Seroprevalence of trypanosomosis and associated risk factors in cattle from coast and amazonian provinces of Ecuador.

Trypanosomosis is a tropical disease caused by various protozoan haemoparasites, which affects wild and domestic animals, the latter ones related to worldwide livestock production systems. Species such as Trypanosoma vivax and Trypanosoma evansi have been described using serological and molecular tools in several countries from South and Central America. However, Ecuador presents a relevant knowledge gap in the associated general epidemiology and risk factors of the disease. Therefore, the objective of this study was to determine the seroprevalence of trypanosomosis in cattle from different regions of Ecuador. 745 serum samples from 7 Coastal and 3 Amazon provinces were screened for IgG anti-Trypanosoma spp. antibodies, using an in-house indirect ELISA. The seropositivity was explored and associated with several variables such as sex, age, breed, region, management, and province, using statistical tools. The general seroprevalence of trypanosomosis was 19.1% (95% CI: 16.30-22.1%). The Amazonian provinces of Sucumbíos and Napo and the Coastal province of Esmeraldas presented the highest seroprevalence values of 36.7% (95% CI: 27.67-46.47%), 23.64% (95% CI: 16.06-32.68%) and 25% (95% CI: 15.99-35.94%), respectively. Statistical significance was found for the region, province, and management variables, indicating as relevant risk factors the extensive management and Amazon location of the cattle analyzed. Specific actions should be taken to identify the exact species on reservoirs and susceptible hosts, evaluate the implication of farm management and cattle movement as risk factors, and implement surveillance and treatment plans for affected herds.

Triclabendazole efficacy, prevalence, and re-infection of Fasciola hepatica in bovine and ovine naturally infected in the Andes of Ecuador.

Fasciola spp., infections are distributed worldwide including the Andes region of Ecuador, affecting cattle, sheep, porcine, humans, and other herbivores. Triclabendazole (TCBZ) is commonly used to treat animal infections. However, prospective studies on TCBZ efficacy and fascioliosis prevalence have not been studied in the highlands of Ecuador. This study was performed in a rural community at central of the Ecuadorian Andes in freely roaming bovine and ovine aimed to 1) evaluate the efficacy of TCBZ by administering a single oral dose of 12 mg/kg body weight, 2) assess the prevalence of F. hepatica infection and 3) to monitor re-infections for a follow-up period of five months. In total, 122, 86, 111, 110, 89, and 90 and 49, 34, 47, 28, 27, and 31 stool samples were collected each month from bovines and ovine, respectively. Besides, 32 stool samples from porcine were also collected at the beginning of the study. Stools were microscopically analyzed by formalin-ether concentration method to detect F. hepatica ova. The prevalence of F. hepatica infections before treatment was 55,7% and 63,3% for bovine and ovine, respectively. The infection prevalence was of 22% in porcine. The efficacity of triclabendazole was 83% and 97% in bovines and ovine, respectively, at 30 days post-treatment. The re-infection reaches to 54,4% in bovines and 61,3% in ovine after five months. TCBZ had a high efficacy and could be used for bovines and ovine Fasciola infections in the study region; however, re-infections reach the initial prevalence after five months. Therefore, we recommend integrated control strategies, including chemotherapy with a single oral dose of TCBZ, vector control, and future drug resistance studies.

Validez y confiabilidad del cuestionario de ansiedad y miedo dental IDAF- 4C+ en embarazadas chilenas / Validity and reliability of the Index of Dental Anxiety and Fear (IDAF-4C+) in Chilean pregnant women

Introducción: La ansiedad dental influye notablemente en el estado de salud oral, entorpeciendo el manejo del paciente durante la atención dental y la adherencia al tratamiento. Por ello su detección es central, sobretodo en grupos vulnerables como las mujeres embarazadas. Debido a la escasez de instrumentos con adecuadas propiedades psicométricas es que se buscó determinar la validez de contenido, validez de constructo y confiabilidad del cuestionario IDAF-4C+ versión en español en mujeres embarazadas en servicios de atención primaria de la Región Metropolitana, Chile. Material y Métodos: Estudio transversal descriptivo. La validez de contenido se determinó mediante el juicio de expertos, la validez de constructo a través del análisis factorial confirmatorio, mientras que la confiabilidad se determinó por consistencia interna, a través del coeficiente alfa de Cronbach. Resultados: Fueron evaluadas 72 mujeres embarazadas. El juicio de expertos no realizó modificación al IDAF-4C+ versión en español. El análisis factorial confirmó la presencia de un solo factor, el cual explicó el 61,86% de la varianza, mientras que la confiabilidad arrojó un alfa de Cronbach de 0,908, considerado excelente. Discusión: El cuestionario IDAF-4C+ presentó una adecuada validez de contenido, validez de constructo y una excelente confiabilidad. Su uso es adecuado para la medición de ansiedad dental en mujeres embarazadas que acuden a servicios de atención primaria en Chile

