Epidemiological characteristics of mortality from infectious intestinal diseases (diarrhea) Paraguay (2015-2019)

Introduction: Infectious intestinal diseases (diarrhea) are a major cause of morbidity and mortality worldwide. In 2015, it constituted the ninth leading cause of death for all ages. Objective: To describe the epidemiological characteristics of mortality due to infectious intestinal diseases (diarrhea) in Paraguay from 2015 to 2019. Methods: Descriptive, ecological, cross-sectional, retrospective, and non-probabilistic sampling of consecutive cases was performed. ICD-10 deaths included cholera (A01), typhoid and paratyphoid fever (A01), shigellosis (A03), other bacterial intestinal infections (A04), other bacterial food poisoning (A05), amebiasis (A06), other intestinal diseases due to protozoa (A07), intestinal infections due to viruses (A08), and diarrhea and gastroenteritis of presumed infectious origin (A09). Open access data were obtained from the WEB page of the General Directorate of Strategic Information in Health of the MSP and BS of all the Departments of the country. Crude and adjusted rates (per 100,000 inhabitants) were calculated. Excel and EPI INFO 7.0 were used. Results: 495 deaths were registered; the highest prevalence was in 2019 (adjusted rate of 1.83) and the lowest in 2017 (1.36). The months with the highest mortality rates were January and July (9.9%). 51.72% were women (256), 30.91% were over 80 years old and 28.28% (140) were under 5 years old, average age 50.8, single 56.77% (281) and without any type of education 41.82% (207). A total of 80.61% (399) of the respondents resided in urban areas. The highest rates were registered in Boquerón (33.3) and Amambay (15.2). Diarrhea and gastroenteritis of infectious origin accounted for 95.56% of the cases (473). Discussion: There was a high percentage of mortality from infectious diarrhea. Extremes of life were the most vulnerable populations.

Introducción: Las enfermedades infecciosas intestinales (diarrea) son una causa importante de morbilidad y mortalidad a nivel mundial. En 2015, constituyeron la novena causa principal de muerte para todas las edades. Objetivo: describir las características epidemiológicas de la mortalidad por enfermedades infecciosas intestinales (diarreas) en Paraguay durante los años 2015 al 2019. Metodología: Estudio descriptivo, ecológico, transversal, retrospectivo, muestreo no probabilístico de casos consecutivos. Se consideraron los óbitos del CIE - 10, que incluyen al cólera (A01), fiebres tifoidea y paratifoidea (A01), shigelosis (A03), otras infecciones intestinales bacterianas (A04), otras intoxicaciones alimentarias bacterianas (A05), amebiasis (A06), otras enfermedades intestinales debidas a protozoarios (A07), infecciones intestinales debidas a virus (A08) y diarrea y gastroenteritis de presunto origen infeccioso (A09). Se utilizaron datos de acceso abierto de la página WEB de la Dirección General de Información Estratégica en Salud del MSP y BS de todos los Departamentos del país. Se calcularon tasas crudas y ajustadas (por 100.000 habitantes). Se utilizaron Excel y EPI INFO 7.0. Resultados: Se registraron 495 muertes, la mayor prevalencia fue en 2019 (tasa ajustada de 1,83) y menor en 2017 (1,36). Los meses con mayor mortalidad fueron enero y julio (9,9%). El 51,72% fueron mujeres (256), 30,91% mayores de 80 años y 28,28% (140) menores de 5 años, edad promedio 50,8, solteros 56,77% (281) y sin ningún tipo de educación 41,82% (207). El 80,61% (399) residía en área urbana. Las mayores tasas se registraron en Boquerón (33,3) y Amambay (15,2). El 95,56% (473) fueron diarreas y gastroenteritis de origen infeccioso. Discusión: Se registra alto porcentaje de mortalidad de diarreas de origen infeccioso. Los extremos de la vida constituyen la población más vulnerable.

