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1.
Artículo en Español | PAHO-IRIS | ID: phr-56623

RESUMEN

[EXTRACTO]. La presente crítica se encuentra orientada al artículo de Galván y cols, que tuvo como objetivo principal, estudiar la factibilidad de la utilización de la inteligencia artificial como método sensible y específico para el cribado de COVID-19 en pacientes con afecciones respiratorias, empleando imágenes de tórax obtenidas con tomógrafo y una plataforma de telemedicina, reportándose que es viable la utilización de esta tecnología para la detección rápida de COVID-19 en los hospitales públicos de Paraguay. El primer problema que observamos se relaciona con la reducida cantidad de pacientes (5%) que mostraron lesiones altamente compatibles con COVID-19, otro es el deficit de equipamiento y de profesionales especializados, limitando su uso. Por lo tanto, la IA solo podría ser utilizada por hospitales de gran envergadura. Además, según el estudio Kundu y cols., del cual se guiaron los autores del articulo original, quedan claro las limitaciones del diseño del estudio ya que no todos los casos de COVID-19 están asociados con patología torácica. Por último, detalla la importancia de especificar en qué características principales se basan para dar el diagnóstico (tamizaje) de COVID-19 de otras patologías relacionadas en las imágenes TAC. La respuesta a esta carta está disponible en: https://doi.org/10.26633/ RPSP.2022.190


Asunto(s)
COVID-19 , Prueba de COVID-19 , Inteligencia Artificial , Telemedicina , Paraguay
2.
Artículo en Español | PAHO-IRIS | ID: phr-56619

RESUMEN

[EXTRACTO]. En respuesta a la carta al editor titulada: Critica al estudio de factibilidad de la utilización de la inteligencia artificial para el cribado de pacientes con COVID-19 en Paraguay, los autores del artículo de referencia elevan a consideración la réplica sobre el contenido de esta, con el objeto de esclarecer los cuestionamientos mencionados en la misma. Respecto al primer problema mencionado en la carta al editor; el estudio utilizó el programa de inteligencia artificial (IA) que fue desarrollado por un equipo de informáticos biomédicos, neumólogos y radiólogos (imagenólogos). El programa utilizado dispone de un método de aprendizaje profundo para realizar el diagnóstico rápido de COVID-19; es decir, cuenta con un algoritmo para detectar patologías neumológicas y un algoritmo de diagnóstico de neumopatías compatibles con COVID-19. En cuanto al segundo problema mencionado en la carta al editor; el presente estudio se realizó entre marzo del 2020 y junio del 2021 en 14 hospitales de las 18 regiones sanitarias del Ministerio de Salud Pública y Bienestar Social (MSPBS), que ya contaban con al menos un tomógrafo funcionando al momento del estudio. El informe de diagnóstico del médico radiólogo y el resultado del diagnóstico por IA fueron remitidos luego a un equipo de neumólogos para su valoración, análisis, correlación y validación; los neumólogos correlacionaron los valores porcentuales del diagnóstico por IA con el resultado de los médicos radió- logos, el resultado del análisis molecular (RT-PCR) y el cuadro clínico del paciente para determinar los grados de concordancia o discordancia entre los resultados, y llegar a un diagnóstico definitivo que permitiera informar al médico del hospital donde se trataba al paciente en cuestión. Esto permitió reducir las aglomeraciones en los centros especializados y optimizar el uso de los limitados recursos disponibles. Esta respuesta se refiere a la carta disponible en: https://doi.org/10. 26633/RPSP.2022.193


Asunto(s)
Inteligencia Artificial , COVID-19 , Paraguay
3.
PLoS One ; 17(11): e0273290, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36346807

RESUMEN

BACKGROUND: Patients with chronic disease represent an at-risk group in the face of the COVID-19 crisis as they need to regularly monitor their lifestyle and emotional management. Coping with the illness becomes a challenge due to supply problems and lack of access to health care facilities. It is expected these limitations, along with lockdown and social distancing measures, have affected the routine disease management of these patients, being more pronounced in low- and middle-income countries with a flawed health care system. OBJECTIVES: The purpose of this study is to describe a protocol for a randomized controlled trial to test the efficacy of the Adhera® MejoraCare Digital Program, an mHealth intervention aimed at improving the quality of life of patients with chronic diseases during the COVID-19 outbreak in Paraguay. METHOD: A two-arm randomized controlled trial will be carried out, with repeated measures (baseline, 1-month, 3-month, 6-month, and 12-month) under two conditions: Adhera® MejoraCare Digital Program or waiting list. The primary outcome is a change in the quality of life on the EuroQol 5-Dimensions 3-Levels Questionnaire (EQ-5D-3L). Other secondary outcomes, as the effect on anxiety and health empowerment, will be considered. All participants must be 18 years of age or older and meet the criteria for chronic disease. A total of 96 participants will be recruited (48 per arm). CONCLUSIONS: It is expected that the Adhera® MejoraCare Digital Program will show significant improvements in quality of life and emotional distress compared to the waiting list condition. Additionally, it is hypothesized that this intervention will be positively evaluated by the participants in terms of usability and satisfaction. The findings will provide new insights into the viability and efficacy of mHealth solutions for chronic disease management in developing countries and in times of pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT04659746.


