Diffuse alveolar haemorrhage in systemic lupus erythematosus patients.

INTRODUCTION: Pulmonary haemorrhage (PH) in systemic lupus erythematosus (SLE) is a rare but potentially fatal complication due to its high mortality. Early treatment benefits the outcome. Reports on predictive factors of PH in SLE patients are scarce. OBJECTIVE: To describe a case series of PH in SLE patients that were attended in the Rheumatology Section of the J. M. Cullen Hospital and to compare this data with published results. METHODS: Patients with SLE (1982-1997 ACR criteria) and PH diagnosed by clinical criteria (cough, dyspnoea, haemoptysis), haemoglobin below 12 g/dL or drop greater than 2 points, new radiological infiltrate and bronchioalveolar lavage, monitored between June 1987 and December 2019 were studied. Demographic, clinical, laboratory, treatment and prognosis data related to PH were analysed. RESULTS: From a database of 306 SLE patients, 25 (8.2%) developed 29 episodes of PH. PH was the first manifestation of SLE in 8 patients. Renal involvement was the most frequent manifestation prior to the development of PH. SLE activity (measured by SLEDAI) was high during the episodes (mean: 16.8). Renal failure (p = .027) and mechanical respiratory support (p = .006) were related to mortality (40.7%) with statistical significance. Patients with SLEDAI higher to 10 at SLE onset showed more likelihood of developing PH. The OR was 2.68 (p = .046). CONCLUSIONS: Although treatment in SLE has progressed in recent years, PH continues to be a rare and severe complication of this disease. When a PH is suspected, studies to confirm it must be done rapidly, since early diagnosis and aggressive treatment have been shown to improve survival. We observed that patients with renal involvement and mechanical respiratory support had higher mortality than SLE patients without them.

Hemorragia alveolar difusa en pacientes con lupus eritematoso sistémico / Diffuse Alveolar Haemorrhage in Systemic Lupus Erythematosus Patients

Introducción: La hemorragia alveolar difusa (HAD) es una complicación infrecuente pero grave en pacientes con Lupus eritematoso sistémico (LES). Su tratamiento debe ser precoz, lo cual mejora la supervivencia. Las comunicaciones de factores predictores de HAD en pacientes con LES son escasas. Objetivo: Describir una serie de casos de HAD en pacientes con LES, del Servicio de Reumatología del Hospital J.M. Cullen, de Santa Fe, y compararlos con un grupo control de pacientes con LES del mismo Servicio y con los datos de la literatura. Material y métodos: Se incluyeron pacientes con LES (Criterios ACR 1982-1997) y HAD definida por parámetros clínicos (tos, disnea, hemoptisis), analíticos (caída de la hemoglobina por debajo de 12 g/dL o mayor a dos puntos respecto del basal en pacientes ya conocidos), imagenológicos (infiltrado radiológico y/o tomográfico bilateral o difuso) y lavado bronquioalveolar (BAL) (retorno sanguinolento en el lavado, más de 20% de siderófagos, sin evidencia de lesiones sangrantes), quienes concurrieron al servicio entre junio de 1987 y diciembre de 2019. Se analizaron datos demográficos, clínicos, de laboratorio, tratamientos y pronóstico de los pacientes. Resultados: Se trabajó con una base de datos de 306 pacientes con diagnóstico de LES, evaluándose 25 de ellos (8,2%) que presentaron 29 episodios de HAD (ocho de ellos como forma de inicio de la enfermedad). El compromiso renal fue el más frecuentemente asociado a la HAD (previo o concomitantemente). La actividad de la enfermedad medida por SLEDAI fue alta durante el episodio, y su media fue de 16,8 puntos. En todos los casos se constató sangrado pulmonar por BAL o tubo endotraqueal. Se halló significación estadística al relacionar la mortalidad (40,7%) con requerimiento de asistencia respiratoria mecánica (ARM) (p = 0,006) y falla renal (p = 0,027). Los pacientes con SLEDAI mayor a 10 al inicio de la enfermedad presentaron más posibilidades de desarrollar HAD (OR = 2,68, p = 0,046).(AU)

