ABSTRACT
BACKGROUND: Cutaneous leishmaniasis (CL) is a neglected disease and a public health problem in Latin America. The diagnosis of CL in poor hyperendemic regions relies to large extent on the identification of amastigotes in Giemsa-stained smears. There is an urgent need for a rapid, sensitive and low cost diagnostic method for use in field conditions for CL as current modalities are not readily available. The primary objective of this study was to determine the sensitivity and specificity of the FDA-cleared CL Detect Rapid Test in Peru, using modified test procedures rather than the instructions-for-use, by 1) increasing the extraction time and 2) increasing the volume of the sample added to the test strip. CL Detect Rapid Test results were compared against microscopy and kDNA-PCR, for the diagnosis of CL in ulcerated lesions. In addition, we compared two collection methods the dental broach used and mentioned in the CL Detect insert and the standard less invasive and easier to conduct scrapping method. METHODOLOGY: Participants were patients who presented for medical consultation due to a suspected CL lesion. Four samples from the index lesion were collected using a dental broach, per package insert, and lancet scraping and tested by the modified CL Detect Rapid Test, microscopy, and PCR. PRINCIPAL FINDINGS: A total of 156 subjects were eligible and evaluated. The modified CL Detect sensitivity was higher in specimens obtained by scraping (83.3%) than those from dental broach (64.2%). The specificity was lower in scrapings (77.8%) with a false positive rate of 22.2% compared with dental broach samples (91.7%) with a false positive rate of 8.3%. However, molecular analysis showed that all 8 false negative microscopy scrapings (those positive by modified CL Detect and negative by microscopy) were positive by kDNA-PCR, meaning that the modified CL Detect was more sensitive than microscopy. CONCLUSIONS: These modifications to the package insert that resulted in a diagnostic sensitivity (83.3%) comparable to microscopy for species found in Peru may enable earlier anti-leishmanial drug treatment decisions based on a positive result from the CL Detect Rapid Test alone until further diagnostic tests like microscopy and PCR can be performed. TRIAL REGISTRATION: NCT03762070; Clinicaltrials.gov.
Subject(s)
Leishmania , Leishmaniasis, Cutaneous , Humans , DNA, Kinetoplast , Peru , Leishmaniasis, Cutaneous/diagnosis , Leishmania/genetics , Polymerase Chain Reaction/methods , Sensitivity and SpecificityABSTRACT
La apendicitis aguda es el cuadro quirúrgico de urgencia más frecuente, y es la causa principal de abdomen agudo quirúrgico. Objetivo: Identificar los factores asociados a la apendicitis aguda complicada en un hospital público de la ciudad de Ica. Material y Métodos: Estudio descriptivo, observacional, analítico, prospectivo, no experimental. Muestra: Constituida por 147 pacientes mayores de 14 años postoperados de apendicitis aguda, obtenidos de diciembre 2018 a julio 2019, utilizándose como base, formularios y/o fichas validados a nivel internacional y adaptado a nuestra realidad, para recojo de información de la historia clínica del paciente, y una encuesta con 3 reactivos de respuestas dicotómicas. Resultados: Predominó el sexo masculino 56,5% y el grupo etario de 20 a 29 años 32,7%. Según la clasificación clínica: Mostró apendicitis aguda complicada 53,1% (78 pacientes) y apendicitis aguda no complicada 46,9% (69 pacientes). Referente a estadios histopatológicos fue flemonosa o supurada 33,3%, gangrenosa o necrótica y perforada con 26,5% ambos, y congestiva o catarral 13,6%. El tiempo transcurrido entre el inicio de los síntomas y el ingreso al hospital fue de menos de 24 horas 51,7%. Tiempo transcurrido entre el ingreso al hospital y la intervención quirúrgica reportó más de 6 horas con 68%. La automedicación fue 65,3%, no recibieron atención médica pre hospitalaria 59,9%. En las complicaciones intraabdominales predomina la peritonitis localizada y plastrón apendicular con 50% y 12,5% respectivamente. Conclusiones: La apendicitis aguda complicada se asoció a factores como la automedicación y el tiempo transcurrido entre el inicio de los síntomas y la intervención quirúrgica. (AU)