Introduction: Dental anxiety is a problem that greatly affects oral health and dental compliance in adults. There are many instruments to assess dental anxiety in general population. IDAF-4C+ has a modular structure that allows to identify dental anxiety levels and feared stimuli related to dental setting. The aim of this study is to determine the construct and content validity, and the reliability of the Spanish version of IDAF-4C+ in pregnant women from primary health care centers in Santiago, Chile. Methods: 72 pregnant women ranged from 18 to 40 years old were recruited at primary health care centers from Santiago, Chile. To determine content validity the agreement among experts was assessed. Confirmatory factor analysis was used to demonstrate the construct validity, meanwhile reliability was determined in terms of internal consistency by undertaken Cronbach's alpha coefficient. Results: The results indicated that the prevalence of dental anxiety is 33.34% in women. The experts did not modify the Spanish version of IDAF-4C+. Confirmatory factor analysis yielded a single factor that accounted for 61,86% of variance. A high Cronbach's alpha (a = 0,908) confirm the internal consistency of the instrument. Conclusion: IDAF-4C+ presents an appropriate construct and content validity, and an excellent reliability. It is a proper instrument to be used in pregnant women enrolled in primary health care centers in Chile

Autoeficacia en salud oral: Concepto, evaluación y tratamiento / Self-efficacy in oral health: Concept, assessment and treatment

La autoeficacia es un factor que permite predecir las conductas que un paciente realizará para obtener un adecuado nivel de salud. En salud oral, esto resulta ser fundamental ya que los comportamientos que realiza el paciente determinan la adherencia a las indicaciones que el odontólogo le entrega. El presente artículo aborda la definición de la autoeficacia en general, y en salud oral en particular, además de revisar cuales son los instrumentos más utilizados para medir esta dimensión dentro del contexto odontológico. Finalmente, se revisa un modelo de intervención de la autoeficacia en salud oral que ha mostrado una adecuada efectividad (AU)

Self-efficacy is a factor that allows predicting patients’ behaviours to gain a suitable health level. In oral health this is fundamental, because patients’ behaviours determine the adherence to indications provided by the dentist. The present article addresses the definition of self-efficacy in general, in oral health in particular, and a review of the most common instruments to measure this dimension inside the dental context. Finally, it presents a review of an intervention model of self-efficacy in oral health that has shown appropriate effectiveness (AU)

Ansiedad dental: Evaluación y tratamiento / Dental anxiety: Assessment and treatment

La ansiedad dental es un fenómeno que influye notablemente en el estado de salud oral, entorpeciendo tanto el manejo del paciente durante la atención dental como la posterior adherencia al tratamiento. Con tasas de prevalencia que van del 4% al 23%, la ansiedad dental es un factor importante a considerar si se quiere mejorar la calidad de vida oral del paciente. El presente artículo propone abordar la definición de ansiedad dental, para luego identificar las causas que explican cómo se origina este fenómeno, además de revisar cuales son los instrumentos más utilizados para medir ansiedad dental dentro del contexto odontológico. Finalmente se revisan las intervenciones que han mostrado mayor efectividad en la reducción de este problema (AU)

Dental anxiety is a phenomenon which significantly affects oral health status, hindering both the patient management during the dental care and the subsequent dental treatment adherence. With prevalence rates ranging from 4% to 23%, dental anxiety is an important factor to consider if you want to improve the quality of the oral health of the patient. This article intends to raise the definition of dental anxiety, identify the causes behind the origin of this phenomenon and besides to check what instruments are used to measure dental anxiety in the dental context. Finally we will review the interventions that have shown greater effectiveness in reducing this problem (AU)

Caracterización clínica y epidemiológica de adolescentes con VIH y /o sida del centro de Atención Integral del Hospital Nacional Dr. Mario Catarino Rivas en el período comprendido de enero 2010 a junio 2011 / Clinical and Epidemiological Characterization of Adolescents with HIV and / or AIDS from the Comprehensive Care Center of the Dr. Mario Catarino Rivas National Hospital in the period from January 2010 to June 2011