Introduction: Pulmonary haemorrhage (PH) in systemic lupus erythematosus (SLE) is a rare but potentially fatal complication due to its high mortality. Early treatment benefits the outcome. Reports on predictive factors of PH in SLE patients are scarce. Objective: To describe a case series of PH in SLE patients that were attended in the Rheumatology Section of the J. M. Cullen Hospital and to compare this data with published results. Methods: Patients with SLE (1982-1997 ACR criteria) and PH diagnosed by clinical criteria (cough, dyspnoea, haemoptysis), haemoglobin below 12 g/dL or drop greater than 2 points, new radiological infiltrate and bronchioalveolar lavage, monitored between June 1987 and December 2019 were studied. Demographic, clinical, laboratory, treatment and prognosis data related to PH were analysed. Results: From a database of 306 SLE patients, 25 (8.2%) developed 29 episodes of PH. PH was the first manifestation of SLE in 8 patients. Renal involvement was the most frequent manifestation prior to the development of PH. SLE activity (measured by SLEDAI) was high during the episodes (mean: 16.8). Renal failure (p = 0.027) and mechanical respiratory support (p = 0.006) were related to mortality (40.7%) with statistical significance. Patients with SLEDAI higher to 10 at SLE onset showed more likelihood of developing PH. The OR was 2.68 (p = 0.046). Conclusions: Although treatment in SLE has progressed in recent years, PH continues to be a rare and severe complication of this disease. When a PH is suspected, studies to confirm it must be done rapidly, since early diagnosis and aggressive treatment have been shown to improve survival. We observed that patients with renal involvement and mechanical respiratory support had higher mortality than SLE patients without them.(AU)

Comparative Analysis of Fracture Resistance between CAD/CAM Materials for Interim Fixed Prosthesis.

The aim of this study was to evaluate and compare the resistance to fracture of interim restorations obtained through additive techniques (3D impressions) and subtractive techniques (milling) using a computer-aided design and manufacture (CAD/CAM) system of a three-unit fixed dental prosthesis (FDP) to ascertain its clinical importance. (1) Materials and methods: In total, 40 samples were manufactured and divided into two groups (n = 20) using: (1) light-curing micro hybrid resin for temporary crowns and bridges (PriZma 3D Bio Prov, MarketechLabs, São Paulo, Brazil) for the rapid prototyping group (RP) and (2) a polymethylmethacrylate (PMMA) CAD/CAM disc (Vipiblock Trilux, VIPI, São Paulo, Brazil) for the computer-assisted milling (CC). The resistance to fracture was determined with a universal testing machine. (2) Results: The strength and the standard deviation for the computer-assisted milling group were higher (1663.57 ± 130.25 N) than the rapid prototyping (RP) group, which had lower values of (1437.74 ± 73.41 N). (3) Conclusions: The provisional restorations from the computer-assisted milling group showed a greater resistance to fracture than the provisional restorations obtained from the rapid prototyping group.

Infectious diseases experts as part of the antibiotic stewardship team in primary care: protocol for a cluster-randomised blinded study (IDASP).

