ABSTRACT
Tuberculosis (TB) in children has been neglected by most countries in the Region of the Americas. After 2006 the TB surveillance and control among children was emphasized with the implementation of the World Health Organizations (WHO) Stop TB strategy. Since then the countries strengthened TB control in children and age-disaggregated data was collected. These advances have made possible this descriptive study of childhood epidemiological situation by using the information annually reported by the National Tuberculosis Program (NTP) to WHO. The analysis was performed by scenarios (quintiles of WHO estimated incidence) of TB notification rate in children under 4years old, 5 - 14 years old, and the percentage of TB notification in children under 15 years old compared to the total of TB cases reported. The conclusion was that in countries with medium-to-high and high-level TB incidence, the detection of cases in children is poor. This is especially evident in children under the 5 years old who are at high risk of developing severe forms of TB and who die as a result.
La tuberculosis (TB) en niños ha sido relegada por la mayoría de los países de la Región de las Américas. Después del año 2006 con la implementación de la estrategia Alto a la TB de la Organización Mundial de la Salud (OMS) se enfatizó la vigilancia y el control de la TB en población infantil. Desde entonces los países fortalecieron el control de la TB en niños y recolectaron datos desagregados por edad. Estos avances han hecho posible realizar este estudio que describe la situación epidemiológica de la TB en la población infantil a partir de la información reportada anualmente por los Programas Nacionales de Tuberculosis (PNT) de los países a la OMS. El análisis se realizó por escenarios (quintiles de la incidencia estimada por OMS) de las tasas de notificación de la TB en menores de 4 años, de 5 y mas años, y del porcentaje de la notificación de la TB en menores de 15 años respecto al total de casos de TB notificados. Se concluyó que en países de mediana-alta y alta incidencia de TB, la detección de casos en niños es deficiente, especialmente en menores de 5 años que tienen alto riesgo de desarrollar formas severas de TB y de morir por esta causa.
Subject(s)
Humans , Male , Adolescent , Female , Infant, Newborn , Infant , Child, Preschool , Child , Tuberculosis/epidemiology , Age Distribution , Americas/epidemiology , Epidemiology, Descriptive , Incidence , Disease Notification/statistics & numerical dataABSTRACT
The aim of this study was to define the frequency and determinants of pregnancy-induced child-specific sensitization shortly after full-term delivery using sensitive single HLA-antigen beads (SAB) and high resolution HLA-typing of the mothers and their children (n = 301). A positive SAB result was defined by a background normalized ratio >1 or a mean fluorescence intensity (MFI) >300, >500 and >1000, respectively. The overall frequency of pregnancy-induced sensitization determined by SAB shortly after full-term delivery was between 45% (MFI > 1000 cut-off) and 76% (ratio cut-off). The rate of child-specific sensitization at the HLA-A/B/C/DRB1 loci was between 28% (MFI > 1000 cut-off) and 38% (ratio cut-off). The number of live birth was associated with a higher frequency of sensitization, which was driven by child-specific, but not third party HLA-antibodies. There was a clear hierarchy of sensitization among the investigated loci (B-locus: 31%; A-locus: 26%; DRB1-locus: 20%; C-locus: 15%; p < 0.0001). Some mismatched paternal HLA-antigens led to a significantly higher rate of sensitization than the average (e.g. HLA-A2, HLA-B49, HLA-B51, HLA-C*15). Furthermore, the mother's own HLA-phenotype--especially HLA-A/B homozygosity--was associated with a higher rate and broadness of sensitization. The number of mismatched HLA-A/B/C eplets strongly correlated with the rate of child-specific class I sensitization.