The appendicitis acute is the most frequent emergency surgical condition, and is the leading cause of acute surgical abdomen. Objective: To identify the factors associated with complicated acute appendicitis in a public hospital in the city of Ica. Material and Methods:Descriptive, observational, analytical, prospective, non-experimental study. Sample:Made up of 147 patients over 14 years of age after acute appendicitis, obtained from December 2019 to July 2019, using as a base, forms and / or files validated internationally and adapted to our reality, in which information was collected from the patient history, and a survey with 3 reagents of dichotomous responses. Results: The male sex was 56.5% and the age group of 20 to 29 years old was 32.7%. According to the clinical classification: He showed complicated acute appendicitis 53.1% (78 patients) and uncomplicated acute appendicitis 46.9% (69 patients). Regarding histopathological stages, 33.3% were phlegmonous or suppurated, gangrenous or necrotic and perforated with 26.5% both, and 13.6% congestive or catarrhal. The time between the onset of symptoms and admission to the hospital was less than 24 hours 51.7%. Time between hospital admission and surgery reported more than 6 hours with 68%. Self-medication was 65.3%, 59.9% did not receive prehospital medical care. In intra-abdominal complications, localized peritonitis and appendicular plastrón predominate with 50% and 12.5% respectively. Conclusions: Complicated acute appendicitis was associated with factors such as self-medication and the time elapsed between the onset of symptoms and surgical intervention. (AU)
Subject(s)
Appendicitis , Epidemiology, Descriptive , Prospective Studies , Observational Studies as TopicABSTRACT
Introducción: la neurocisticercosis es una de las formas más comunes de enfermedad parasitaria del sistema nervioso central en el Perú. Objetivos: determinar la prevalencia y factores de riesgo asociados a neurocisticercosis en trabajadores de un camal. Material y Métodos: se efectuó un estudio de tipo transversal en 60 trabajadores de un camal de la capital del Perú; a los cuales se les realizó una evaluación clínica, epidemiológica y serológica (EITB), realizándose una tomografía axial computarizada a los EITB positivos. Para establecer el diagnóstico de neurocisticercosis se utilizó los criterios propuestos por Del Bruto y col. en 1996. Para determinar la prevalencia y a su vez la asociación con los factores de riesgo se empleó el paquete estadístico SPSS versión 10.0. Resultados: en la población estudiada la prevalencia de neurocisticercosis fue 1,7% y la seroprevalencia de cisticercosis del 15%. Los inadecuados hábitos higiénicos y la eliminación inadecuada de excretas fueron los factores de riesgo con mayor asociación presentando un OR de 11,6 y 2,14 respectivamente. Conclusiones: la prevalencia de neurocisticercosis para la población estudiada (1,7%) fue menor que la prevalencia nacional encontrada en autopsias de adultos (3,1%). La seroprevalencia encontrada (15%), es bastante similar a las áreas endémicas del Perú y de países como México (10,8%), Ecuador (21,4%) y Colombia (19,6%). El desconocimiento y la falta de información de estas personas sobre los mecanismos de transmisión de la neurocisticercosis explicarían la asociación con los factores de riesgo mencionados.
Introducction: neurocysticercosis is the most common parasitic disease of the Central Nervous System in Perú; it is hyperendemic in the Highlands and also in some areas of the Coast and Jungle. Objectives: To determine the prevalence and risk factors related to neurocysticercosis in workers of a slaughterhouse in an impoverished area of Lima. Materials and methods: this is a transversal study in 60 workers of a slaughterhouse in the capital of Perú; the workers underwent a clinical, epidemiological and serological (EITB) evaluation; an axial computer tomography was obtained from those who were EITB positive. The O.H Del Brutto (1996) neurocysticercosis diagnostic criteria were used. The prevalence of neurocysticercosis and its association with risk factors were calculated with the SPSS statistical package, v 10.0. Results: the prevalence of neurocysticercosis in our study was 1.7% and the cysticercosis seroprevalence was 15%. Among the risk factors, those which had a greater association with EITB positive patients were: inadequate hygienic habits and lack of sewage services; the ORs were 11.6 and 2.14 respectively. Conclusions: the prevalence of neurocysticercosis (1.7%) in our study was less than that found in autopsies of Peruvian adults (3.1%). The seroprevalence found (15%) is quite similar to that found in endemic areas of Perú and in countries like Mexico (10.8%), Ecuador (21.4%) and Colombia (19.6%). The lack of knowledge of these people on the mechanisms of neurocysticercosis transmission and of means for its prevention may explain the association with the risk factors mentioned.