INTRODUCTION: Antibiotic overuse is directly related to antibiotic resistance, and primary care is one of the main reasons for this overuse. This study aims to demonstrate that including experts on infectious diseases (ID) within the antimicrobial stewardship (AMS) programme team in primary care settings achieves higher reductions in overall antibiotic consumption and increases the quality of prescription. METHODS AND ANALYSIS: A multicentre, cluster-randomised, blinded clinical trial will be conducted between 2021 and 2023. Six primary care centres will be randomly assigned to an advanced or a standard AMS programme. The advanced AMS programme will consist of a standard AMS programme combined with the possibility that general practitioners (GP) will discuss patients' therapies with ID experts telephonically during working days and biweekly meetings. The main endpoint will be overall antibiotic consumption, defined as daily defined dose per 1000 inhabitants per day (DHD). Secondary end-points will be: (1) unnecessary antibiotic prescriptions in patients diagnosed with upper respiratory tract or urinary tract infection, (2) adequacy of antibiotic prescription, (3) reattendance to GP or emergency room within 30 days after the initial GP visit and (4) hospital admissions for any reason within 30 days after the GP visit. Two secondary endpoints (unnecessary antibiotic therapy and adequacy of therapy) will be evaluated by blinded investigators.We will select three clusters (centres) per arm (coverage of 147 644 inhabitants) which will allow the rejection of the null hypothesis of equal consumption with a power of 80%, assuming a moderate intracluster correlation of 0.2, an intracluster variance of 4 and a mean difference of 1 DHD. The type I error will be set at 5%. ETHICS AND DISSEMINATION: The protocol was reviewed and approved by local ethics committees. The results of this study will be published in peer-reviewed journals and presented at medical conferences. TRIAL REGISTRATION NUMBER: NCT04848883.

Diffuse Alveolar Haemorrhage in Systemic Lupus Erythematosus Patients. / Hemorragia alveolar difusa en pacientes con lupus eritematoso sistémico.

INTRODUCTION: Pulmonary haemorrhage (PH) in systemic lupus erythematosus (SLE) is a rare but potentially fatal complication due to its high mortality. Early treatment benefits the outcome. Reports on predictive factors of PH in SLE patients are scarce. OBJECTIVE: To describe a case series of PH in SLE patients that were attended in the Rheumatology Section of the J. M. Cullen Hospital and to compare this data with published results. METHODS: Patients with SLE (1982-1997 ACR criteria) and PH diagnosed by clinical criteria (cough, dyspnoea, haemoptysis), haemoglobin below 12 g/dL or drop greater than 2 points, new radiological infiltrate and bronchioalveolar lavage, monitored between June 1987 and December 2019 were studied. Demographic, clinical, laboratory, treatment and prognosis data related to PH were analysed. RESULTS: From a database of 306 SLE patients, 25 (8.2%) developed 29 episodes of PH. PH was the first manifestation of SLE in 8 patients. Renal involvement was the most frequent manifestation prior to the development of PH. SLE activity (measured by SLEDAI) was high during the episodes (mean: 16.8). Renal failure (p = 0.027) and mechanical respiratory support (p = 0.006) were related to mortality (40.7%) with statistical significance. Patients with SLEDAI higher to 10 at SLE onset showed more likelihood of developing PH. The OR was 2.68 (p = 0.046). CONCLUSIONS: Although treatment in SLE has progressed in recent years, PH continues to be a rare and severe complication of this disease. When a PH is suspected, studies to confirm it must be done rapidly, since early diagnosis and aggressive treatment have been shown to improve survival. We observed that patients with renal involvement and mechanical respiratory support had higher mortality than SLE patients without them.

Comparación de pacientes con lupus eritematoso sistémico tratados en centros públicos versus centros privados de salud / Comparison of systemic lupus erythematosus patients treated in the public system of health versus private centers

Estudios recientes sobre lupus eritematoso sistémico (LES) han comunicado desenlaces más favorables gracias al mejor conocimiento de la enfermedad, al manejo más experto del mismo y al uso racional de los tratamientos. En este estudio se identificaron 301 pacientes con lupus eritematoso sistémico (LES), vistos entre 1988 y 2019. Doscientos veintiocho fueron tratados en el sistema público de salud y 73 en el sistema privado. Ambos grupos fueron comparados, observando que los primeros tenían menor edad al momento de la primera consulta y al inicio del LES y menor tiempo de evolución hasta la primera consulta que los pacientes atendidos en el sistema privado de salud de manera estadísticamente significativa. También mostraron mayor frecuencia de leucopenia, con presencia de anticuerpo Sm y compromiso renal en la primera consulta, como así también mayor uso de corticoides EV. Los pacientes hospitalarios presentaron mayor daño acumulado en los primeros 10 años de evolución, pero el desenlace muerte fue similar en ambos grupos. Ambos grupos de pacientes (tanto los del sistema público como los del sector privado) fueron atendidos por especialistas, realizando un cuidadoso seguimiento de estos pacientes.