Asunto(s)
COVID-19 , Telemedicina , Humanos , Adolescente , Adulto , COVID-19/epidemiología , Calidad de Vida , SARS-CoV-2 , Paraguay/epidemiología , Control de Enfermedades Transmisibles , Enfermedad Crónica , Ensayos Clínicos Controlados Aleatorios como Asunto
4.
Int J STD AIDS ; 33(14): 1212-1222, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36257834

RESUMEN

BACKGROUND: Our study aimed to measure HIV prevalence and associated risk factors among men who have sex with men (MSM) in three regions of Paraguay in 2020. METHODS: MSM were recruited for cross-sectional surveys in three regions of Paraguay using respondent-driven sampling. Interview were conducted face-to-face to collect demographic characteristics and risk and preventive behaviors. The analysis assessed HIV prevalence and associated risk factors in the three samples of MSM within each region. RESULTS: A total of 1,207 MSM were recruited, including 559 in Asunción-Central, 245 in Alto Paraná, and 403 in Caaguazú. HIV prevalence was 24.2% (95% CI 20.6-27.9) in Asunción-Central, 10.2% (95% CI 6.7-14.6) in Alto Paraná, and 3.2% (95% CI 1.7-5.4) in Caaguazú. In Asunción-Central, associations with HIV were age ≥25 years (1.86, 95% CI 1.15-3.00), being employed (1.82, 95% CI 1.07-3.11), self-reporting as homosexual (1.90, 95% CI 1.06-3.43), having sex with a known HIV-positive partner acquisition (4.19, 95% CI 2.37-7.43), self-perceived as being at higher risk for HIV acquisition (4.15, 95% CI 2.54-6.77), and able to access condoms and lubricants (1.82, 95% CI 1.08-3.05). In Alto Paraná, associations with HIV were self-reporting as homosexual (4.33, 95% CI 1.19-15.65) and having higher HIV knowledge (2.53, 95% CI 0.97-6.61). In Caaguazú, associations with HIV were self-reporting as homosexual (7.06, 95% CI 1.53-32.46) and being diagnosed with depression (4.68, 95% CI 0.89-24.43). CONCLUSIONS: HIV prevalence among MSM in Paraguay varied by region, being highest in the capital and major metropolitan area of Asunción-Central, followed by the border area of Alto Paraná. While being self-identified as homosexual was associated with HIV in all three regions, other associations differed, indicating prevention programs need to be tailored to the locale.


Asunto(s)
Infecciones por VIH , Minorías Sexuales y de Género , Masculino , Humanos , Adulto , Homosexualidad Masculina , Conducta Sexual , Prevalencia , Estudios Transversales , Paraguay/epidemiología , Infecciones por VIH/diagnóstico , Factores de Riesgo , Encuestas y Cuestionarios , Asunción de Riesgos
5.
Rev. cient. cienc. salud ; 4(2): 56-63, 28-10-2022.
Artículo en Español | BDNPAR | ID: biblio-1400313

RESUMEN

Introducción. El embarazo no planeado durante la adolescencia se configura como un problema de salud pública. Son múltiples los factores de riesgo relacionados con esta situación, estos pueden ser individuales, familiares y sexuales. Objetivo. Describir la distribución de los factores de riesgo relacionados con el embarazo adolescente, a partir de los datos obtenidos en la Unidad de Salud San Gerónimo de Limpio-Paraguay, de enero 2020 a noviembre 2021. Metodología. Estudio descriptivo, cuantitativo, transversal de adolescentes embarazadas con por lo menos dos consultas prenatales. Se obtuvieron datos por fuente primaria mediante una encuesta y por fuente secundaria por revisión de fichas de consultas prenatales. Se aplicaron medidas estadísticas de distribución de frecuencia y porcentaje. Se describieron los factores de riesgo posiblemente relacionados con el embarazo en adolescentes. Resultados.Se incluyeron en el estudio 45 adolescentes embarazadas. Entre los factores individuales, el 69% de las adolescentes encuestadas manifestaron tener un grado de conocimiento básico y deficiente sobre planificación familiar y métodos anticonceptivos. En cuanto al factor familiar, en el 71% se observó la repetición de patrones familiares, como embarazos precoces. Conclusión.El estudio brinda información sobre los factores de riesgo de este grupo vulnerable de mujeres de la Unidad de Salud de la Familia de la localidad, mostrando la necesidad de incrementar acciones de promoción-prevención hacia este grupo de edad, para mejorar su salud sexual y reproductiva.


Introduction.Unplanned pregnancy during adolescence is configured as a public health problem. There are multiple risk factors related to this situation, these can be individual, family and sexual. Objective:To describe the distribution of risk factors related to adolescent pregnancy, based on the data obtained at the San Gerónimo de Limpio-Paraguay Health Unit, from January 2020 to November 2021. Methodology:descriptive, quantitative, cross-sectional study of adolescent pregnant women with at least two prenatal visits. Data were obtained by primary source through a survey and by secondary source by reviewing prenatal consultation records. Statistical measures of frequency and percentage distribution were applied. Risk factors possibly related to pregnancy in adolescents were described. Results:45 pregnant adolescents were included in the study. Among the individual factors, 69% of the adolescents surveyed stated that they had a basic and deficient level of knowledge about family planning and contraceptive methods. Regarding the family factor, in 71% the repetition of family patterns was observed, such as early pregnancies. Conclusion:the study provides information on the risk factors of this vulnerable groupof women from the local Family Health Unit, showing the need to increase promotion-prevention actions towards this age group, to improve their sexual health and reproductive.