OBJETIVOS. Documentar una caracteri - zaci ón cl ínica y epidemiol ógica de adoles - centes con VIH y/o Sida atendidos en el Hospital Dr. Mario Rivas de Enero 2010 a Junio del 2011 y abrir la brecha de investiga - cio nes futuras en otros centros. MATERIALES Y M ÉTODOS. Estudio descriptivo transversal, prospectivo, con recolecci ón de datos mediante interrogatorio directo al paciente y sus cuidadores, complementando con el expediente cl ínico, aplic ándose un instrumento de trabajo de tipo formulaci ón a 214 adolescentes con VIH Sida RESULTADOS. El 85 % de los adolescentes est án entre 11 y 18 a ños, el 18% de los mayores de 18 añ os han pasado a consulta de adultos. En su mayor ía son hu érfanos de padre, madre o ambos (66%), 22% viven en hogares y un 2% viven en parejas. Se establece que un 6% no estudia. La categor ía clínica C3 fue la m ás frecuente al momento del diagn óstico, sin embargo el 66% tení a inmunosupresi ón severa al momento del diagnostico. Se registra un 13% con fracaso virol ógico mayor de 2,000 copias. Un 19% de los adolescentes utiliza terapia de rescate. El 32% ha presentado alg ún efecto adverso con la terapia antirretroviral. El 3% de las mujeres se ha embarazado. El 95% de los adolescentes conoce su estado serol ógico y el 35% han ameritado apoyo psicol ógico en alg ún momento. En esta cohorte el 0.5% han fallecido. CONCLUSIONES. Se recomienda la formaci ón de grupos de auto apoyo juveniles que fomenten la adherencia y su participaci ón social as í como tambi én inc luir de forma real el apoyo nutricional en el con- cepto de atenci ón integral, fortalecer y coor - dinar con la cl ínica de adultos el paso de los adolescentes y continuar la educaci ón sexual en los adolescentes con VIH. Se discuten otros aspectos cl ínicos y e pidemiol ógicos.

Field evaluation of urine antigen detection for diagnosis of Taenia solium cysticercosis.

(Neuro)cysticercosis is an important zoonotic disease caused by infection with Taenia solium metacestode larvae. Existing immunodiagnostic techniques detect antibodies and circulating antigens (Ag) in serum and cerebrospinal fluid (CSF). Blood/CSF collection is an invasive procedure associated with blood-borne infections and is often not well accepted by communities. Detection of circulating Ag in urine has been suggested as an alternative, however this has been evaluated in clinical settings only. The aim of the present study was to evaluate the performance of a urine Ag-ELISA under field conditions. Paired serum and urine samples were obtained from participants in endemic areas of Ecuador (n=748) and Zambia (n=690) and were subjected to a monoclonal antibody-based Ag-ELISA. Calculation of positive and negative agreement indices (AI) showed better agreement in the negative direction both for Ecuadorian and Zambian samples (AI of 93.1 and 86.8, respectively). Using a Bayesian approach to determine the test characteristics, similar sensitivities were obtained for serum and urine Ag detection, whereas a decreased specificity was determined for the urine Ag-ELISA with a lower specificity (78.6%) for Zambian samples than for Ecuadorian samples (88.4%). This study indicates a higher specificity for the serum test under field conditions and promotes further research to improve the urine test.

Mucopolysaccharidosis type IV: N-acetylgalactosamine-6-sulfatase mutations in Tunisian patients.

Mucopolysaccharidosis type IVA (MPS IVA; OMIM #253000) or Morquio A syndrome is an autosomal recessive inborn error resulting from the deficient activity of the lysosomal enzyme, N-acetylgalactosamine-6-sulfatase (GALNS), and the progressive lysosomal accumulation of sulfated glycosaminoglycans. Clinically, the severe form of this lysosomal storage disease is characterized by a characteristic severe bone dysplasia and normal intelligence. To date, a variety of mutations have been associated with the severe MPS IVA phenotype. Here, we report the GALNS mutations in six severe MPS IVA patients from four unrelated Tunisian families. For mutation detection, each of the 14 exons and adjacent intron-exon junctions of the GALNS gene were sequenced after PCR-amplification from genomic DNA. Two novel mutations were identified: a G to A transition in the conserved 5' donor splice site of intron 1 (GACgt-->GACat: designated IVS1(+1g-->a)) and a G to C transversion in codon 66 of exon 2 predicting a glycine to arginine substitution (G66R). The IVS1(+1g-->a) mutation was homozygous in five similarly affected patients from three presumably unrelated families, but haplotype analysis suggested a common ancestor. The affected patient in the fourth family was homozygous for the G66R mutation. These are the first GALNS mutations causing severe MPS IVA disease identified in Tunisia. These molecular findings provide genotype/phenotype correlations, and permit accurate carrier detection, prenatal diagnosis, and counseling for MPS IVA disease in Tunisia where first cousin consanguineous mating remains frequent.