Recent studies on systemic lupus erythematosus (SLE) have reported more favorable outcomes thanks to better knowledge of the disease, more expert management of it, and rational use of treatments. In this study we identified 301 SLE patients, seen between 1988 and 2019. Two hundred and twenty eight patients were treated in the public health system and 73 in private practice. In comparing both groups, we discovered that patients in the public health system were younger at first consultation and at SLE onset and that the mean duration of their disease prior to first consultation was shorter in a statistically significant way. Also, they showed more frequence of leucopenia, Sm antibody, renal involvement and received I.V. corticosteroids. Patients treated in the public system of health showed more accrual damage over the 10 first years of the disease than patients seen in the private system of health, but death in both groups was similar. Patients from both public and private groups were attended by medical specialist practices who made close follow-ups.

Infecciones graves en pacientes con enfermedades autoinmunes tratados con ciclofosfamida / Severe infections in patients with autoimmune diseases treated with cyclophosphamide

Introducción Las infecciones son una de las principales causas de morbimortalidad en los pacientes con enfermedades autoinmunes sistémicas. Los corticoides y los inmunosupresores como la ciclofosfamida (CF) son algunos de los factores que se asocian a esta complicación. El objetivo de este estudio fue determinar el porcentaje de pacientes que presentaron infecciones graves durante el tratamiento con CF y en los 3 meses posteriores. Pacientes y métodos. Se realizó un análisis retrospectivo de 60 pacientes con diferentes enfermedades autoinmunes que recibieron tratamiento con CF. Se valoró el porcentaje de infecciones graves. Resultados. La patología mñas común fue el lupus eritematoso sistémico y la indicación más común fue la glomerulonefritis proliferativa difusa. El 15% de los pacientes presentó un episodio infeccioso. Las infecciones más frecuentes fueron neumonía adquirida en la comunidad en 3 casos y herpes zóster en 2 casos. La dosis acumulada de corticoides fue el único parámetro que se asoció a infecciones 32,8 ± 16,7 vs. 20,1 ± 15,3 p = 0,007. Conclusión. Un seguimiento estricto, la utilización de corticoides en la menor dosis posible y el tratamiento enérgico de los procesos infecciosos permiten un perfil de seguridad aceptable en aquellos pacientes tratados con CF (AU)

Introduction. Infectious diseases are a significant cause of morbidity and mortality in patients with connective tissue diseases. Corticosteroids and immunosuppressive drugs, such as cyclophosphamide (CYC), increases the risk of infections. The objective of this study was to estimate the incidence rates of severe infections in patients who received treatment with CYC. Patients and methods. The records of 60 patients with systemic autoimmune diseases who received treatment with CYC were retrospectively reviewed. We evaluated the rate of severe infections that occurred during CYC therapy and the 3 subsequent months. Results. Systemic lupus erythematosus was the most common disease, and diffuse proliferative glomerulonephritis the most frequent indication. Severe infection occurred in 9 patients (15%). Community acquired pneumonia was the most frequent infection with 3 cases (33%) followed by Herpes Zoster with 2 reports (22%). The cumulative dose of corticosteroid was the only significant risk factor for infection 32.8±16.7 vs. 20.1±15.3 P=.007. Conclusion. The use of lower doses of corticosteroids and an aggressive management of infectious complications, allows for an acceptable safety profile in patients treated with CYC (AU)

Severe infections in patients with autoimmune diseases treated with cyclophosphamide.

