Facilitators of peer leader retention within a Type 2 diabetes intervention trial for US Latinos/Hispanics of Mexican origin.

Peer support is effective in improving self-management behaviors and health outcomes among individuals with Type 2 diabetes. Volunteer peer support programs offer a cost-effective resource for diabetes self-management support; however, factors affecting the retention of volunteer peer leaders remain understudied. Herein, we examined factors associated with volunteer retention and satisfaction among 34 predominantly Mexican-origin peer leaders who assisted patients from a Federally Qualified Health Center located on the US/Mexico border with their diabetes management. Peer leaders completed surveys with open- and close-ended questions at baseline, 6 months and 12 months. Quantitative and qualitative data analyses were guided by the Volunteer Process Model. Using nonparametric Mann-Whitney U tests, self-efficacy as a peer leader at 6 months was most associated with interest to continue volunteering (P = 0.01), and satisfaction with support from the program at 12 months was most associated with interest to continue volunteering (P = 0.01). The qualitative data indicated that the relationship between the peer leaders and their patients was the primary factor for a satisfying volunteer experience. Future research should focus on increasing peer leaders' self-efficacy and satisfaction with program support and examine how organizations can support the development of the patient-peer relationship. Practitioners should consider appealing to volunteer peers' motivations to promote their retention.

[Ophthalmological evaluation in children referred to a low-vision rehabilitation project of a social assistance agency]. / Evaluación oftalmológica en niños derivados a un proyecto de rehabilitación en baja visión de un organismo de apoyo social.

INTRODUCTION: A low-vision (LV) rehabilitated child can receive comprehensive education. Objec tive: To study the profile of school children referred for evaluation to a rehabilitation project in a social assistance agency. PATIENTS AND METHOD: Descriptive cross-sectional study of beneficiaries evaluated between September 2015 and September 2016 in the National Board of School Assistan ce and Scholarships (JUNAEB). The referral diagnosis, monocular visual acuity (VA) with optical correction at far (Feinbloom chart) and close (Zeiss chart) distances were considered. They were classified according to VA and perimetry. Treatment success was considered if VA reaches > 0.4 at far and/or close distances with optical devices. RESULTS: 278 students were assessed. 153 (55%) were men, 121 (43.5%) between the ages of 10 to 14. Bilateral congenital cataract, retinal dystrophies, high myopia, optic atrophy, and congenital nystagmus were the most frequent pathologies. 224 students (80.6%) received optical devices. 85 (37.9%) presented moderate LV and 63 (28.6%) severe LV; 122 (54.5%) presented normal perimetry, 68 (30.4%) tubular Visual Field (VF), 19 (8.5%) sectoral VF defects, and 15 (6.7%) central scotoma. 198 (88.4%) students achieved visual success at a far distance and all achieved visual success at a near distance. 48 (17.2%) students could not be rehabilitated due to a neuro-ophthalmological condition (41.7%), high refractive error (16.6%) or congenital glauco ma (10.4%).Six (2.2%) cases improved VA with a new optical correction. CONCLUSION: This success demonstrates the need to provide low vision aids to schoolchildren with LV. Our challenge is to maintain this program and to educate ophthalmologist for timely referral.

Evaluación oftalmológica en niños derivados a un proyecto de rehabilitación en baja visión de un organismo de apoyo social / Ophthalmological evaluation in children referred to a low-vision rehabilitation project of a social assistance agency

INTRODUCCIÓN: Un niño con baja visión (BV) rehabilitado puede tener una educación integral. Objetivo: Estudiar el perfil de los escolares derivados para evaluación a un Proyecto de Rehabilitación en un organismo de apoyo social. PACIENTES Y MÉTODO: Estudio transversal descriptivo de beneficiarios evaluados entre septiembre 2015 y septiembre 2016 en JUNAEB. Se consideró diagnóstico de derivación, agudeza visual monocular (AV) con corrección óptica para lejos (cartillas Feinbloom) y cerca (cartillas Zeiss). Se clasificaron según AV y perimetría. Se consideró éxito de tratamiento lograr AV > 0,4 para le jos y/o cerca con ayuda óptica. RESULTADOS: Se evaluaron 278 escolares. 153 (55%) fueron hombres, 121(43,5%) entre 10 a 14 años. Catarata congénita bilateral, distrofias retinales, alta miopía, atrofia óptica y nistagmus congénito fueron las patologías más frecuentes. 224 (80,6%) se habilitaron con ayudas. 85 (37,9%) presentaron BV moderada y 63 (28,6%) BV severa. 122 (54,5%) presentaban perimetría normal, 68 (30,4%) campo visual (CV) tubular, 19 (8,5%) defecto sectorial del CV y 15 (6,7%) compromiso central del CV. 198 (88,4%) escolares lograron éxito visual de lejos y todos lograron éxito visual de cerca. 48 (17,2%) escolares no pudieron ser rehabilitados, estando asocia dos a una afección neuroftalmológica (41,7%), alto error refractivo (16,6%) o glaucoma congénito (10,4%). 6 (2,2%) casos mejoraron su AV con nueva corrección óptica. CONCLUSIÓN: El éxito obtenido demuestra la necesidad de habilitar visualmente a escolares con BV. Nuestro desafío es mantener este programa y educar al oftalmólogo prestador para una derivación oportuna.