Concurrent cisplatin/gemcitabine chemotherapy along with radiotherapy in locally advanced cervical carcinoma: a phase II trial.

OBJECTIVE: To evaluate the efficacy and safety of a concurrent regimen of gemcitabine/cisplatin and radiotherapy in women with locally advanced cervical carcinoma (LACC). METHODS: From April 2001 to June 2002, we enrolled women diagnosed with histologically proven LACC (FIGO stages IIA through IIIB), for treatment with concurrent regimen of chemo-radiotherapy. The treatment consisted of: cisplatin 40 mg/m(2), followed by gemcitabine 125 mg/m(2), once weekly, given about 1 to 2 h before radiotherapy. External beam radiation was delivered 5 days/week to entire pelvic radiation field for a total of 50 Gy in 25 fractions over 5 weeks. After completion of external radiation, patients received brachytherapy with cesium-137 via standard Fletcher-suit applicators delivering 30 Gy to point A. RESULTS: Of the 23 enrolled patients (mean age 47 years), 20 completed the treatment and were evaluable for response and safety. The complete response rate was 90% (18/20), and partial response rate was 10% (2 patients with persistent disease after therapy). Toxicity was moderate: 2 patients required blood transfusions; 5% patients had grade 2 leukopenia or thrombocytopenia; 40% had grade 1-2 nausea-vomiting, and 50% had grade 1 diarrhea. At a median follow-up of 12 months, all patients are alive, and 16/20 (80%) are disease-free. CONCLUSIONS: The gemcitabine/cisplatin combination administered concurrently with radiotherapy is highly active in locally advanced cervical carcinoma. The tolerable toxicity and synergistic activity of this concurrent chemoradiation regimen are consistent with prior reports. Definitive results are awaited from an on-going large, randomized trial comparing this regimen with standard treatment.

Mucopolysaccharidosis I: Alpha-L-Iduronidase mutations in three Tunisian families.

Mucopolysaccharidosis type I (MPS I) is a lysosomal storage disease resulting from the defective activity of the enzyme alpha-L-iduronidase (IDUA). The disease has severe and milder phenotypic subtypes. The IDUA mutations in five MPS I patients from three unrelated families from central and southern Tunisia were determined by amplifying and sequencing each of the IDUA exons and intron-exon junctions. Two novel IDUA mutations, c.1805delTinsGAACA in exon 13 and I270S in exon 7, and two previously reported mutations, P533R and R628X, were detected. The two patients in family 1 who had the Hurler phenotype were homoallelic for the novel deletion-insertion mutation. The patient in family 2 who also had the Hurler phenotype was heteroallelic for the novel missense mutation I270S and the previously reported nonsense mutation R628X. The two patients in family 3 who had the Hurler-Scheie phenotype were homoallelic for P533R. In addition, six known IDUA polymorphisms were identified. These are the first Tunisian MPS I patients to be genotyped. The identification of these mutations and their genotype-phenotype correlations should facilitate prenatal diagnosis and counselling for MPS I in Tunisia, where a very high rate of consanguinity exists.

Assessing the burden of Taenia solium cysticercosis and echinococcosis.

This collection of articles provides an account of the papers delivered at the 19th International Conference of the World Association for the Advancement of Veterinary Parasitology (WAAVP)(held in New Orleans, LA, USA, from 10 to 14 August 2003) in a symposium session on assessing the burden of Taenia solium cysticercosis and echinococcosis organised and chaired by A. Lee Willingham III from the WHO/FAO Collaborating Center for Research and Training on Emerging and other Parasitic Zoonoses in Denmark and Peter M. Schantz from the Parasitic Diseases Division of the US Centers for Disease Control and Prevention, USA. The focus was on the persistence of the zoonotic parasitic diseases cysticercosis, caused by the pork tapeworm T. solium, and echinococcosis,caused by species of the tapeworm Echinococcus, and why these diseases are given very little attention on the national and international agendas in spite of the availability of tools to detect, treat,control and prevent them when it is quite clear in most instances that they are clearly associated with and help perpetuate poverty. A major reason for this is that in many endemic areas the presence and impact of these diseases are not known due to the lack of investigation and information thus policymakers are not aware of their burden and benefits of their control. Documentation is also needed to help increase awareness of the international community and hopefully result in financial and technical support being made available. Thus, burden assessments of cysticercosis and echinococcosis provide an essential evidence base for securing political will and financial and technical support as well as providing a basis for cost-benefit analysis of prevention and control efforts. In order to make an appropriate and full burden assessment one must consider the health, agricultural, social and other impacts of these parasitic zoonoses comprehensively. During the symposium presentations were given concerning current ongoing initiatives to assess the burden of cysticercosis and echinococcosis and examples of the impact of these diseases in both developing and developed countries were provided. In addition, cost factors related to vaccines for these cestode diseases were discussed and the possibilities for technical and financial support from multilateral agencies for assessments and interventions presented.

