Comportamiento del cáncer gástrico en pacientes de la EPS-s provincia de García Rovira (Santander), en el periodo 2007-2014 / Comportamento do câncer gástrico nos pacientes da EPS-s da província de Garcia Rovira (Santander) no periodo de 2007-2014 / Gastric Cancer Behavior in EPS-s (Health Insurance Company) in The Province of García Rovira (Santander), during the 2007 – 2014 Period

Introducción: El cáncer gástrico es en Colombia y Santander, la primera causa de muerte por tumores malignos, a pesar de no ser la primera neoplasia en frecuencia. Objetivo: Teniendo en cuenta lo anterior, el cáncer gástrico es un problema de salud pública y en nuestro medio no existen estudios analíticos que permitan caracterizar esta población; lo que se propone es una investigación en la cual se caracterice el comportamiento en la población con cáncer gástrico en la provincia de García Rovira, Santander, en el periodo 2007-2014. Metodología: Estudio analítico con 57 historias clínicas revisadas de pacientes de una empresa promotora de salud del régimen subsidiado (EPS-s) con diagnóstico de cáncer gástrico confirmado por histopatología. Las variables consideradas fueron: sexo, edad, estadio, patología, localización, tratamiento y sobrevida, se realizó análisis univariado teniendo en cuenta la variable edad categorizada por rangos (hasta 50 años, 51 a 60 años, 61 a 70 años, y más de 70 años); variables cualitativas descritas en tabla de frecuencias, porcentajes e intervalos de confianza; el análisis bivariado se realizó buscando el valor P del test de Fisher, los datos fueron analizados en el paquete estadístico Stata. Resultados y conclusiones: Los resultados mostraron que los hombres representan un 77.2% de los casos de cáncer gástrico estudiados; el 68.4% del total de los pacientes tenía más de 60 años. Se encontraron diferencias significativas en la localización del tumor por sexo, ya que en las mujeres el cáncer se localizó en el antro pilórico mientras que en los hombres fue predominantemente en el cardias y el cuerpo del estómago (p<0.05); por su parte, las variables estadio clínico y tratamiento recibido se encontraron asociados de manera estadística a mortalidad (p<0.05). (au)

Introduction: Gastric cancer is in Colombia and Santander, the leading cause of death from malignant tumors, despite not being the first neoplasia in frequency. Objective: Considering the above, the gastric cancer is a major public health and our environment are not analytical studies to characterize this population, what is proposed is an investigation in which behavior is characterized in people with gastric cancer the province of Garcia Rovira, Santander, in the 2007-2014 period. Methodology: analytical study reviewed medical records of 57 patients from a health promoter subsidized system (EPS-S) diagnosed with gastric cancer confirmed by histopathology. The variables considered were: sex, age, stage, pathology, localization, treatment and survival, univariate analysis was performed taking into account the varying categorized by age ranges (up to 50 years, 51-60 years old, 61-70 years and over 70); qualitative variables described in table of frequencies, percentages and confidence intervals; bivariate analysis was performed looking for the P value of the test of Fisher, the data were analyzed in the Stata statistical package. Results and Conclusions: The results showed that men represent 77.2% of gastric cancer cases studied; 68.4% of patients had more than 60 years. Significant differences in tumor localization by sex were found in women as cancer was located in the antrum while in men was predominantly in the cardia and body of the stomach (p <0.05); For its part, the variables clinical stage and received treatment associated mortality statistics (p <0.05) were found way.