INTRODUCTION: Infectious diseases are a significant cause of morbidity and mortality in patients with connective tissue diseases. Corticosteroids and immunosuppressive drugs, such as cyclophosphamide (CYC), increases the risk of infections. The objective of this study was to estimate the incidence rates of severe infections in patients who received treatment with CYC. PATIENTS AND METHODS: The records of 60 patients with systemic autoimmune diseases who received treatment with CYC were retrospectively reviewed. We evaluated the rate of severe infections that occurred during CYC therapy and the 3 subsequent months. RESULTS: Systemic lupus erythematosus was the most common disease, and diffuse proliferative glomerulonephritis the most frequent indication. Severe infection occurred in 9 patients (15%). Community acquired pneumonia was the most frequent infection with 3 cases (33%) followed by Herpes Zoster with 2 reports (22%). The cumulative dose of corticosteroid was the only significant risk factor for infection 32.8±16.7 vs. 20.1±15.3 P=.007. CONCLUSION: The use of lower doses of corticosteroids and an aggressive management of infectious complications, allows for an acceptable safety profile in patients treated with CYC.

Embodied Cognition and Empathy in Miguel de Cervantes's El celoso extremeño.

This article examines the portrayal of cognitive experience in the published version of Miguel de Cervantes's short story El celoso extremeño (1613), drawing both on recent studies of empathy and current debates about the inseparability of cognition and emotion. It considers how cognitive experience is marked by particular bodily sensations and shaped by internal representations (i.e., mental images) that are closely tied to emotions such as fear, jealousy, joy, and sorrow. Paying particular attention to the ways in which the narrative underscores the characters' limited sensory experiences and their defective understanding of each other's positions, the article argues that this provides the reader with the opportunity to simulate mentally his or her own challenging situations, faulty judgments, and injudicious actions. While being invited to use his or her imagination and judgment to enjoy being placed in a position of greater power and knowledge than the characters, Cervantes's reader is also encouraged to consider the possibility of not knowing and to accept the limits of empathy.

Necessidades básicas insatisfeitas, desnutrição infantil e risco de doenças na vida / Inappropriate basic health conditions, infantile malnourishment and adult illness risk

OBJETIVO: Analisar o estado nutricional de crianças e adolescentes habitantes de uma região com necessidades básicas inadequadamente atendidas a fim de detectar alterações de nutrição e crescimento que possam se tornar fatores de risco para o desenvolvimento de eventos cardiovasculares na idade adulta. MÉTODOS: Estudo descritivo do tipo transversal, incluindo 136 crianças e adolescentes, entre cinco e 15 anos de idade, pertencentes a duas regiões da Cidade de Santa Fé, Argentina. Foram coletados dados socioeconômicos (escolaridade, causas de absenteísmo escolar e tipo de alimentação), dados clínicos (pressão arterial), dados antropométricos (peso, altura e índice de massa corpórea) e dados laboratoriais (hemograma e perfil lipídico). Os dados foram analisados por meio do teste do qui-quadrado e teste exato de Fisher. Utilizou-se a regressão logística para determinar um modelo preditor de hipertensão arterial. RESULTADOS: A idade média do grupo estudado foi de 10±2,6 anos, sendo 49 por cento do sexo feminino. Observou-se 22 por cento da amostra com algum tipo de desnutrição, 11 por cento com sobrepeso ou obesidade, 20 por cento com hipertensão arterial e 49 por cento com alguma alteração no perfil lipídico. Pelo modelo de regressão logística, o sexo feminino (OR=3,64; IC95 por cento=1,13- 11,73) e a relação LDL/HDL alterada (OR=2,57; IC95 por cento=1,00-6,62) aumentaram o risco de hipertensão arterial. CONCLUSÕES: Alterações nutricionais na infância e adolescência podem aumentar o risco de doenças cardiovasculares já nessas faixas etárias e também na vida adulta, principalmente diante da presença de fatores de risco como alteração no perfil lipídico e obesidade, além do sexo feminino.