INTRODUCTION: A low-vision (LV) rehabilitated child can receive comprehensive education. OBJECTIVE: To study the profile of school children referred for evaluation to a rehabilitation project in a social assistance agency. PATIENTS AND METHODS and Method: Descriptive cross-sectional study of beneficiaries evaluated between September 2015 and September 2016 in the National Board of School Assistan ce and Scholarships (JUNAEB). The referral diagnosis, monocular visual acuity (VA) with optical correction at far (Feinbloom chart) and close (Zeiss chart) distances were considered. They were classified according to VA and perimetry. Treatment success was considered if VA reaches > 0.4 at far and/or close distances with optical devices. RESULTS: 278 students were assessed. 153 (55%) were men, 121 (43.5%) between the ages of 10 to 14. Bilateral congenital cataract, retinal dystrophies, high myopia, optic atrophy, and congenital nystagmus were the most frequent pathologies. 224 students (80.6%) received optical devices. 85 (37.9%) presented moderate LV and 63 (28.6%) severe LV; 122 (54.5%) presented normal perimetry, 68 (30.4%) tubular Visual Field (VF), 19 (8.5%) sectoral VF defects, and 15 (6.7%) central scotoma. 198 (88.4%) students achieved visual success at a far distance and all achieved visual success at a near distance. 48 (17.2%) students could not be rehabilitated due to a neuro-ophthalmological condition (41.7%), high refractive error (16.6%) or congenital glauco ma (10.4%).Six (2.2%) cases improved VA with a new optical correction. CONCLUSION: This success demonstrates the need to provide low vision aids to schoolchildren with LV. Our challenge is to maintain this program and to educate ophthalmologist for timely referral.

Detection and significance of inapparent infection in Chagas disease in western Venezuela.

Inapparent infections of Trypanosoma cruzi were detected in symptomless seropositive people living in close proximity, and under the same conditions of risk, to patients with acute Chagas disease. Similar infections were also detected in sera samples of people from 25 villages of western Venezuela where Chagas disease is endemic. Seropositivity in all the 1,251 studied samples was established by use of 3 serological methods (direct agglutination test, indirect immunofluorescence antibody test, and enzyme-linked immunosorbent assay). Each seropositive sample was tested for detection of anti-T. cruzi-specific immunoglobulin (Ig) M and IgG levels and specific T. cruzi infection by molecular methodology (polymerase chain reaction assay). The combined analysis of the serologic (IgM and IgG levels), molecular (specific T. cruzi DNA), and statistical findings demonstrated the existence of a different stage of T. cruzi infection in asymptomatic patients, which is suggested to be recognized as inapparent infection. Its definition, significance, and comparison with typical Chagas disease phases are presented, and its potential epidemiological importance is discussed.

Myocardial parasite persistence in chronic chagasic patients.

The persistence of Trypanosoma cruzi tissue forms was detected in the myocardium of seropositive individuals clinically diagnosed as chronic chagasic patients following endomyocardial biopsies (EMBs) processed by immunohistochemical (peroxidase-anti-peroxidase [PAP] staining) and molecular (polymerase chain reaction [PCR]) techniques. An indirect immunofluorescent technique revealed antigenic deposits in the cardiac tissue in 24 (88.9%) of 27 patients. Persistent T. cruzi amastigotes were detected by PAP staining in the myocardium of 22 (84.6%) of 26 patients. This finding was confirmed with a PCR assay specific for T. cruzi in 21 (91.3%) of 23 biopsy specimens from the same patients. Statistical analysis revealed substantial agreement between PCR and PAP techniques (k = 0.68) and the PCR and any serologic test (k = 0.77). The histopathologic study of EMB specimens from these patients revealed necrosis, inflammatory infiltrates, and fibrosis, and made it possible to detect heart abnormalities not detected by electrocardiogram and/or cineventriculogram. These indications of myocarditis were supported by the detection of T. cruzi amastigotes by the PAP technique or its genome by PCR. They suggest that although the number of parasites is low in patients with chronic Chagas' disease, their potential for heart damage may be comparable with those present during the acute phase. The urgent necessity for testing new drugs with long-term effects on T. cruzi is discussed in the context of the present results.

