga a digitalizar los pacientes, y en ausencia de respuesta al tratamiento, o la falta de respuesta al "cierre farmacológico" con indometacina, a optar por la intervención quirúrgica. Esta serie muestra que la decisión temprana para operar conlleva menos displasia broncopulmonar y reducción del número de días de ventilación así como menor número de días de hospitalización. Se desprende de esta corta serie, que tiene grandes ventajas la cirurgía temprana del conducto arterial en prematuros con insuficiencia respiratoria
Subject(s)
Infant, Newborn , Humans , Male , Female , Ductus Arteriosus, Patent/surgery , Infant, Premature , Respiratory Distress Syndrome, Newborn/surgery , Ductus Arteriosus, Patent/complications , Respiratory Distress Syndrome, Newborn/complicationsABSTRACT
Normas de diagnostico y tratamiento de las enfermedades infecciosas realizadas por el Departamento de Epidemiologia del Ministerio deSalud Publica. Tecnicas de vacunacion, de aplicacion de insecticidas en pediculosis y sarna, normas de aislamiento y atencion de enf.infecciosas, tecnicas para toma de muestras serologicas, de secrecion nasofaringea, expectoracion, heces y contenido gastrico. Normas de atencion de enfermeria para enfermedades transmisibles
Subject(s)
Humans , Communicable Diseases/standards , Communicable Disease Control/methods , Vaccination/standardsABSTRACT
Investigacion epidemiologica sobre enfermedades transmisibles agudas y cronicas realizadas en el area de Resistencia, Barranqueras y Puerto Vilelas y una encuesta de prevalencia por muestreo de anomalias cardiacas de 1961
Subject(s)
Humans , Health Surveys , Communicable Diseases , Prevalence , Public Health/history , Leprosy , Chagas Disease , Tuberculosis , Malaria , Intestinal Diseases, Parasitic , Syphilis , Heart Defects, CongenitalABSTRACT
Investigacion epidemiologica sobre enfermedades transmisibles agudas y cronicas realizadas en el area de Resistencia, Barranqueras y Puerto Vilelas y una encuesta de prevalencia por muestreo de anomalias cardiacas de 1961
Subject(s)
Humans , Communicable Diseases , Health Surveys , Prevalence , Heart Defects, Congenital , Chagas Disease , Intestinal Diseases, Parasitic , Leprosy , Malaria , Public Health/history , Syphilis , TuberculosisABSTRACT
Normas de diagnostico y tratamiento de las enfermedades infecciosas realizadas por el Departamento de Epidemiologia del Ministerio deSalud Publica. Tecnicas de vacunacion, de aplicacion de insecticidas en pediculosis y sarna, normas de aislamiento y atencion de enf.infecciosas, tecnicas para toma de muestras serologicas, de secrecion nasofaringea, expectoracion, heces y contenido gastrico. Normas de atencion de enfermeria para enfermedades transmisibles
Subject(s)
Humans , Communicable Disease Control/methods , Communicable Diseases/standards , Vaccination/standardsABSTRACT
A statistically acceptable epidemiological investigation of the prevalence of Chagas' Disease was made by sampling in the cities of Resistencia, Barranqueras, and Vilelas, of a population of 61,697, 1,641 (2.66 percent) persons aged 6 or more were surveyed. The margin of security obtained from 99 percent (of the 1,641 covered by the survey, 1,625 were investigated) is highly plausible, for it confirms the value of the survey
The investigation consisted of a complement fixation test, background history of the disease, clinical examination, and electrocardiogram. Moreover, an investigation of the tuberculosis prevalence and rate, made in the same area in 1961, showed that 10.8 percent of the 8,276 persons examined suffered from cardiac enlargement
The serological rate was 5.17 percent and the persons examined showed a very high percentage of electrocardiographic alterations (38.53 percent); only 1.65 percent of the population examined were considered to have abnormal electrocardiograms imputable to Chagas' Disease
Of the 84 seropositives, 50 percent had electrocardigraphic alteration, and in one of three of the latter group such alteration was considered to be imputable to the disease. As expected, the percentage distribution (rate) of abnormal electrocardiograms showed a tendency to increase from childhood to old age. The percentage rates for seropositives according to age group were high, ... (AU)