OBJECTIVE: To analyze the nutritional status of children and adolescents living in a region with inadequate care of basic needs in order to detect nutritional and growth problems that are potential risk factors of cardiovascular events in the adult age. METHODS: Cross sectional descriptive study that enrolled 136 children and adolescents between five and 15 years old, living in two regions of Santa Fé City, Argentine. Data collected included: socioeconomic characteristics (schooling, causes of school absenteeism and type of feeding), clinical data (blood pressure), anthropometric data (weight, height and body mass index) and laboratorial data (hemoglobin, hematocrit and blood lipids). Statistical analysis included chi-square test, Fisher exact test, and logistic regression to determine a predictor model of hypertension. RESULTS: The studied population presented a mean age of age of 10±2.6 years, 49 percent were female, 22 percent presented some type of malnutrition, 11 percent overweight or obesity, 20 percent hypertension and 49 percent had some altered parameter of the blood lipid profile. According to the logistic regression, female gender (OR=3.64; 95 percentCI=1.13-11.73) as well as LDL/HDL cholesterol ratio (OR=2.57; 95 percentCI=1.00-6.62) increased the risk of arterial hypertension. CONCLUSIONS: Nutritional problems in infancy and adolescence increase the risk of cardiovascular disease in these ages and, probably, in the adult life, mainly in the presence of risk factors such as serum lipid profile alteration, obesity, and female gender.

[Traffic law compliance in the city of Santa Fe, Argentina]. / El respeto a las normas de tránsito en la cuidad de Santa Fe, Argentina.

An observational, descriptive study was conducted to evaluate compliance with certain traffic regulations in city of Santa Fe, Argentina, and compare these with measurements taken in prior years. During January 2-4, 2006, at 13 sites across the city, compliance with the following traffic rules was measured: for car drivers: seat belt use and restricting minors to the rear seat; and for motorcycle drivers: helmet use and not carrying a minor on board. At total of 4 173 cars and 1 013 motorcycles were observed. Only 9% of the car drivers wore seatbelts. Of the 246 cars carrying minors, 56% had a minor in the front seat. Regarding the motorcycles drivers, only 12% wore a helmet and 6.7% had a child on board. When these observations were compared with those of the previous five years, findings showed that over the past three years compliance rates had decreased. The results of this study suggest that most drivers in city of Santa Fe do not obey the stated traffic laws. In order to reduce the high rate of mortality from traffic accidents, in addition to legislation and public-awareness campaigns, a system for enforcing compliance is needed.

El respeto a las normas de tránsito en la cuidad de Santa Fe, Argentina / Traffic law compliance in the city of Santa Fe, Argentina

Se realizó un estudio de campo observacional descriptivo para evaluar el cumplimiento de algunas normas de tránsito en la ciudad de Santa Fe, Argentina, y comparar los resultados con mediciones realizadas anteriormente. Para ello, entre el 2 y el 4 de enero de 2006, se verificó en 13 sitios de la ciudad el cumplimiento de las normas que obligan a los automovilistas a usar cinturón de seguridad y a llevar a los menores de 10 años en el asiento trasero, y a los motociclistas, a conducir con casco y a no transportar menores. Las observaciones abarcaron 4 173 automóviles y 1 013 motocicletas. Solo 9 por ciento de los conductores de automóviles usaban el cinturón de seguridad. En 56 por ciento de los 246 automóviles que transportaban menores, estos se hallaban en el asiento delantero. En cuanto a los motociclistas, solo 12 por ciento usaba casco y 6,7 por ciento transportaba niños. Al comparar estas observaciones con cinco registros anuales anteriores, se comprobó que en los últimos tres años disminuyeron los porcentajes de acatamiento de estas normas de tránsito. Los resultados de este estudio sugieren que la mayoría de los conductores de vehículos de la ciudad argentina de Santa Fe viola las normas de tránsito consideradas. Para lograr disminuir la elevada mortalidad por accidentes viales no basta con contar con leyes de tránsito y organizar campañas de información, sino que, además, es necesario implementar sistemas que vigilen el cumplimiento de las normas.