Acute Chagas' disease in western Venezuela: a clinical, seroparasitologic, and epidemiologic study.

A clinical, parasitologic, and serologic study carried out between 1988 and 1996 on 59 acute-phase patients in areas of western Venezuela where Chagas' disease is endemic showed 19 symptomatic patterns or groups of symptoms appearing in combination with different frequencies. The symptomatic pattern with the highest frequency was that showing simultaneously fever, myalgia, headache, and Romaña's sign, which was detected in 20% of the acute-phase patients. Asymptomatic individuals and patients with fever as the only sign of the disease made up 15% and 11.9% of the total acute cases, respectively. Statistical correlation analysis revealed that xenodiagnosis and hemoculture were the most reliable and concordant of the five parasitologic methods used; these two methods also showed the highest proportions in detecting any clinical symptomatic pattern in acute-phase patients. A similar high reliability and concordance was obtained with a direct agglutination test, an indirect immunofluorescent antibody test, and an ELISA as serologic tests, which also showed a higher proportion of positive detection of clinical patterns than parasitologic methods (P < 0.001). It is recommended that individuals coming from endemic areas showing mild and/or severe clinical manifestations should be suspected of being in contact or having been in contact with Trypanosoma cruzi, be referred for parasitologic and serologic evaluations to confirm the presumptive clinical diagnosis of acute Chagas' disease, and start specific treatment. The epidemiologic implications of the present findings are discussed and the use of similar methodology to evaluate other areas where Chagas' disease is endemic is suggested.

[Clinical, parasitological and histopathologic follow-up studies of acute Chagas patients treated with benznidazole]. / Seguimiento clínico, parasitológico e histopatológico de pacientes chagásicos agudos tratados con benznidazol.

With the purpose of studying their clinical and histopathologic evolution, 10 acute chagasic patients with myocarditis diagnosed by endomyocardial biopsy and positive sero-parasitologic methods were evaluated at 11 months (8-21 months) after treatment with oral benznidazole. Four of them were reevaluated 5 years post-treatment (58-68 months). Study protocol consisted of clinical, hemodynamic, echocardiographic, seroparasitologic and histopathologic evaluations. Results showed evidence of persisting myocarditis in 90% and 75% of patients evaluated at 11 months and 5 years respectively, along with asymptomatic, subclinical left ventricular systolic dysfunction being recognized in 75% of patients evaluated 5 years after treatment. All parasitologic studies became negative during follow-up, but serology remained positive for Trypanosoma cruzi antibodies in 80% and 75% of patients studied at 11 months and 5 years. In conclusion, myocardial damage was constantly found in our acute chagasic patients. Treatment with benznidazole eliminated symptoms and parasitemia, but it does not seem to alter favorably the histopathological evolution of the chagasic cardiac disease.

Cardiac involvement is a constant finding in acute Chagas' disease: a clinical, parasitological and histopathological study.

During the last 8 years 58 acute cases of Chagas' disease were studied. Patients from an endemic area of the state of Barinas, Venezuela, showed fever (98%) and circulating forms of T. cruzi (100%), and were treated with oral benznidazole. The recorded mortality was 8.6%. Acute myocarditis was constantly found either in myocardial biopsies or at necropsy, even in patients without any other sign of cardiac compromise (36%), which was detected by chest X-ray in 58%, by 2D echocardiography in 52%, by resting ECG in 41% and by clinical findings in 27.5% of the patients. Cardiomegaly was due to pericardial effusion rather than ventricular dilatation in most instances. Treatment eliminated parasitemia but negativized serology in only 20% of patients. It also appeared to have little influence on the ongoing myocarditic process, emphasizing the need for better therapeutic schedules, able to avoid or control the early appearance of immunologic mechanisms and microcirculatory damage involved in the future development of chronic chagasic myocarditis.

Results of electrophysiologic studies in patients with acute Chagasic myocarditis.