Características epidemiológicas de la mortalidad por meningitis bacteriana en Paraguay (2015 ­ 2019) / Epidemiological characteristics of mortality due to bacterial meningitis in Paraguay (2015 ­2019)

Introducción. La meningitis es una emergencia que requiere diagnóstico y tratamiento inmediato. La epidemiología cambió con las vacunas conjugadas, pero la carga de la enfermedad y las muertes siguen altas. Objetivo. Describir las características epidemiológicas de la mortalidad por meningitis en Paraguay en el periodo 2015-2019. Materiales y métodos. Estudio ecológico y descriptivo en el que se obtuvieron datos de acceso abierto disponibles en la página WEB de la Dirección General de Información Estratégica en Salud del Ministerio de Salud Pública y Bienestar Social de todas las regiones sanitarias del país. Se calcularon las tasas crudas y ajustadas (por 100.000 habitantes) por Excel y EPI INFO 7.0. Resultados. Se registraron 125 muertes, la mayor prevalencia fue en el 2018, con una tasa ajustada de 0,55 por 100.000 habitantes y la menor en 2017, con 0,27 por 100.000 habitantes. Los meses con mayor mortalidad fueron agosto (15,2%) y diciembre (11,2%). El 58,40% de los fallecidos fueron varones (73), 21,60% (27) menores de 4 años, en su mayoría mujeres y 12% (11) adultos mayores (60-70 años), mayoría varones. La edad promedio fue 37,76 años, solteros el 67,20% (84) y no escolarizados el 26,40% (33). El 80,80% (101) residía en el área urbana. Las mayores tasas se registraron en Paraguarí (6,8 por 100.000 habitantes) y Caazapá (3,3 por 100.000 habitantes), no se registraron casos en Alto Paraguay. Conclusión. Los extremos de la vida siguen siendo una población vulnerable para la meningitis.

Introduction.Meningitis is a disease that requires immediate diagnosis and treatment. The epidemiology changed over the years due to the advances in conjugate vaccines, however, the mortality rate, as well as the disease burden, are still very high. Objective.To describe the epidemiological characteristics of meningitis mortality in Paraguay in the 2015-2019 period. Materials and methods.Descriptive and ecological study in which data was obtained from the open and official website of the General Department of Strategic Information of the Ministry of Public Health and Social Welfare. Crude and adjusted rates (per 100,000 inhabitants) were calculated using Excel and EPI INFO 7.0. Results.In the study period, 125 deaths were registered with the highest prevalence in 2018 (adjusted rate of 0.55 per 100,000 inhabitants) and the lowest in 2017 (adjusted rate of 0.27 per 100,000 inhabitants). The months with the highest mortality were August and December with 15.2% and 11.2%, respectively. Males were the predominant gender with 58.40% (73 people), 21.60% (27) were under 4 years of age, mostly women, and 12% (11) were seniors (60-70 years), mostly men. Average age was 37.76 years, 67.20% single (84) and 26.40% (33)had no formal education and 80.80% (101) lived in urban areas. The highest rates were registered in Paraguarí (6.8 per 100,000 inhabitants) and Caazapa (3.3 per 100,000 inhabitants). There were no cases in Alto Paraguay. Conclusion: The extremes of life remain a vulnerable population for meningitis.

Congenital Toxoplasmosis: Findings in Fetal MRI.

Toxoplasma gondii infection, when acquired as an acute infection during pregnancy, can have substantial adverse effects on fetuses. We present the case of a 19-year-old pregnant woman with no previous relevant medical history. The ultrasound in the third trimester showed brain and abdominal abnormalities such as congenital hydrocephalus, volume loss of the brain parenchyma, and hepatosplenomegaly. The laboratory test showed positive IgM for Toxoplasma gondii. MRI was performed for better assessment and it shows the lesions in the central nervous system and other organs with more details.

Epidemiologia de los casos de COVID - 19 diagnosticados en albergues sanitarios del gran Asunción, Paraguay (2020) / Epidemiology of COVID cases - 19 diagnosed in sanitary shelters in greater Asunción, Paraguay (2020)

Paraguay habilitó albergues sanitarios para que guarden cuarentena las personas venidas del exterior, como medida para evitar la propagación de casos de COVI-19. El objetivo fue describir las características epidemiológicas de los casos de COVID-19 diagnosticados en los albergues sanitarios en el Gran Asunción desde el 7 de marzo al 30 de setiembre. Estudio descriptivo, transversal, temporalmente retrospectivo. El muestreo fue no probabilístico de casos consecutivos. Las variables de los casos confirmados fueron, sexo, edad y distritos. Fueron utilizados datos de acceso abierto del Ministerio de Salud Pública y Bienestar Social. Para análisis estadístico de las variables fueron incluidas frecuencias, expresadas como porcentajes, para lo cual fue utilizado el programa Excel. Se diagnosticaron 390 casos en el Gran Asunción. El mayor número de casos se registró en agosto (118 casos). El 69,2% (270) de los casos en el Gran Asunción fue del sexo masculino, relación hombre/mujer de 2,3. El 34,9% (136) tenía edades entre 20 a 29 años, (promedio 33.8±16,14, IC95% 2,2- 65,5). El 80% (310) del total se presentó en menores de 50 años. Las ciudades con mayor cantidad de casos fueron Asunción (46,2%, 180) y los Distritos de Luque (8,7%, 34); Ñemby (6,4%, 25) y Capiatá (5,1%,20). Las características epidemiológicas presentadas son las esperadas, dado el perfil sociodemográfico de estas ciudades