Asunto(s)
Humanos , Femenino , Adolescente , Embarazo en Adolescencia , Paraguay , Atención Primaria de Salud , Factores de Riesgo
6.
Rev. cient. cienc. salud ; 4(2): 64-73, 28-10-2022.
Artículo en Español | BDNPAR | ID: biblio-1400319

RESUMEN

Introducción.Las patologías neurológicas bacterianas constituyen un problema de salud mundial. En Paraguay, se emplean dos tipos de vigilancia epidemiológica para las infecciones meningocócicas: universal y centinela. Objetivo. Evaluar el sistema de vigilancia epidemiológica universal de las meningoencefalitis. Metodología.Estudio descriptivo transversal, basado en las directrices del Updated Guidelines for Evaluating Public Health Surveillance Systems-CDC-2001. Se analizó la base de datos del sistema nacional del 2016 seleccionando en forma aleatoria una muestra de 240 casos sospechosos de un total de 640 casos para evaluar los atributos de calidad de datos, aceptabilidad, oportunidad, sensibilidad y valor predictivo positivo (VPP), mediante una escala de calificaciones. Las medidas de frecuencias y tendencia central (media, mediana) fueron calculadas en Excel. Resultado.La evaluación de la calidad de los datos mostró una completitud de 95% e inconsistencia 4,2%. La aceptabilidad de los actores alcanzó 92%. La oportunidad de toma de muestra ≤ 24h (mediana= 1 día; rango= -31-35 días), el de diagnóstico ≤72h (mediana= 0 día; rango= 0-61 días) y la de notificación ha superado las 24h requeridas (mediana= 3 días; rango= 0-41 días). La sensibilidad del sistema fue 90% y elVPP 7,5%. Conclusión. El sistema es sensible en cuanto a la vigilancia clínica con un VPP bajo, la calidad de datos es excelente, aceptable por los actores, oportuna para la toma de muestras y de diagnóstico. Sin embargo, se debe mejorar la oportunidad de notificación.


Introduction. Bacterial neurological diseases are a global health problem. In Paraguay, two types of epidemiological surveillance are used for meningococcal infections: universal and sentinel. Objetive.The objective was to evaluate the universal epidemiological surveillance system for meningoencephalitis. Methodology:Cross-sectional descriptive study, following the guidelines of the Updated Guidelines for Evaluating Public Health Surveillance Systems-CDC-2001. The database of the national system of 2016 was analyzed. To evaluate the attributes: data quality, acceptability, timeliness, sensitivity and positive predictive value (PPV) the sample size of a total population of 640 was calculated using EpiInfo7.2.2.2, confidence level 95%. The minimum size studied was 240 suspected cases. The grading scale was developed. Random samples of records, frequency measurements and central tendency (mean, median) were calculated in Excel. Results:Epidemiological files were evaluated, the quality of the data in terms of completeness was 95% and inconsistency 4.2%. The acceptability of the actors reached 92%. The opportunity to take a sample ≤ 24 hours (Me= 1 day; R= -31-35 days), diagnosis ≤72h (Me= 0 days; R= 0-61 days) and notification has exceeded the required 24h (Me= 3 days; R= 0-41 days). The sensitivity of thesystem was found to be 90% with a PPV of 7.5%. Conclusion.In conclusion, the system is sensitive in terms of clinical surveillance with a low PPV, the data quality is excellent, acceptable by the actors, timely for sampling and diagnosis. However, the timeliness of notification needs to be improved.


Asunto(s)
Humanos , Meningoencefalitis , Paraguay , Sistema de Vigilancia Sanitaria , Monitoreo Epidemiológico
7.
Vector Borne Zoonotic Dis ; 22(10): 520-526, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-36255416

RESUMEN

Objective: The objective of this work was to adapt a diagnostic kit developed for humans to identify Dengue (DENV1, DENV2, DENV3, DENV4), Zika (ZIKV) and Chikungunya virus (CHIKV) in females of Aedes aegypti and Aedes albopictus and to verify if the occurrence of mosquitoes infected with these three arboviruses are being found in regions with high occurrence of these diseases in humans. Materials and Methods: For this purpose, live mosquitoes were captured between January and June 2020 using 3,476 traps permanently installed in the field were used. After capture, the species were identified, then the females were placed in a pool of 2 to 10 specimens and sent to the laboratory for detection of DENV1, DENV2, DENV3, DENV4, ZIKV and CHIKV by RT-PCR using a commercial human kit for arboviruses. Results: Of the 76 mosquito pools collected, six (7.9%) pools tested positive for the DENV2 virus. The DENV-positive mosquitoes were collected in regions with a high incidence of reported cases of Dengue or in adjacent areas. Conclusion: The absence of kits for the detection of these arboviruses in Aedes is a limiting factor and the adequacy of commercial kits, already used for the diagnosis of arboviruses in humans, the results presented demonstrate that it is possible to identify the presence of DENV2 in mosquitoes with the respective kit, reinforcing the use of RT-qPCR as a robust diagnostic tool for epidemiological surveillance allowing managers to receive timely results for decision-making regarding prevention and control actions.