BACKGROUND: As the acute stage of Chagas' myocarditis is rarely detected, little is known about the electrophysiologic characteristics of that stage. HYPOTHESIS: This investigation was undertaken to conduct an electrophysiologic study of the properties of the heart during the acute phase of Chagasic myocarditis. METHODS: We studied eight patients who had positive xenodiagnosis, positive mice culture, and positive complement fixation test for Chagas' disease. RESULTS: Trypanosoma cruzi were identified in all of the patients' stained blood samples. Right ventricular endomyocardial biopsies were obtained, evidencing a distinct infiltrate of lymphocytes that confirmed the diagnosis of acute myocarditis. The cardiac dimensions and the ventricular systolic and diastolic function were preserved in all patients. The electrocardiogram evidenced conduction defects in two patients. The signal-averaged electrocardiogram displayed late potentials in three patients. In the electrophysiologic study, atrial fibrillation or flutter was induced in four patients. When compared with control patients, Chagasic patients were found to have greater values of atrial threshold, A-H interval, and atrioventricular (AV) nodal effective refractory period. The H-V interval was mildly prolonged in two patients, but the dynamic AV nodal conduction was preserved (1:1 conduction during right atrial stimulation at a cycle length of 400 ms) in all the Chagasic patients. The ventricular parameters were within normal limits, and no sustained ventricular arrhythmia could be induced. CONCLUSIONS: Patients with mild acute Chagasic myocarditis may suffer from electrical abnormalities and arrhythmias that are more evident at the supraventricular level and the AV junction.

[Clinical and psychological characterization of children and adolescents with recurrent abdominal pain]. / Caracterización clínica y psicológica de escolares y adolescentes con dolor abdominal recurrente.

There is ample empirical evidence supporting the view of emotional disturbances in children with recurrent abdominal pain (RAP) as well as in their parents. However, controlled studies have reported that such manifestations can also be found in patients with other chronic ailments. In order to characterize further the nature of emotional factors in RAP patients, we conducted a controlled psychological evaluation of 46 consecutive new patients with RAP, aged 7-17 years, (group A) by means of structured interviews and questionnaires. Two control groups of pediatric patients with chronic illnesses were also assessed using the same methodology. Group B consisted of 22 individuals with chronic abdominal pain and endoscopy-proven peptic ulcer or duodenitis, and group C consisted of 24 individuals with chronic, stable, non-gastroenterological diseases (e.g., diabetes mellitus or physical handicaps). Parents were evaluated for depressive symptoms. One-way analysis of variance and contingency tables were used for statistical comparisons. There was a higher proportion of female patients in group A than in group B (70 vs 41%; p < 0.05). There were significantly more patients in group A than in group B that reported that their abdominal pain: a) never appeared during sleep, b) began soon after the patient's arousal in the morning, c) remitted completely or was alleviated during school holidays, d) its remission was usually spontaneous during the day and e) did never interfere with recreational activities. Emotional problems were significantly more prevalent in patients in group B than in those in group A (p = 0.016). Past diagnosis of depression was more frequent in group A mothers (40%) than in those in group B (27%), or group C (17%), but these differences did not attain statistical significance. These results suggest that psychological profiles of children suffering from certain chronic conditions (and those of their parents) may be more complex and particular than hitherto recognized. The role of type II error and of some potential socioeconomic and demographic confounding factors must be considered when analyzing the validity of these data.

Prognostic implications of clinical, electrocardiographic and hemodynamic findings in chronic Chagas' disease.

To evaluate the prognostic importance of 19 clinical, electrocardiographic and hemodynamic variables, 556 chronic chagasic patients were submitted to an extensive protocol, including left cineventriculogram and Holter monitoring, and followed for up to 15 years. The protagonist role of the magnitude of the myocardial compromise in the evolution of chagasic patients is underscored by our results, which indicated the independent prognostic value of an ejection fraction below 0.30 (P < 0.001), a heart rate higher than 89 beats/min (P < 0.01), grade IV functional capacity (P < 0.05), end systolic stress > 120 g/cm2 (P < 0.05), and end diastolic volume index > 200 ml/m2 (P < 0.05). When only patients with an ejection fraction over 0.29 were considered, variables with independent prognostic value were: the cardio-thoracic ratio (P < 0.01), functional capacity (P < 0.05) and heart rate (P < 0.05). Survival analysis demonstrated that the presence of complex (Lown III, IV) ventricular arrhythmias increased mortality significantly (P < 0.01) only in patients with an ejection fraction over 0.29. Therefore, preservation of myocardial function is the capital measure in the treatment of chronic chagasic patients.