Paraguay opened sanitary shelters to quarantine people arriving from abroad, as a measure to prevent the spread of COVID-19 cases. The objective was to describe the epidemiological characteristics of COVID-19 cases diagnosed in sanitary shelters in Greater Asunción from March 7 to September 30. It was a descriptive, cross-sectional, temporally retrospective study, with non - probabilistic sampling of consecutive cases. The variables of confirmed cases in quarantine facilities were sex, age and departments. Open access data from the Ministry of Public Health and Social Welfare were used. For statistical analysis of the variables, frequencies, expressed as percentages, were included and the Excel program was used for it. Three hundred and ninety cases were diagnosed in Greater Asunción. The highest number of cases was in August (118 cases), 69.2% (270) of the cases in Greater Asunción were male, with a male/female ratio of 2.3, 34.9% (136) ranged from 20 to 29 years old, (mean 33.8 ±16.14, 95% CI 2.2-65.5). Eighty percent (310) of the cases occurred in the population under 50 years of age. The locations that presented the highest number of cases were Asunción (46.2%, 180) and the Districts of Luque (8.7%, 34); Ñemby (6.4%, 25) and Capiatá (5.1%, 20). The epidemiological characteristics presented were expected given the socio demographic profile of these cities

Epidemiology of COVID-19 cases diagnosed at quarantine facilities in Paraguay / Epidemiologia dos casos de COVID-19 diagnosticados nas instalações de quarentena no Paraguai

Aims: This study aimed to describe the epidemiological characteristics of COVID-19 cases diagnosed inquarantine facilities in Paraguay. Methods: This was a descriptive, cross-sectional, temporarily retrospective study. The time scope was from April 1 to September 30 2020. The variables were sex, age and administrative departments. The open access data available on the website of the Ministry of Public Health and Social Welfare was used. Frequencies expressed in percentages and the Chi square value were calculated to observe the statistically significant differences between cases and age and sex. Results: from April 4 to September 30 2020, 1.581 cases were diagnosed in COVID-19. The fewest number of positive cases were reported in April (50) and the highest number was reported in May (628). From the total, 69.6% (1.101) were male, (male / female ratio 2.3), 42.1% (666) were aged between 20-29 years, the average age was 30.23 years (range 0 to 87, standard deviation 14.66. 95% CI 1.5 - 58.95). The departments with the highest number of cases were Caaguazú 21.7 % (343), Alto Paraná 17.3 % (274), Central 13.3% (210) and Asunción 11.4% (180). The least number of cases of COVID-10 in women were registered in the Departments of Amambay, Pdte. Hayes, Ñeembucú and Boquerón, and in men the Departments of Ñeembucú and Boquerón. The largest number of male cases were registered in Caaguazú 70.8% (243), Alto Paraná 66.1% (181), Central 69.5% (146) and Asunción 68.9% (124). The number of Covid-19 infected people in quarantine facilities presented statistically significant differences between the variables sex and age. Conclusion: the quarantine facilities are one of the measures that the Paraguayan government needed to avoid the rapid spread and dispersion of the virus. The epidemiology of the cases diagnosed in them corresponds to what was expected according to the characteristics of the country.