Subject(s)
HLA Antigens/genetics , HLA Antigens/immunology , Hypersensitivity/etiology , Pregnancy Complications/etiology , Adult , Alleles , Child , Female , Gene Frequency , Genotype , HLA Antigens/classification , Humans , Pregnancy , PrognosisABSTRACT
Objetivo educativo: A la conclusión del módulo, el alumno estará capacitado en las bases conceptuales y metodológicas para la gerencia de un Programa de Control de la Tuberculosis
Subject(s)
Bolivia , Education , TuberculosisABSTRACT
Contiene: I. Informe general gestiones 1997 - 2001; II. Antecedentes; III. Objetivos del PNCT; IV. Metas del PNCT; V. Plan quinquenal 1999-2004; VI. Actividades desarrolladas por línea estratégica; VII. Logros obtenidos en el control; VIII. Situación actual del control de la tuberculosis a nivel nacional; IX. Situación actual del control de la tuberculosis a nivel regional; X. Conclusiones del XII seminario de evaluación nacional del PNCT; XIII. Recomendaciones al programanacional de OPS/OMS; XIV. Problemas encontrados y/o recomendaciones de expertos nacionales; XV. Anexos
Subject(s)
Annual Report , Bolivia , National Health Programs , TuberculosisABSTRACT
Contiene: I. Epidemiología de la TB; II. Diagnóstico de la TB; III. Tratamiento de la TB; IV. Prevención de la TB; V. Gerencia de un PCT
Subject(s)
Tuberculosis , Mentoring , Bolivia , Communicable Diseases , Population , Tuberculinum kochABSTRACT
Contiene: I. Marco referencial; II. Gerencia de un PNCT; III. Interpretación y análisis de indicadores; IV. Ejercicios; V. Anexos
Subject(s)
Organization and Administration , National Health Programs , Tuberculosis , Bolivia , Infection Control , Health Education , Population , TuberculosisSubject(s)
Hemoglobins, Abnormal/chemistry , Hemoglobins, Abnormal/genetics , Hemoglobins, Abnormal/metabolism , Adolescent , Amino Acid Substitution , Chromatography, High Pressure Liquid , DNA Mutational Analysis , Exons , Family Health , Female , Genetic Variation , Humans , Oxygen/chemistry , Oxygen/metabolism , Oxyhemoglobins/metabolism , Pedigree , Point Mutation , Polycythemia/etiology , Polycythemia/genetics , Polymerase Chain Reaction , Polymorphism, Single-Stranded Conformational , Portugal/epidemiology , Portugal/ethnologyABSTRACT
La Dirección General de Epidemiología y el Servicio de Control de Tuberculosis, vio necesario realizar el presente Seminario de Evaluación no solo para fortalecer a los Servicios Departamentales, en su capacidad analítica de sus realidades epidemiológicas así como en el intercambio de experiencias locales para la elaboración de estrategias, si no además para la actualización en las normas y procedimientos del servicio, fundamentalmente referidos a la localización de casos y tratamiento de los mismos. Asimismo, este documento pretende mejorar la eficiencia en el control de la tuberculosis en Bolivia para alcanzar las metas nacionales e internacionales para el año 2000 de: Detectar al 70 de las fuentes de infección existentes en la comunidad y curar al 85 de las mismas.
Subject(s)
Tuberculosis , BoliviaABSTRACT
Local and systemic effects of intracoronary (two bolus injections of 25 micrograms at 3-min intervals) ergonovine were determined in 60 patients with angiographic non-spastic normal coronary arteries and were compared with the most usual intravenous ergonovine dose to induce coronary artery spasm (incremental doses of 50, 100 and 200 micrograms at 3-min intervals). The mean diameter of the vessels was reduced by 15% after selective injections (baseline 2.38 +/- 0.7; after intracoronary ergonovine 2.02 +/- 0.6 mm; p less than 0.001) and no significant changes were induced in the heart rate (before 80 +/- 15; after 79 +/- 15 beats/min) and systolic aortic pressure (before 147 +/- 27; after 149 +/- 28 mmHg). Following intravenous administration, the mean coronary diameter decreased by 20% (1.90 +/- 0.6 mm; p less than 0.01 vs intracoronary dose) and the heart rate diminished slightly (76 +/- 12 beats/min; p less than 0.01). Nevertheless, the systolic aortic pressure did increase by 16% (171 +/- 28 mmHg; p less than 0.001). No major complications were observed and the appearance of side effects was minimal. Thus, the intracoronary delivery route, at the applied dosage, induces lesser vasoconstriction than usual intravenous administration, and systemic effects, such as hypertension, are avoided.