Asunto(s)
Aedes , Arbovirus , Fiebre Chikungunya , Virus Chikungunya , Virus del Dengue , Dengue , Infección por el Virus Zika , Virus Zika , Femenino , Humanos , Animales , Virus Zika/genética , Virus Chikungunya/genética , Infección por el Virus Zika/diagnóstico , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/veterinaria , Fiebre Chikungunya/diagnóstico , Fiebre Chikungunya/epidemiología , Fiebre Chikungunya/veterinaria , Brasil/epidemiología , Salud Pública , Argentina , Paraguay , Virus del Dengue/genética , Mosquitos Vectores , Dengue/epidemiología , Dengue/veterinaria
8.
Artículo en Inglés | MEDLINE | ID: mdl-36231491

RESUMEN

Dengue fever has been endemic in Paraguay since 2009 and is a major cause of public-health-management-related burdens. However, Paraguay still lacks information on the association between climate factors and dengue fever. We aimed to investigate the association between climatic factors and dengue fever in Asuncion. Cumulative dengue cases from January 2014 to December 2020 were extracted weekly, and new cases and incidence rates of dengue fever were calculated. Climate factor data were aggregated weekly, associations between dengue cases and climate factors were analyzed, and variables were selected to construct our model. A generalized additive model was used, and the best model was selected based on Akaike information criteria. Piecewise regression analyses were performed for non-linear climate factors. Wind and relative humidity were negatively associated with dengue cases, and minimum temperature was positively associated with dengue cases when the temperature was less than 21.3 °C and negatively associated with dengue when greater than 21.3 °C. Additional studies on dengue fever in Asuncion and other cities are needed to better understand dengue fever.


Asunto(s)
Dengue , Clima , Dengue/epidemiología , Humanos , Humedad , Incidencia , Paraguay/epidemiología , Temperatura
9.
Artículo en Inglés | MEDLINE | ID: mdl-36232228

RESUMEN

We aimed to determine the prevalence of depression, anxiety, and stress in university students in Paraguay during the COVID-19 pandemic. A cross-sectional study was conducted among 293 students from four universities in Paraguay in 2021. The DASS-21 mental health scale was used to measure the outcomes (depression, anxiety, and stress) and evaluate their association with socio-educational variables. A total of 77.1% of the participants were women and 136 (46.4%) were between 21 and 25 years old. The prevalence of depression, anxiety, and stress was 74.7%, 87.4%, and 57%, respectively. We found that being a woman and studying at a public university was positively associated with depression, anxiety, and stress. Receiving COVID-19 training increases the prevalence of mental health problems. In conclusion, high levels of anxiety, depression, and stress were found in university students during the COVID-19 pandemic. Being a woman, studying at a public university, and receiving training on COVID-19 were factors associated with a higher prevalence of presenting all the mental health problems evaluated. Furthermore, students aged 31 and over had a higher prevalence of depression and stress.


Asunto(s)
COVID-19 , Adulto , Ansiedad/epidemiología , Ansiedad/psicología , COVID-19/epidemiología , Estudios Transversales , Depresión/epidemiología , Femenino , Humanos , Masculino , Pandemias , Paraguay/epidemiología , Prevalencia , SARS-CoV-2 , Estrés Psicológico/epidemiología , Estrés Psicológico/psicología , Estudiantes/psicología , Universidades , Adulto Joven
10.
Asunción; OPS; 2022-09-23. (OPS/PRY/22-0001).
No convencional en Español | PAHO-IRIS | ID: phr2-56354

RESUMEN

En el 2022 se celebra el 120.º aniversario de la Organización Panamericana de la Salud (OPS). En calidad de organismo independiente especializado en salud del sistema interamericano, la OPS brinda cooperación técnica a sus Estados Miembros para abordar las enfermedades transmisibles y no transmisibles y sus causas, fortalecer los sistemas de salud y responder a situaciones de emergencia y desastres en toda la Región de las Américas. Asimismo, como Oficina Regional de la Organización Mundial de la Salud para la Región de las Américas, participa en los equipos de las Naciones Unidas en los países, colaborando con otros organismos, fondos y programas del sistema de las Naciones Unidas para contribuir al logro de los Objetivos de Desarrollo Sostenible a nivel de país. A nivel subregional, la OPS trabaja con los mecanismos de integración para que la salud y sus determinantes tengan un lugar en la agenda política. En el informe anual correspondiente al 2021 se presenta la cooperación técnica de la OPS en los países y territorios en este período, con la aplicación de las estrategias de cooperación en los países, la respuesta a sus necesidades y prioridades, y el desarrollo de las actividades en el marco de los mandatos regionales y mundiales de la OPS y los Objetivos de Desarrollo Sostenible. En consonancia con el tema general de "responder a la COVID-19 y prepararse para el futuro", se ponen de relieve las medidas que ha adoptado la OPS con respecto a la pandemia de COVID-19 y sus esfuerzos continuos en áreas prioritarias como las emergencias de salud, los sistemas y servicios de salud, las enfermedades transmisibles, las enfermedades no transmisibles y la salud mental, la salud a lo largo del curso de vida y la equidad en la salud. También se presenta un resumen financiero del bienio 2020-2021.