Objetivo: descrever as características epidemiológicas dos casos de COVID-19 diagnosticados em instalações de quarentena no Paraguai. Metodologia: estudo descritivo, transversal, temporalmente retrospectivo. Quanto ao âmbito temporal foi considerado o período de 1 de abril a 31 de setembro de 2020. As variáveis analisadas foram: sexo, idade e Departamentos Administrativos. Foram utilizados dados abertos de acesso público que estão disponíveis na página oficial do Ministério da Saúde Pública e Bem-Estar Social. Foram calculadas frequências expressadas em porcentagem e aplicado o teste de qui-quadrado para ver diferenças estatisticamente significativas entre os casos, idade e sexo. Resultados: De 4 de abril a 30 de setembro de 2020, foram diagnosticados 1.581 casos de COVID-19. Em abril houve a menor quantidade de casos positivos (50) e em maio a maior quantidade (628). 69.6% (1.101) foram em indivíduos do sexo masculino (relação homem/mulher de 2,3). 42.1% (666) tinham idade compreendida entre 20-29 anos, com uma média de 30.23 anos (classificação 0 a 87, desvio padrão 14,66, IC 95% 1.5 ­ 58.95). Os Departamentos com maior número de casos foram 21.7 % (343), Alto Paraná 17.3 % (274), Central 13.3% (210) e Assunção 11.4% (180). O menor número de casos de COVID-19 em mulheres foi registado nos Departamentos de Amambay, Pdte. Hayes, Ñeembucú e Boquerón, e nos homens, os Departamentos de Ñeembucú e Boquerón. A maior quantidade de casos no sexo masculino foi registrado em Caaguazú 70.8% (243), Alto Paraná 66.1% (181), Central 69.5% (146) e Assunção 68.9% (124). O número de infectados por COVID-19 nos albergues apresentou diferenças estatisticamente significativas entre as variáveis sexo e idade. Conclusão: Os abrigos temporários são uma das importantes medidas adotadas pelo governo paraguaio para evitar a rápida dispersão e propagação do vírus. A epidemiologia dos casos neles diagnosticados correspondem às esperadas para as características do país.

Brain and kidney GHS-R1a underexpression is associated with changes in renal function and hemodynamics during neurogenic hypertension.

Ghrelin is a peptide hormone whose effects are mediated by the growth hormone secretagogue receptor subtype 1a (GHS-R1a), mainly expressed in the brain but also in kidneys. The hypothesis herein raised is that GHS-R1a would be player in the renal contribution to the neurogenic hypertension pathophysiology. To investigate GHS-R1a role on renal function and hemodynamics, we used Wistar (WT) and spontaneously hypertensive rats (SHR). First, we assessed the effect of systemically injected vehicle, ghrelin, GHS-R1a antagonist PF04628935, ghrelin plus PF04628935 or GHS-R1a synthetic agonist MK-677 in WT and SHR rats housed in metabolic cages (24 h). Blood and urine samples were also analyzed. Then, we assessed the GHS-R1a contribution to the control of renal vasomotion and hemodynamics in WT and SHR. Finally, we assessed the GHS-R1a levels in brain areas, aorta, renal artery, renal cortex and medulla of WT and SHR rats using western blot. We found that ghrelin and MK-677 changed osmolarity parameters of SHR, in a GHS-R1a-dependent manner. GHS-R1a antagonism reduced the urinary Na+ and K+ and creatinine clearance in WT but not in SHR. Ghrelin reduced arterial pressure and increased renal artery conductance in SHR. GHS-R1a protein levels were decreased in the kidney and brain areas of SHR when compared to WT. Therefore, GHS-R1a role in the control of renal function and hemodynamics during neurogenic hypertension seem to be different, and this may be related to brain and kidney GHS-R1a downregulation.

Behavioral effects evoked by the beta globin-derived nonapeptide LVV-H6.

LVV-hemorphin-6 (LVV-h6) is bioactive peptide and is a product of the degradation of hemoglobin. Since LVV-h6 effects are possibly mediated by opioid or AT4/IRAP receptors, we hypothesized that LVV-h6 would modify behavior. We evaluated whether LVV-h6 affects: i) anxiety-like behavior and locomotion; ii) depression-like behavior; iii) cardiovascular and neuroendocrine reactivity to emotional stress. Male Wistar rats ( ± 300 g) received LVV-h6 (153 nmol/kg i.p.) or vehicle (NaCl 0.9% i.p.). We used: i) open field (OF) test for locomotion; ii) elevated plus maze (EPM) for anxiety-like behavior; iii) forced swimming test (FST) for depression-like behavior and iv) air jet for cardiovascular and neuroendocrine reactivity to stress. Diazepam (2 mg/kg i.p.) and imipramine (15 mg/kg i.p.) were used as positive control for EPM and FST, respectively. To evaluate the LVV-h6 mechanisms, we used: the antagonist of oxytocin (OT) receptors (atosiban - ATS 1 and 0.1 mg/kg i.p.); the inhibitor of tyrosine hydroxylase (Alpha-methyl-p-tyrosine - AMPT 200 mg/kg i.p.) to investigate the involvement of catecholaminergic paths; and the antagonist of opioid receptors (naltrexone - NTX 0.3 mg/kg s.c.). We found that LVV-h6: i) evoked anxiolytic-like effect; ii) evoked antidepressant-like effect in the FST; and iii) did not change the locomotion, neuroendocrine and cardiovascular responses to stress. The LVV-h6 anxiolytic-like effect was not reverted by ATS and AMPT. However, the antidepressant effects were reverted only by NTX. Hence, our findings demonstrate that LVV-h6 modulates anxiety-like behavior by routes that are not oxytocinergic, catecholaminergic or opioid. The antidepressant-like effects of LVV-h6 rely on opioid pathways.