ABSTRACT
BACKGROUND: Cutaneous leishmaniasis is a serious public health problem in the developing world. The main therapeutic agent--pentavalent antimony, developed >50 years ago--is expensive, often accompanied by severe adverse effects, and complicated by the emergence of drug resistance. Better therapies are urgently needed. In the present pilot study, we compared the use of imiquimod, an immunomodulatory molecule, to the use of meglumine antimoniate alone and in combination for the initial treatment of cutaneous leishmaniasis. MATERIALS AND METHODS: Patients with newly diagnosed cutaneous leishmaniasis were enrolled from a single referral center in Lima, Peru, from August 2005 through October 2005. Patients were randomly assigned to 1 of 3 treatment groups and received either imiquimod 7.5% cream administered topically every other day for 20 days, intravenous meglumine antimoniate administered at a dosage of 20 mg/kg per day every day for 20 days, or combination therapy with both intravenous meglumine antimoniate and imiquimod 7.5% cream. Patients were evaluated weekly and at 1 and 3 months after treatment. Patients who had healed lesions at 3 months were considered to be clinically cured. RESULTS: Although several patients showed initial resolution of symptoms with imiquimod treatment alone, all of these patients experienced relapse after treatment discontinuation. Four (57%) of 7 patients treated with meglumine antimoniate alone and 7 (100%) of 7 patients treated with combination therapy were cured. Combination therapy was not only more effective than the other 2 treatments (P<.05) but also led to faster healing and better cosmetic results. CONCLUSION: Combination therapy with imiquimod and meglumine antimoniate is a promising regimen for the initial treatment of cutaneous leishmaniasis that warrants additional larger studies.
Subject(s)
Aminoquinolines/therapeutic use , Antiprotozoal Agents/therapeutic use , Antirheumatic Agents/therapeutic use , Leishmaniasis, Cutaneous/drug therapy , Meglumine/therapeutic use , Organometallic Compounds/therapeutic use , Administration, Topical , Adult , Aged , Aged, 80 and over , Animals , Drug Therapy, Combination , Female , Humans , Imiquimod , Injections, Intravenous , Male , Meglumine Antimoniate , Middle Aged , Pilot Projects , Treatment OutcomeABSTRACT
El presente proyecto tiene por objeto de contribuir a mejorar la atención de los pacientes en estado crítico de salud en el Hospital Corea de la ciudad de La Paz. Es en este entendido que el contenido se halla centrado en la sitematización metodologicas de un connjunto de actividades destinadas a la actualización de conocimientos de las enfermeras profesionales que prestan sus servicios en el Hospital Corea. Por que es necesario diseñar procedimientos fundamentales que contribuyan a una mejor atención de los pacientes en estado critico de salud que son atendidos y superar los factores que dificultan en adecuado seguimiento de estos pacientes por parte de las enfermeras profesionales a partir del programa de capacitación. Con este propposito el programa de actualización propone realizar, diversos cursos de actualización dos veces a la semana con temáticas relacionados al adecuado manejo de pacientes en estado crítico...
Subject(s)
Education/organization & administration , Skilled Nursing Facilities/standards , Patients/classification , Nurses/standards , SocietiesABSTRACT
El objetivo general del presente trabajo es actualizar y elaborar instrumentos normativos administrativos para las Direcciones nacionales de Derechos Humanos y Comunicación Social y Relaciones Internacionales dentro del Comando General de la Policía