Introdução: O câncer gástrico é, na Colômbia e no estado de Santander, a principal causa de morte ocasionada pelos tumores malignos, apesar deste tipo de neoplasia não ser a mais frequente. Esta realidade mostra que o câncer gástrico é um problema de saúde pública e, no contexto nacional, não existem estudos analíticos que permitam caracterizar esta população; o que se propõe no caso, é uma pesquisa na qual se caracterize o comportamento da população com câncer gástrico na província de Garcia Rovira, Santander, durante o periodo de 2007-2014. Metodologia: O estudo é de caráter analítico realizado com 57 prontuários de pacientes de uma empresa promotora da saúde (EPS-S), do sistema subsidiado, diagnosticados com câncer gástrico confirmado pelo exame histopatológico. As variáveis consideradas foram: sexo, idade, estágio, patologia, localização, tratamento e sobrevida. Foi realizada análise univariada tendo em conta as diferentes faixas etárias (até 50 anos, 51-60 anos, 61-70 anos e mais 70); variáveis qualitativas descritas na tabela de frequências, percentagens e intervalos de confiança; a análise bivariada foi realizada procurando o valor P do teste de Fisher, os dados foram analisados no pacote estatístico Stata. Resultados e Conclusões: Os resultados mostraram que os homens representam 77.2% dos casos de câncer gástrico estudados; 68.4% dos pacientes tinham mais de 60 anos. Foram encontradas diferenças significativas na localização do tumor de acordo com o gênero dos pacientes; no caso das mulheres o câncer foi localizado no antro, enquanto que nos homens ele se encontrou predominantemente na cárdia e no corpo do estômago (p <0.05); ao passo que as variáveis estágio clínico e tratamento recebido estão associadas estatisticamente com a mortalidade (p <0.05).

Integrated surveys of neglected tropical diseases in southern Sudan: how much do they cost and can they be refined?

BACKGROUND: Increasing emphasis on integrated control of neglected tropical diseases (NTDs) requires identification of co-endemic areas. Integrated surveys for lymphatic filariasis (LF), schistosomiasis and soil-transmitted helminth (STH) infection have been recommended for this purpose. Integrated survey designs inevitably involve balancing the costs of surveys against accuracy of classifying areas for treatment, so-called implementation units (IUs). This requires an understanding of the main cost drivers and of how operating procedures may affect both cost and accuracy of surveys. Here we report a detailed cost analysis of the first round of integrated NTD surveys in Southern Sudan. METHODS AND FINDINGS: Financial and economic costs were estimated from financial expenditure records and interviews with survey staff using an ingredients approach. The main outcome was cost per IU surveyed. Uncertain variables were subjected to univariate sensitivity analysis and the effects of modifying standard operating procedures were explored. The average economic cost per IU surveyed was USD 40,206 or USD 9,573, depending on the size of the IU. The major cost drivers were two key categories of recurrent costs: i) survey consumables, and ii) personnel. CONCLUSION: The cost of integrated surveys in Southern Sudan could be reduced by surveying larger administrative areas for LF. If this approach was taken, the estimated economic cost of completing LF, schistosomiasis and STH mapping in Southern Sudan would amount to USD 1.6 million. The methodological detail and costing template provided here could be used to generate cost estimates in other settings and readily compare these to the present study, and may help budget for integrated and single NTDs surveys elsewhere.

Integrated mapping of neglected tropical diseases: epidemiological findings and control implications for northern Bahr-el-Ghazal State, Southern Sudan.