An observational, descriptive study was conducted to evaluate compliance with certain traffic regulations in city of Santa Fe, Argentina, and compare these with measurements taken in prior years. During January 2-4, 2006, at 13 sites across the city, compliance with the following traffic rules was measured: for car drivers: seat belt use and restricting minors to the rear seat; and for motorcycle drivers: helmet use and not carrying a minor on board. At total of 4 173 cars and 1 013 motorcycles were observed. Only 9 percent of the car drivers wore seatbelts. Of the 246 cars carrying minors, 56 percent had a minor in the front seat. Regarding the motorcycles drivers, only 12 percent wore a helmet and 6.7 percent had a child on board. When these observations were compared with those of the previous five years, findings showed that over the past three years compliance rates had decreased. The results of this study suggest that most drivers in city of Santa Fe do not obey the stated traffic laws. In order to reduce the high rate of mortality from traffic accidents, in addition to legislation and public-awareness campaigns, a system for enforcing compliance is needed.

Coagulación optimizada: influencia en la eliminación de enteroparásitos

Los objetivos del trabajo fueron evaluar modificaciones del pH en la etapa de coagulación con polihidroxicloruro de aluminio, a fin de optimizar la remoción de materia orgánica y comprobar si estas modificaciones afectan la eliminación de enteroparasitos. Se trabajo con equipos de laboratorio para ensayos de coagulación. Para el recuento de enteroparasitos, se aplicaron métodos con antivuerpos monicionales por inmunofluorescencia

Coagulación optimizada: influencia en la eliminación de enteroparásitos

Los objetivos del trabajo fueron evaluar modificaciones del pH en la etapa de coagulación con polihidroxicloruro de aluminio, a fin de optimizar la remoción de materia orgánica y comprobar si estas modificaciones afectan la eliminación de enteroparasitos. Se trabajo con equipos de laboratorio para ensayos de coagulación. Para el recuento de enteroparasitos, se aplicaron métodos con antivuerpos monicionales por inmunofluorescencia

[Selective vs. mass treatment with antihelminthic drugs: experience in two hyperendemic communities]. / El tratamiento antihelmíntico selectivo frente al tratamiento masivo. Experiencia en dos comunidades hiperendémicas.

OBJECTIVE: To compare the prevalence and intensity of soil-transmitted nematode infection among children from two hyperendemic communities who were treated with antihelminthic drugs under two different regimens: selective or individual treatment was administered to members of one of the communities, and repeated mass treatment was given to the control community. METHODS: The study population was comprised of 909 children of both sexes between the ages of 2 and 13 from two peri-urban communities: Las Lomas and El Abastos, both in Santa Fe, Argentina. A prospective, longitudinal, quasi-experimental study was carried out in these communities. During the 22-month study period, 5 parasitologic controls were performed and results were qualitatively and quantitatively examined. Treatment with antihelminthic drugs was given at controls 0, 2, 3, and 4. At Las Lomas, selective treatment was administered to those in sample A (n = 55) who were positive for parasites; in El Abasto, mass treatment was given to all children, including those in sample B (n = 50). Both samples received follow-up. RESULTS: The prevalence and intensity of A. lumbricoides infections were found to be significant in El Abasto. No differences were detected in the case of T. trichiura. When prevalence and parasitic burden of A. lumbricoides were compared among controls within a single community (at the beginning and end of the study), no significant differences were observed in sample A, but a significant difference was seen in sample B. Insofar as T. trichiura is concerned, there were significant differences among controls in both samples. CONCLUSIONS: Only repeated and massive treatment significantly lowered the prevalence and intensity of A. lumbricoides infections during the study period.