Subject(s)
Coronary Vasospasm/diagnosis , Coronary Vessels/drug effects , Ergonovine/pharmacology , Cardiac Catheterization , Coronary Angiography , Coronary Disease/diagnosis , Coronary Disease/physiopathology , Coronary Vasospasm/physiopathology , Dose-Response Relationship, Drug , Ergonovine/administration & dosage , Hemodynamics/drug effects , Humans , Injections, Intra-Arterial , Injections, IntravenousABSTRACT
To assess the local and systemic intracoronary (IC) ergonovine maleate (EM), single or repeated 25 micrograms bolus injections were administered to 108 consecutive patients with chest pain and normal coronary arteriograms. Coronary artery spasm (CAS) was induced in 17 (15.7%) patients. None of these patients developed ST-segment depression, and ST-segment elevation appeared in only 6 (35.3%). In 59 of the 91 patients without CAS, both the IC and the intravenous (IV) EM arteriographic and hemodynamic effects were compared. The mean diameter of the vessels was reduced by 15% (p less than 0.001) after two single 25 micrograms ICEM injections. Only insignificant changes were induced in the heart rate (baseline 80 +/- 15; after ICEM 79 +/- 15 beats/min; p = NS) and systolic aortic pressure (baseline 147 +/- 27; after ICEM 149 +/- 28 mmHG; p = NS). Following 350 micrograms of cumulative IVEM, the mean coronary diameter decreased by 20% (p less than 0.01 vs. ICEM dose) and the heart rate diminished slightly (76 +/- 12 beats/min, p less than 0.01). However, the systolic aortic pressures did increase by 16% (171 +/- 28 mmHg; p less than 0.001). No major complications were observed. Thus, to induce CAS the IC delivery route appears to be safe, allows for more accurate titration, and adverse systemic effects, such as hypertension, are avoided.
Subject(s)
Coronary Angiography , Coronary Vasospasm/chemically induced , Ergonovine , Adult , Aged , Angiography , Coronary Vasospasm/physiopathology , Coronary Vessels/drug effects , Electrocardiography/drug effects , Ergonovine/administration & dosage , Ergonovine/pharmacology , Female , Hemodynamics/drug effects , Humans , Injections, Intra-Arterial , Male , Middle AgedABSTRACT
A common pathophysiology for the clinical association of variant angina and migraine has been suggested, but the pathogenesis of both illnesses is yet unknown. Our report presents two siblings with both illnesses and a familial history of migraine where coronary artery spasm was documented, spontaneously in one and after the administration of ergonovine maleate in the other one. Our study strongly supports the hypothesis that genetic factors possibly play a role in the etiology of variant angina and migraine at least in some patients.
Subject(s)
Coronary Vasospasm/genetics , Migraine Disorders/genetics , Angiography , Cardiac Catheterization , Coronary Vasospasm/complications , Coronary Vasospasm/diagnostic imaging , Coronary Vasospasm/physiopathology , Electrocardiography , Female , Hemodynamics , Humans , Male , Middle Aged , Migraine Disorders/complications , Migraine Disorders/drug therapy , Nifedipine/therapeutic useABSTRACT
Blood cultures of 24 patients from the Hospital das Clinicas da Faculdade de ciências Médicas e Biológicas de Botucatu showed a prevalence of gram-negative isolates (83%) over gram-positive (16%). Among the microorganisms Salmonella typhimurium was the most frequent (25%) followed by Klepsiella sp. (21%) and Escherichia coli (17%). It was also observed that the main cuase of death was the largest occurrence of Salmonella typhimurium and Pseudomonas aeruginosa among the isolates. Regarding drug resistance gentamycin revealed more active than other antibiotic tested.