BACKGROUND: There are few detailed data on the geographic distribution of most neglected tropical diseases (NTDs) in post-conflict Southern Sudan. To guide intervention by the recently established national programme for integrated NTD control, we conducted an integrated prevalence survey for schistosomiasis, soil-transmitted helminth (STH) infection, lymphatic filariasis (LF), and loiasis in Northern Bahr-el-Ghazal State. Our aim was to establish which communities require mass drug administration (MDA) with preventive chemotherapy (PCT), rather than to provide precise estimates of infection prevalence. METHODS AND FINDINGS: The integrated survey design used anecdotal reports of LF and proximity to water bodies (for schistosomiasis) to guide selection of survey sites. In total, 86 communities were surveyed for schistosomiasis and STH; 43 of these were also surveyed for LF and loiasis. From these, 4834 urine samples were tested for blood in urine using Hemastix reagent strips, 4438 stool samples were analyzed using the Kato-Katz technique, and 5254 blood samples were tested for circulating Wuchereria bancrofti antigen using immunochromatographic card tests (ICT). 4461 individuals were interviewed regarding a history of 'eye worm' (a proxy measure for loiasis) and 31 village chiefs were interviewed regarding the presence of clinical manifestations of LF in their community. At the village level, prevalence of Schistosoma haematobium and S. mansoni ranged from 0 to 65.6% and from 0 to 9.3%, respectively. The main STH species was hookworm, ranging from 0 to 70% by village. Infection with LF and loiasis was extremely rare, with only four individuals testing positive or reporting symptoms, respectively. Questionnaire data on clinical signs of LF did not provide a reliable indication of endemicity. MDA intervention thresholds recommended by the World Health Organization were only exceeded for urinary schistosomiasis and hookworm in a few, yet distinct, communities. CONCLUSION: This was the first attempt to use an integrated survey design for this group of infections and to generate detailed results to guide their control over a large area of Southern Sudan. The approach proved practical, but could be further simplified to reduce field work and costs. The results show that only a few areas need to be targeted with MDA of PCT, thus confirming the importance of detailed mapping for cost-effective control.

The performance of haematuria reagent strips for the rapid mapping of urinary schistosomiasis: field experience from Southern Sudan.

The implementation of programmes to control neglected tropical diseases (NTDs) requires up-to-date information on the prevalence and distribution of each NTD. This study evaluated the performance of reagent strip testing for haematuria to diagnose Schistosoma haematobium infection among school-aged children in the context of a rapid mapping survey in Southern Sudan. The reagent strips were highly sensitive (97.8%) but only moderately specific (58.8%). The proportion of false positive diagnoses was significantly higher among girls than boys, especially among girls aged 5-10 years. These findings suggest that reagent strips alone are not sufficient for rapid mapping surveys. A two-step approach is thus recommended whereby haematuria-positive urine samples are subsequently examined using urine filtration.

Trachoma in Western Equatoria State, Southern Sudan: implications for national control.

BACKGROUND: Trachoma is thought to be common over large parts of Southern Sudan. However, many areas of the country, particularly west of the Nile, have not yet been surveyed. The aim of this study was to confirm whether trachoma extends into Western Equatoria State from neighboring Central Equatoria, where trachoma is highly prevalent, and whether intervention with the SAFE strategy is required. METHODS AND FINDINGS: Population-based cross-sectional surveys were conducted using a two-stage cluster random sampling method to select the study population. Subjects were examined for trachoma by experienced graders using the World Health Organization (WHO) simplified grading scheme. Two counties thought to be most likely to have trachoma were surveyed, Maridi and Mundri. In Maridi, prevalence of one of the signs of active trachoma (trachomatous inflammation-follicular (TF)) in children aged 1-9 years was 0.4% (95% confidence interval (CI), 0.0%-0.8%), while no children showing the other possible sign, trachomatous inflammation-intense (TI), were identified. No trachomatous trichiasis (TT) was found in those aged under 15, and prevalence was 0.1% (95% CI, 0.0%-0.4%) in those aged 15 years and above. In Mundri, active trachoma was also limited to signs of TF, with a prevalence of 4.1% (95% CI, 1.4%-6.9%) in children aged 1-9 years. Again, no TT was found in those aged under 15, and prevalence in those aged 15 years and above was 0.3% (95% CI, 0.0%-0.8%). CONCLUSION: Trachoma prevalence in the east of Western Equatoria State is below the WHO recommended intervention threshold for mass drug administration of antibiotic treatment in all villages. However, the prevalence of TF and TT in some villages, particularly in Mundri County, is sufficiently high to warrant targeted interventions at the community level. These results demonstrate that trachoma is not a major public health problem throughout Southern Sudan. Further studies will be required to determine trachoma prevalence in other areas, particularly west of the Nile, but there are presently no resources to survey each county. Studies should thus be targeted to areas where collection of new data would be most informative.