Asunto(s)
COVID-19 , Urgencias Médicas , Sistemas de Salud , Servicios de Salud , Enfermedades Transmisibles , Equidad , Equidad de Género , Diversidad Cultural , Cooperación Técnica , Américas , Paraguay
11.
Front Public Health ; 10: 935405, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35910871

RESUMEN

Purpose: To determine the prevalence and factors associated with computer vision syndrome in medical students at a private university in Paraguay. Methods: A survey study was conducted in 2021 in a sample of 228 medical students from the Universidad del Pacífico, Paraguay. The dependent variable was CVS, measured with the Computer Visual Syndrome Questionnaire (CVS-Q). Its association with covariates (hours of daily use of notebook, smartphone, tablet and PC, taking breaks when using equipment, use of preventive visual measures, use of glasses, etc.) was examined. Results: The mean age was 22.3 years and 71.5% were women. CVS was present in 82.5% of participants. Higher prevalence of CVS was associated with wearing a framed lens (PR = 1.11, 95% CI: 1.03-1.20). In contrast, taking a break when using electronic equipment at least every 20 min and every 1 h reduced 7% (PR = 0.93, 95% CI: 0.87-0.99) and 6% (PR = 0.94, 95% CI: 0.89-0.99) the prevalence of CVS, respectively. Conclusion: Eight out of 10 students experienced CVS during the COVID-19 pandemic. The use of framed lenses increased the presence of CVS, while taking breaks when using electronic equipment at least every 20 min and every 1 h reduced CVS.


Asunto(s)
COVID-19 , Enfermedades Profesionales , Estudiantes de Medicina , Adulto , Computadores , Estudios Transversales , Ergonomía , Femenino , Humanos , Masculino , Enfermedades Profesionales/epidemiología , Pandemias , Paraguay/epidemiología , Encuestas y Cuestionarios , Síndrome , Universidades , Adulto Joven
12.
Cir. plást. ibero-latinoam ; 48(3): 339-346, jul.-sep. 2022. ilus
Artículo en Español | IBECS | ID: ibc-211347

RESUMEN

Introducción y objetivo: Las quemaduras eléctricas de alta tensión en nuestro país, Paraguay, constituyen un serio problema de salud pública debido a su elevado porcentaje en comparación con otros países. Debido a que, en su gran mayoría, afectan a la población adulta trabajadora de sexo masculino, nos vemos obligados a evitar el mayor número de amputaciones posible.Teniendo en cuenta esta problemática, comenzamos en nuestro Servicio de Cirugía Plástica a realizar la reparación de los nervios periféricos en miembros que aparentemente no tenían buen pronóstico. Material y método: Describimos 3 casos de pacientes con quemaduras eléctricas de alta tensión que presentaron lesiones severas de tejidos blandos, nervios y tendones en miembro superior. Tras el protocolo de apoyo vital, lavados, desbridamientos seriados y cobertura de tejidos blandos con colgajo inguinal, llevamos a cabo la reparación nerviosa a los 3 meses de la lesión.Resultados: A pesar de las brechas nerviosas importantes entre los cabos afectados, el injerto de nervio sural demostró ser efectivo en los 3 pacientes, con recuperación de al menos la sensibilidad protectora en los territorios de los nervios mediano y cubital en el miembro afectado. La reconstrucción nerviosa además se complementó con reconstrucciones como injertos, transferencias tendinosas y fisioterapia para optimizar la función de la mano. Conclusiones: Los 3 casos presentados fueron capaces de realizar sus actividades de la vida cotidiana una vez finalizada la reconstrucción. (AU)


Background and objective: High voltaje electrical burns in our country, Paraguay, are a public health problem because of their high incidence when compared with other countries. As most of the affected patients are adult men at work, we felt the responsability to avoid as most as posible amputation cases.Due to this problematic, we began in our Plastic Surgery Unit to repair peripheral nerves in upper limbs with initial bad prognostic.Methods: We describe 3 patients with high voltaje electrical burns afecting upper limb soft tissues, nerves and tendons. After vital support, serial debridement and reconstruction using inguinal flap, nerve reconstruction was conducted 3 months after the initial injury.Results: In spite of the great damage, sural nerve grafts were effective in the 3 patients, who recovered at least protective sensibility in medial and cubital áreas. Nerve reconstruction was completed with other grafts, tendinous tranfers and phisitoterapy to optimize hand function.Conclusions:Our 3 patients recovered their usual dayly activi- ties after reconstruction. (AU)


Asunto(s)
Humanos , Masculino , Adulto , Reconstrucción Posdesastre , Nervios Periféricos , Quemaduras por Electricidad , Paraguay , Extremidad Superior
13.
J Health Serv Res Policy ; 27(3): 180-189, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35732068

RESUMEN

OBJECTIVE: Paraguay's health care system is characterized by segmented provision and low public spending, with limited coverage and asymmetries in terms of access and quality of care. The present study provides national estimates of income-related inequality in health care utilization and trends in the country over the past two decades. METHODS: Using data from the Paraguayan Permanent Household Survey, we estimated socioeconomic inequality in health care use during the period 1999-2018. We used poverty-to-income ratio as the socioeconomic stratifier and defined health care use as having reported a health problem and subsequent health care use in the last 90 days before interview. Inequality was summarized by rank- and level-based versions of the Concentration Index for binary outcomes. RESULTS: Inequalities affecting those with lower incomes were present in all years assessed, although the magnitude of these inequalities declined over time. Inequality as expressed by the rank-based index decreased from 0.209 (95%CI 0.164; 0.253) in 1999 to 0.032 (95%CI -0.010; 0.075) in 2018. The level-based index decreased from 0.076 (95%CI -0.029; 0.182) in 1999 to 0.024 (0.002; 0.045) in 2018. Trends in both indices were generally stable from 1999 to 2009, with a noticeable decrease in 2010. The sharpest decreases relative to the 1999 baseline were observed in the period 2010-2018, reflecting changes in health care use and income distribution. Stratification by area, sex and older people suggest similar trends within subgroups. CONCLUSIONS: Decreases in inequality coincide temporally with increments in public health expenditure, removal of user fees in public health care facilities and the expansion of conditional cash-transfer programmes. Future research should disentangle the role of each of these policies in explaining the trends described.