Taeniosis-cysticercosis in man and animals in the Sierra of Northern Ecuador.

Taenia solium is endemic in the Andean region of Ecuador. The recent rediscovery of Taenia saginata in humans urges to reconsider some assumptions in relation to the epidemiology of the taeniosis/cysticercosis complex in this country.Therefore, data were compiled on the infection of both tapeworms in man and animals in Pichincha and Imbabura provinces in the Andean region, north of Quito. On post mortem inspection 3 out of 806 (0.37%) carcasses had T. saginata metacestodes, however, 35 sera out of 869 (4.03%) showed circulating antigen in a monoclonal antibody-based sandwich ELISA (Ag-ELISA). Porcine cysticercosis was detected in 15 out of 2896 (0.52%) carcasses and 93 out of 1032 serum samples (9.01%) were positive in Ag-ELISA. In humans, 4.99% (215 out of 4306) cases of antigen positives were found, whereas coprological examination of 1935 stools resulted in 30 positive cases (1.55%). The limited number of adult tapeworms (29) that were collected does not allow firm conclusions on the proportion of each species, but in total 21 specimen were identified as T. saginata and 8 as T. solium. These data have been discussed in view of the epidemiology of human cysticercosis.

[Stature of Chilean parents and children of different ethnicity and social vulnerability]. / Estatura de padres e hijos chilenos de diferente etnia y vulnerabilidad social.

OBJECTIVE: To analyze and compare the heights of first-year school children and their parents, according to ethnic background and socioeconomic status. MATERIAL AND METHODS: This is a cross-sectional study of indigenous and non-indigenous school children and their parents, belonging to three levels of social vulnerability: very high (poverty), medium, and very low. An indigenous school child was defined as any child having all four parental surnames of Mapuche origin; non-indigenous were those having Hispanic parental surname. Height was compared using Z scores, using WHO nutritional change reference values. Statistical analysis consisted in comparing differences of mean heights between parents and their children. Differences were assessed using Scheffe's method. RESULTS: Improvement in socioeconomic conditions was associated with increasing mean parental height (p < 0.001), except for indigenous mothers, who showed no height increase. Fathers from highly impoverished counties were 4 cm shorter than those living in very low vulnerability areas; height differences reached 2 cm among mothers (p < 0.001). Indigenous school children showed a positive height gradient with improving socioeconomic conditions (p < 0.001). This was not observed among non-indigenous children. When comparing parental height with children's height, children had a better height/age ratio than their parents (p < 0.01). This was specially evident among indigenous school children, who had on average 1.4 Z scores more than their parents. CONCLUSIONS: The upward height gradient related to improved social conditions, and the better height/age ratio seen in children in comparison to their parents, regardless their ethnic background and level of social vulnerability, is encouraging and suggests that interventions directed to the poorest groups, including the indigenous population, must be carried out.

[Nutritional status of school children from indigenous and non indigenous ancestry]. / Comparación del estado nutricional entre escolares indígenas y no indígenas.

BACKGROUND: The few studies in Chile assessing the nutritional status of indigenous children show a high prevalence of stunting, excess weight and feeding problems. AIM: To compare anthropometric indices in children from indigenous and non indigenous ancestry. SUBJECTS AND METHODS: School children aged 6 to 8 years old, living in locations with three clear cut levels of social vulnerability were studied. Children were considered indigenous if their last names, as well as those of their parents were of Mapuche origin. Non indigenous were those whose last names were of Spanish origin. RESULTS: Four hundred and fifty indigenous and 684 non indigenous children were studied. Indigenous children from high vulnerability communities were approximately 0.5 z score shorter than those of non indigenous origin. Heights of indigenous and non indigenous children were similar in communities with intermediate and low social vulnerability. The proportion of the lower segment followed the same trend. Weight/height ratios were higher among indigenous children in the three vulnerability levels. Among indigenous children coming from areas of low vulnerability arm circumference was 1 cm broader than that of their non indigenous counterparts. CONCLUSIONS: Stunting is prevalent among school children from areas of high socioeconomic vulnerability, mainly rural, and independent from ethnicity. Among indigenous school children overweight and a broader arm circumference are frequent. These results urgently call for located and specific nutrition interventions.