[Left ventricular mechanics in Chagas' disease and primary dilated myocardiopathies. A hemodynamic study]. / Mecánica ventricular izquierda en la enfermedad de Chagas y las miocardiopatías dilatadas primarias. Estudio hemodinámico.

The evolution of several mechanical parameters of left ventricular function was studied in 32 control subjects, 171 chronic chagasic and 60 primary dilated cardiomyopathy patients, which were submitted to an extensive invasive and non-invasive protocol. Preload and afterload (end-diastolic and end-systolic stress), contractile status (ejection fraction), the magnitude (mass/index) and adequacy of hypertrophy (mass/volume ratio) and afterload (systolic stress/volume ratio) were derived from the invasive explorations. There was an increased afterload in 25% of chronic chagasic patients without other evidence of early myocardial damage, which was accompanied by signs of inadequate hypertrophy. Both findings increased further with the progression of the disease. Systolic performance was initially preserved, but showed a progressive depression paralleling the clinical evolution. Patients with dilated cardiomyopathy showed a mechanical profile similar to chagasic patients with advanced degree of myocardial damage. The hemodynamic determination of mass index, mass/volume ratio, end-systolic and end-diastolic stress seem to be the best parameters for detection of early abnormalities in loading conditions of the heart in chronic Chagas, disease, and for indication and evaluation of the results of vasodilator therapy in both groups of patients.

[Ventricular mechanics and cardiac arrhythmias in patients with chagasic and primary dilated cardiomyopathy. Echo-electrocardiographic follow-up]. / Mecánica ventricular y arritmias cardiacas en pacientes chagásicos y con miocardiopatías dilatadas primarias. Seguimiento eco-electrocardiográfico.

PURPOSE: To determine the prognostic significance of several parameters of left ventricular mechanics and of complex ventricular arrhythmias. PATIENTS AND METHODS: 184 chronic chagasic and 85 primary dilated cardiomyopathy patients were submitted to non-invasive and invasive studies, including Holter monitoring and "M" mode echocardiogram and followed for a maximum of 8 years. RESULTS: Finding of a depressed left ventricle (LV) systolic function (% AC) was the most important independent prognostic factor in both groups of patients. The presence of complex ventricular arrhythmias had an additional, but very limited, independent prognostic importance, observed only in chagasic patients with depressed LV systolic function. When patients with similar degrees of left ventricular systolic dysfunction, inadequate hypertrophy or increased afterload were compared, chagasic patients had significantly worse prognosis than those with primary dilated cardiomyopathy. This is partly attributed to higher prevalence of complex ventricular arrhythmias. CONCLUSION: The higher prevalence of complex ventricular arrhythmias in patients with chronic Chagas' disease may explain the prognostic differences between the groups.

Resecciones hepáticas / Hepatic resections

Desde noviembre de 1987 a julio de 1989 en protocolo prospectivo se realiza un programa de resecciones hepáticas para patología benigna y maligna de hígado y vías biliares. Se opera 34 pacientes, 28 mujeres y 6 varones con distribución de edad entre los 29 y 70 años. Se efectúan los siguientes procedimientos: 20 resecciones segmentarias de lecho hepático más linfadenectomía regional por cáncer de vesícula biliar y 14 lobectomías hepáticas (10 por hidatidosis, 2 por metástasis hepáticas, 1 por adenoma hepático y 1 por desgarro del lóbulo izquierdo por traumatismo abdominal cerrado). La serie no presenta mortalidad perioperatoria. La morbilidad es de 8,8%y la mortalidad alejada de 2,9%

Ventricular arrhythmias and left ventricular myocardial function in chronic chagasic patients.

To study the relationship of complex ventricular arrhythmias to the presence and extent of myocardial damage, 556 chronic chagasic patients were submitted to an extensive protocol, including left ventricular cineangiography and Holter monitoring, and properly classified according to clinical, electrocardiographic and hemodynamic findings. Stages of the clinical-hemodynamic classification corresponded to increasing degrees of myocardial damage, age, prevalence and complexity of ventricular arrhythmias. Myocardial damage (particularly left ventricular dilatation) was the most important clinical factor linked to the presence of complex ventricular arrhythmias. A clear difference in terms of ventricular function was found only when arrhythmias were grouped into simple (Lown grades I and II) and complex (grades III and IV) forms. It is recommended that any classification for chagasic patients must be based on signs of myocardial involvement, instead of clinical or electrocardiographic findings alone. Evaluation should include accurate determination of left ventricular myocardial function, along with the search for the presence of complex ventricular arrhythmias and abnormalities of conduction.