Asunto(s)
Disparidades en Atención de Salud , Renta , Anciano , Humanos , Paraguay , Aceptación de la Atención de Salud , Factores Socioeconómicos
14.
Acta Trop ; 233: 106543, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-35643185

RESUMEN

Animal trypanosomosis, caused by Trypanozoon trypanosomes (Trypanosoma evansi and T. equiperdum), and Trypanosoma vivax, is endemic to South American countries and has a negative impact on the livestock industry. However, the risk factors for trypanosomosis in Paraguay remain unknown. This study aimed to determine the risk factors for equine trypanosomosis in Paraguay based on a PCR-based molecular survey and individual horse sampling data. In this study, 739 blood samples were collected from horses in 16 departments of Paraguay between August 2019 and November 2020. To elucidate the risk factors for trypanosome infection, the relationship between trypanosome infection status detected by PCR and the location, sex, age, breed of horses, and season of sample collection was analyzed. There were no significant differences in trypanosome prevalence in horses between the eastern and western regions, ages, or breeds of horses in Paraguay. Sex and season were identified as risk factors for trypanosome infection in horses in Paraguay in the current study. These results suggest that the rainy-summer season, when vectors increase in number and their blood-sucking activity, could be the most important risk factor for trypanosome infection in Paraguay horses. Preventive measures and treatments should be developed to address these factors.


Asunto(s)
Enfermedades de los Caballos , Tripanosomiasis , Animales , Sangre/parasitología , Femenino , Enfermedades de los Caballos/diagnóstico , Enfermedades de los Caballos/epidemiología , Caballos , Masculino , Paraguay/epidemiología , Reacción en Cadena de la Polimerasa/veterinaria , Prevalencia , Factores de Riesgo , Trypanosoma/genética , Trypanosoma/aislamiento & purificación , Tripanosomiasis/diagnóstico , Tripanosomiasis/epidemiología , Tripanosomiasis/veterinaria
15.
Int J Soc Psychiatry ; 68(5): 1063-1070, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35652309

RESUMEN

BACKGROUND: Although technologies (including information, e-learning, and communication) have been daily employed by University students in the last years, the COVID-19 pandemic has led to a considerable increase in their use. Technostress is a modern term referring to levels of stress caused by the prolonged exposure to technology. AIM: The aim of this study is to assess the technostress and related anxiety and depression among Paraguayan University students, describing their sociodemographic characteristics and relevant associations. METHODS: A cross-sectional and descriptive study has been conducted. Participants were recruited through an Internet-based survey. Technostress, anxiety, and depression have been assessed with the Technostress Questionnaire (TechQ), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and the Patient Health Questionnaire-2 (PHQ-2), respectively. RESULTS: A total of 378 participants were included, 74.1% of whom were women. According to the TechQ scores, 47.4% of the participants reported a low/moderate level of technostress whereas 5.2% showed severe scores. About 58.5% of participants reported a GAD-7 score ⩾10, meeting diagnostic criteria for generalized anxiety. About 60.3% scored ⩾3 at the PHQ-2 reporting significant levels of depression. Technostress has been significantly associated with levels of anxiety (p < .001) as well as depression (p < .001). CONCLUSION: Our results suggest further research regarding the implications of technostress on the well-being of University students. Specific measures aimed to improve students' coping with the challenges of technology and technostress should be promoted.


Asunto(s)
COVID-19 , Pandemias , Ansiedad/epidemiología , Ansiedad/etiología , Trastornos de Ansiedad/epidemiología , COVID-19/epidemiología , Estudios Transversales , Depresión/epidemiología , Depresión/etiología , Femenino , Humanos , Masculino , Paraguay/epidemiología , Estudiantes , Universidades
16.
J Med Virol ; 94(10): 5061-5065, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-35701340