Stating asymmetry in neural pathways: methodological trends in autonomic neuroscience.

Aim: Many particularities concerning interhemispheric differences still need to be explored and unveiled. Functional and anatomical differential features found between left and right brain sides are best known as asymmetries and are consequence of the unilateral neuronal recruitment or predominance that is set to organize some function. The outflow from different neural pathways involved in the autonomic control of the cardiovascular system may route through asymmetrically relayed efferences (ipsilateral/lateralized and/or contralateral). In spite of this, the literature reporting on the role of central nuclei involved in the autonomic control is not always dedicated on these interhemispheric comparisons. Considering the recent reports demonstrating that asymmetries may set differential functional responses, it is worth checking differences between right and left sides of central regions. This review aims to inspire neuroscientists with the idea that studying the interhemispheric differences may deepen the understanding on several centrally controlled responses, with special regard to the autonomic functions underlying the cardiovascular regulation. Conclusions: Thus, an avenue of knowledge may unfold from a field of research that requires further exploration.

Caracterização dos pacientes acompanhados pelo Programa HIPERDIA em uma Unidade Básica de Saúde da Família em Fortaleza / The profile of patients accompanied by the HIPERDIA program in a Family Basic Unit of Health in Fortaleza

Objetivou-se traçar o perfil dos pacientes acompanhados pelo programa HIPERDIA de uma Unidade Básica de Saúde da Família de Fortaleza-Ceará. A amostra constou de 601 cadastros de pessoas acompanhadas pelo programa em 2004. A idade predominante foi entre 50 e 69 anos (302) indivíduos e 71,27 por cento do sexo feminino. Quanto às complicasções, encontramos AVC (5,82 por cento ), hipertensão (83,36 por cento) e diabetes 2 (25,95 por cento), havendo sobreposição de doenças. Sobre o estilo de vida adotado verificamos sedentarismo (61,80 por cento) e tabagismo (11,48 por cento). Acerca das medicações utilizadas econtrou-se captoril (278) e glibenclamida (84). Alguns dados mostraram preocupantes, no que acreditamos que a inserção do educador físico e do nutricionista junto à participação dos enfermeiros e médicos no programa, em muito ajudaria.

Endoscopías digestivas altas y biopsias gástricas en la Clínica Médica Cayetano Heredia / Gastrointestinal endoscopies and gastric biopsies at Clínica Médica Cayetano Heredia

Determinar los diagnósticos endoscópicos e histopatológicos de las biopsias gástricas en pacientes sometidos a endoscopía digestiva alta, la frecuencia de H. Pylori en biopsias gástricas no neoplásicas y su relación con el diagnóstico endoscópico e histopatológico. Material y métodos: estudio retrospectivo de 435 endoscopías realizadas en la Clínica Médica Cayetano Heredia entre 1º de setiembre de 1993 y el 31 de enero de 1996. Se realizó la relectura de 104 láminas por un mismo examinador, para estandarizar los informes finales de anatomía patológica. Resultados: la edad promedio fue de 44.41 años, el 47.36 por ciento varones y el 52.64 por ciento, mujeres. La gastritis fue el diagnóstico endoscópico mas frecuente (56.78 por ciento). Asimismo, gastritis fue el diagnóstico histológico más frecuente (91.05 por ciento), de las cuales fueron gastritis activas 91.9 por ciento, con daño mucinoso 98.8 por ciento y con metaplasia intestinal 22.5 por ciento. En el 48.97 por ciento de la población estudiada se realizó biopsia endoscópica. La frecuencia de H. pylori en mucosa gástrica no neoplasica fue de 78.69 por ciento, y se encontró asociación estadísticamente significativa entre la presencia de H. pylori y hallazgos histológico de gastritis, actividad de la gastritis, presencia de daño mucinoso y el diagnóstico endoscópico de úlcera gástrica.