El tratamiento antihelmíntico selectivo frente al tratamiento masivo: experiencia en dos comunidades hiperendémicas / Selective vs. mass treatment with antihelminthic drugs: experience in two hyperendemic communities

OBJETIVO: Evaluar la prevalencia e intensidad de las infecciones por geohelmintos en niños de dos comunidades hiperendémicas tratadas con técnicas antihelmínticas diferentes: una con tratamiento selectivo o individual, y la otra con tratamiento masivo reiterado. MÉTODOS: La población estuvo compuesta por 909 niños de uno u otro sexo, con edades entre 2 y 13 años, que vivían en dos comunidades marginales de la ciudad: Las Lomas y El Abasto, Santa Fe, Argentina. Se realizó un trabajo prospectivo longitudinal, cuasiexperimental, de comunidades. Durante los 22 meses del estudio se llevaron a cabo 5 controles parasitológicos, evaluados desde el punto de vista cualitativo y cuantitativo, y se dispensaron tratamientos antihelmínticos después de los controles 0, 2, 3 y 4. En Las Lomas se aplicó el tratamiento selectivo a los casos con diagnóstico parasitológico positivo que integraban la muestra A (n = 55) y en El Abasto, tratamiento masivo a todos los niños, incluidos los integrantes de la muestra B (n = 50). Ambas muestras fueron escogidas para realizar los controles. RESULTADOS: Se comprobó una prevalencia e intensidad de la infección por Ascaris lumbricoides significativamente mayor en El Abasto. No se detectaron diferencias para Trichuris trichiura. Al comparar las prevalencias y cargas parasitarias de A. lumbricoides entre los controles realizados dentro de una misma comunidad (inicio y final del estudio) no se observaron diferencias significativas en la muestra A, aunque sí en la muestra B. En cuanto a T. trichiura, se detectaron diferencias significativas entre ambos controles en las dos muestras. CONCLUSIONES: Solo el tratamiento masivo y reiterado logró disminuir eficaz y significativamente la prevalencia y la carga parasitaria de A. lumbricoides durante el período estudiado

El agua subterránea como agente transmisor de protozoos intestinales / Subterranean water as agent of intestinal protozoa trasmission

Objetivo: el objetivo del presente trabajo fue establecer si había asociación entre el consumo de agua obtenida de fuentes subterráneas, sólo desinfectada con cloro, y la presencia de protozoos intestinales en una población pediátrica. Población: se estudiaron 4 grupos de niños, de 4 meses a 12 años de edad, que compartían similares condiciones socioecónomicas y sanitarias. Los grupos A (n=34), B (n=36) y C (n=45), consumían agua de red que proveniente de fuentes subterráneas, sólo tratada con cloro antes de ser distribuida. El grupo de control, D (n=34), consumía agua de fuente superficial con tratamiento de potabilización convencional completo. Material y métodos: en cada grupo se analizó el agua, desde el punto de vista fisicoquímico, bacteriológico y parasitológico y se realizaron cultivos coproparasitológicos seriados a los niños seleccionados. Se realizó, además, una encuesta a los padres. Resultados: se comprobó contaminación bacteriológica y parasitológica en algunas de las perforaciones que abastecían a los grupos de población A, B y C. Se detectaron quistes u ooquistes de protozoos en los tanques B y C. Los porcentajes de estudios coproparasitológicos positivos en los niños en cada grupo fueron: A,47 por ciento; B, 41 por ciento; C, 67 por ciento y D, 12 por ciento. Se obtuvieron diferencias significativas entre A y D (p=0.0039; OR 5.16[1.43-19.65]), B y D (p=0.012; OR 4.14[1.16-15.62]) y entre C y D (p<10 elevado -5; OR 11.60[3.35-42.88]). Según los resultados de la encuesta, los 4 grupos compartían condiciones socio-ecónomicas-sanitarias similares. Conclusiones: en las muestras estudiadas, las diferencias relativas existentes entre el grupo control y el resto de los grupos estudiados permitían inferir que existe un alto riesgo de infección con protozoos intestinales cuando se consume agua contaminada de origen subterráneo que sólo fue clorada antes de su distribución