RESUMEN

Human immunodeficiency virus (HIV) drug resistance increases mortality and morbidity and antiretroviral therapy (ART) costs. We describe Paraguay's first nationally representative survey on pretreatment drug resistance (PDR) conducted among persons who initiated or reinitiated ART in 2019. ​​​​We conducted a cross-sectional survey of antiretroviral (ARV) drug resistance in Paraguay in 2019. Participants were sampled at four comprehensive care clinics where 90% of patients with HIV in Paraguay initiate ART. Patients included were adults ≥18 years old who initiated first-line ART or reinitiated the same first-line ART regimen after ≥3 months of discontinuation. Of 208 patients, 93.8% had no prior ART exposure, 3.8% reinitiated the same regimen, 2.4% had unknown prior ART exposure; and 31.3% had a CD4 count <200 cells/µl. Mutations associated with resistance were present in 15.4% of patients. Mutations associated with resistance to nonnucleoside reverse transcriptase inhibitors (NNRTI) were present in 13.0% of patients, nucleoside reverse transcriptase inhibitors in 4.3%, and integrase inhibitors in 3.4%. Mutations associated with resistance to tenofovir were present in 1.0% of patients and emtricitabine/lamivudine in 1.4%. ​​Nearly one in six patients had PDR in Paraguay's first nationally representative sample. High NNRTI PDR prevalence underscores the need to accelerate the transition to dolutegravir-based first-line ART. The low PDR prevalence of tenofovir and emtricitabine is reassuring as these ARVs are part of the World Health Organization (WHO)-recommended oral pre-exposure prophylaxis regimen. The high proportion of individuals initiating ART at a late disease stage highlights the need to improve treatment linkage strategies and implement WHO rapid ART initiation recommendations.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , VIH-1 , Adolescente , Adulto , Fármacos Anti-VIH/farmacología , Fármacos Anti-VIH/uso terapéutico , Antirretrovirales/uso terapéutico , Estudios Transversales , Farmacorresistencia Viral/genética , Emtricitabina/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , VIH-1/genética , Humanos , Paraguay/epidemiología , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Tenofovir/uso terapéutico , Carga Viral
17.
Rev Chilena Infectol ; 39(1): 86-90, 2022 02.
Artículo en Español | MEDLINE | ID: mdl-35735285

RESUMEN

We present a clinical case of keratitis caused by M. abscessus in a 76-year-old female patient, resident in the city of Asunción, without trauma or previous ocular surgery and with a history of herpetic keratouveitis. Because it is a keratitis caused by a rare etiological agent and because of the importance of a correct and timely diagnosis for the establishment of appropriate treatment, the present case is reported, the first of Mycobacteria keratitis in Paraguay.


Asunto(s)
Queratitis , Anciano , Femenino , Humanos , Queratitis/microbiología , Paraguay
18.
Hum Vaccin Immunother ; 18(5): 2069974, 2022 11 30.
Artículo en Inglés | MEDLINE | ID: mdl-35543602

RESUMEN

This study aimed to investigate the public health and economic benefit of using a quadrivalent influenza vaccine (QIV) instead of a trivalent influenza vaccine (TIV) in past seasons in Paraguay. The budget impact of switching from TIV to QIV in the Immunization Program was also evaluated. The adapted model includes two modules. The first compared retrospectively Health and Economic outcomes resulting from the use of QIV instead of TIV. The second forecast the spending and savings that would be associated with the switch from TIV to QIV. Our findings estimate that the switch from TIV to QIV during the seasons 2012 to 2017 could have prevented around 2,600 influenza cases, 67 hospitalizations and 10 deaths. An alternative scenario using standardized estimates of the burden of influenza showed that 234 influenza-related hospitalizations and 29 deaths could have been prevented. The estimated annual budget impact of a full switch from TIV to QIV was around USD1,6 million both from the payer and societal perspectives. Those results are mainly driven by vaccine prices and coverage rate. In sum, this manuscript describes how the use of QIV instead of TIV could have prevented influenza cases and subsequent complications that led to hospitalizations and deaths. This could have generated savings for the health system and society, offsetting part of the additional investment needed to switch from TIV to QIV.


Asunto(s)
Vacunas contra la Influenza , Gripe Humana , Análisis Costo-Beneficio , Humanos , Gripe Humana/prevención & control , Paraguay , Salud Pública , Estudios Retrospectivos , Vacunas Combinadas , Vacunas de Productos Inactivados
19.
Rev. cient. cienc. salud ; 4(1): 84-92, 17-05-2022.
Artículo en Español | LILACS-Express | BDNPAR | ID: biblio-1388754

RESUMEN

RESUMEN Introducción. Los índices antropométricos son combinaciones de medidas utilizadas para evaluar el crecimiento normal del niño desde el nacimiento, entre ellos el perímetro cefálico (PC). Objetivo. Medir las concordancias entre las curvas de crecimiento de la OMS, los aplicativos Anthro WHO e Intergrowth 21st, en un grupo de recién nacidos (RN) diagnosticados con microcefalia. Metodología. estudio analítico transversal a 329 RN con microcefalia de un hospital regional. Se tomó como parámetro oro a las curvas de referencia de la OMS comparándolo con el puntaje Z obtenido con los aplicativos Anthro WHO e Intergrowth 21st. Se clasificó a la población según sexo; se calcularon los promedios con desviación estándar para edad gestacional, peso, talla, perímetro cefálico. Se estimó el coeficiente Kappa de Cohen y se utilizó la escala cualitativa Landis y Koch para medir la concordancia. Estadísticos con SPSS. Resultados. De 329 nacimientos, 195 (59%) fueron niñas. Sin diferencias significativas entre los promedios de edad gestacional, peso, talla y PC. Entre OMS/Anthro WHO Kappa=0,813 para las niñas y Kappa=0,804 para los niños (Landis-Koch= casi perfecto y considerable respectivamente). Entre OMS/Intergrowth 21st Kappa=0,030 para niñas y Kappa=0,305 para los niños (Landis-Koch= leve y aceptable respectivamente). Conclusión. El grado de acuerdo entre el parámetro oro OMS y Anthro WHO estuvieron entre considerable y casi perfecto por lo que ambos se pueden utilizar indistintamente. Se sugieren estudios adicionales para evaluar el impacto que pudiera tener las diferencias de acuerdos encontradas entre los parámetros de OMS e Intergrowth 21st.


ABSTRACT Introduction. Anthropometric indices are combinations of measures used to evaluate the normal growth of the child from birth; including head circumference (PC). Objetive. to measure the concordances between the WHO growth curves, the Anthro WHO and Intergrowth 21st applications, in a group of newborns (NB) diagnosed with microcephaly. Methodology. cross-sectional analytical study to 329 NBs with microcephaly from a regional hospital. The WHO reference curves were the gold parameter, comparing it with the Z score obtained with the Anthro WHO and Intergrowth 21st applications. Classified the population according to sex; the averages with standard deviation were calculated for gestational age, weight, height, head circunsfenere. The Cohen Kappa coefficient was estimated and Landis and Koch qualitative scale was used to measure the concordance. Statisticians with SPSS. Results. Of 329 births, 195 (59%) were girls. No significant differences between the means of gestational age, weight, size and CP. Between WHO / Anthro WHO Kappa = 0.813 for girls and Kappa = 0.804 for boys (Landis-Koch = almost perfect and considerable respectively). Between OMS / Intergrowth 21st Kappa = 0.030 for girls and Kappa = 0.305 for boys (Landis-Koch = mild and acceptable respectively). Conclusion. The degree of agreement between WHO gold parameter and the Anthro WHO parameter was between considerable and almost perfect, so both can be used interchangeably. Additional studies are suggested to assess the impact that the differences in agreement found between the WHO and Intergrowth 21st parameters could have.


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Antropometría , Paraguay , Estándares de Referencia , Reproducibilidad de los Resultados , Gráficos de Crecimiento
20.
Rev. cient. cienc. salud ; 4(1): 93-104, 17-05-2022.
Artículo en Español | LILACS-Express | BDNPAR | ID: biblio-1388755

RESUMEN

RESUMEN Introducción. Paraguay es un país endémico para el dengue y la intervención primaria para esta arbovirosis es el control químico de su vector Aedes aegypti, siendo necesario estudiar su resistencia frente a insecticidas utilizados para el control y conocer su sostenibilidad en espacio y tiempo. Objetivo. Determinar la susceptibilidad de poblaciones silvestres de Ae. aegypti procedentes de Villa Elisa-Central, frente al adulticida deltametrina y conocer el área potencial de distribución de estas poblacionesresistentes/susceptibles. Metodología. Se utilizaron mosquitos Ae. aegypti adultos de la Filial 1 obtenidos de ovitrampas colocadas en viviendas geo-localizadas entre diciembre 2017-marzo 2018. Las hembras resultantes de la cría en condiciones ad hoc en laboratorio fueron expuestas a concentraciones crecientes del insecticida. La distribución real de las poblaciones de mosquitos y su área de influencia, fueron modeladas mediante DIVA-GIS. Resultados. La mortalidad promedio observada para cada dosis de deltametrina fue: 5,3% para (0,03%); 47,4% para (0,15%) y 61,2% para (0,3). Se observó áreas de influencia para la presencia de Ae. aegypti. Conclusión. los valores correspondientes a la mortalidad resultaron inferiores al 98%, lo cual fue indicativo de resistencia a dosis diagnóstica. El modelo de distribución geográfica de la población evaluada demostró la existencia de áreas idóneas con condiciones bioclimáticas óptimas (niveles de precipitación, temperatura y humedad), propicias para la aparición de reservorios de agua y presencia del vector, tanto en Villa Elisa, como en los distritos localizados en la periferia tales como San Lorenzo, Lambaré, Ñemby, San Antonio y Fernando de la Mora.


ABSTRACT Introduction. Paraguay is an endemic country for dengue and the primary intervention for this arbovirus is the chemical control of its vector Aedes aegypti, being necessary to study its resistance against insecticides used for control and to know its sustainability in space and time. Objective. To determine the susceptibility of wild populations of Ae. aegypti from Villa Elisa-Central, against the adulticide deltamethrin and to know the potential area of ​​distribution of these resistant/susceptible populations. Methodology. Mosquitoes Ae. aegypti adults from Filial 1 obtained from ovitraps placed in geo-located dwellings between December 2017 and March 2018. The females resulting from rearing under ad hoc conditions in the laboratory were exposed to increasing concentrations of the insecticide. The actual distribution of mosquito populations and their area of ​​influence were modeled using DIVA-GIS. Results. The average mortality observed for each dose of deltamethrin was: 5.3% for (0.03%); 47.4% for (0.15%) and 61.2% for (0.3). Areas of influence were observed for the presence of Ae. aegypti. Conclusion. The values ​​corresponding to mortality were lower than 98%, which was indicative of resistance to diagnostic dose. The geographic distribution model of the evaluated population demonstrated the existence of suitable areas with optimal bioclimatic conditions (levels of precipitation, temperature and humidity), conducive to the appearance of water reservoirs and the presence of the vector, both in Villa Elisa and in the districts located on the outskirts such as San Lorenzo, Lambaré, Ñemby, San Antonio and Fernando de la Mora.


Asunto(s)
Aedes , Paraguay , Resistencia a los Insecticidas
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