Hidatidosis pulmonar: Reporte de casos y preludio endémico de la equinococosis quística humana en Paraguay / Pulmonary hydatidosis: Case report and endemic prelude to human cystic echinococcosis in Paraguay

El Paraguay integra la Iniciativa Sudamericana para el Control y Vigilancia de Equinococosis Quística. Con el fin de optimizar los informes epidemiológicos sobre hidatidosis, presentamostres casos clínicos vistos en centros nacionales y realizamos una revisión de la literatura local sobre el tópico. Desde 1969 hasta la fecha se describen 70casos de equinococosis quística. Se requieren estudios epidemiológicos sistemáticos para evaluar el grado de penetración, la distribución geográfica y las características de transmisión de esta enfermedad en nuestro país.Palabras clave: equinococosis;equinococosispulmonar; equinococosis hepática; equinococcus granulosus; zoonosis.

Paraguay is a member of the South American Initiative for the Control and Surveillance of Cystic Echinococcosis. In order to optimize the epidemiological reports on hydatidosis, we present three clinical cases seen in national centers and we carry out a review of the local literature on the topic. From 1969 to date, 70cases of cystic echinococcosis have been described. Systematic epidemiological studies are required to assess the degree of penetration, geographic distribution, and transmission characteristics of this disease in our country.Key words:echinococcosis;echinococcosispulmonar;echinococcosishepatic;echinococcus granulosus; zoonoses.

Asma en el adulto: características clínicas, comorbilidades y riesgo para apnea obstructiva de sueño / Asthma in adults: clinical characteristics, comorbidities and risk for obstructivesleep apnea

Introducción:Escasos reportes sobre asma existen en la literatura nacional. El objetivo delestudio es describir ciertas características clínicas, las comorbilidades y el riesgo para apnea obstructiva del sueño (AOS) en este colectivo. Material y métodos:Mediante un estudio observacional tipo caso-control, se incluyeron pacientes portadores de asma de ambos sexos y un grupo control pareado por sexo y edad. Se consignaron datos demográficos, características de la enfermedad, datos relativos al control del asma y espirometría, comorbilidades y riesgo de apnea de sueño medido por el cuestionario STOP-BANG durante una entrevista estructurada. Resultados: Se incluyeron 132 individuos en el grupo caso y 132 en el grupo control. Entre los asmáticos, se consignaron 38,63% de formas no controladas y 9% severas. También se constató mayor frecuencia dehipertensión arterial, obesidad, rinitis alérgicay trastornos de la memoria. Riesgo mayor para AOS, aunque no significativo, se consignó en el grupo de casos. En el subgrupo de asmáticos con obesidad o en adultos mayores, la diferencia fue estadísticamente significativa-Discusión:Aundisponiendo de medicamentos preventivos,la tasa de control de los asmáticos en esta muestra es llamativa y merece estudios sistemáticos. Es extremadamente importante tener en cuenta algunas comorbilidades para el manejo de este grupo de pacientes,incluyendo la estratificación de riesgo para AOS.Palabras clave:asma; comorbilidad; apnea obstructiva del sueño

Introduction.Few reports on asthma exist in the national literature. The objective of our study is to describe certain clinical characteristics, comorbidities, and risk for obstructive sleep apnea (OSA) in this group. Material and methods.Through an observational case-control study, patients with asthma of both sexes and a control group matched by sex and age were included. Demographic data, disease characteristics, data related to asthma control and spirometry, comorbidities, and risk of sleep apnea measured by the STOP-BANG questionnaire were recorded during a structured interview. Results.132 individuals were included in the case group and 132 in the control group. Among the asthmatics, 38.63% of uncontrolled forms and 9% were severe. There was also a higher frequency of arterial hypertension, obesity, allergic rhinitis and memory disorders. Higher risk for OSA, although not significant, was recorded in the case group. In the subgroup of asthmatics with obesity or in older adults, the difference was relevant to the statistical analysis. Discussion.Even with preventive medications available, the control rate of asthmatics in this sample is striking and deserves systematic studies. It is extremely important to take into account some comorbidities for the management ofthis group of patients, including risk stratification for OSA.Key Words:asthma; comorbidity;obstructive sleep apnea

Hidatidosis pulmonar: Reporte de casos y preludio endémico de la equinococosis quística humana en Paraguay

El Paraguay integra la Iniciativa Sudamericana para el Control y Vigilancia de Equinococosis Quística. Con el fin de optimizar los informes epidemiológicos sobre hidatidosis, presentamos tres casos clínicos vistos en centros nacionales y realizamos una revisión de la literatura local sobre el tópico. Desde 1969 hasta la fecha se describen 70 casos de equinococosis quística. Se requieren estudios epidemiológicos sistemáticos para evaluar el grado de penetración, la distribución geográfica y las características de transmisión de esta enfermedad en nuestro país.

Paraguay is a member of the South American Initiative for the Control and Surveillance of Cystic Echinococcosis. In order to optimize the epidemiological reports on hydatidosis, we present three clinical cases seen in national centers and we carry out a review of the local literature on the topic. From 1969 to date, 70 cases of cystic echinococcosis have been described. Systematic epidemiological studies are required to assess the degree of penetration, geographic distribution, and transmission characteristics of this disease in our country.

Latin American Registry of Idiopathic Pulmonary Fibrosis (REFIPI): Clinical Characteristics, Evolution and Treatment

Introduction: Idiopathic pulmonary fibrosis (IPF) is a progressive, irreversible and frequently fatal disease. Currently there are national and multinational registries in Europe, United States, Australia and China to better understand the magnitude of the problem and the characteristics of the IPF patients. However, there are no national or regional registries in Latin America, so the objective of this study was to carry out a Latin American registry that would allow the identification of IPF patients in our region. Methodology: A system consisting of 3 levels of control was designed, ensuring that patients met the diagnostic criteria for IPF according to international guidelines ATS/ERS/ALAT/JRS 2011. Demographic, clinical, serological, functional, tomographic, histological and treatment variables were recorded through a digital platform. Results: 761 IPF patients from 14 Latin American countries were included for analysis, 74.7% were male, with a mean age of 71.9+8.3 years. In general there was a long period of symptoms before definitive diagnosis (median 1 year). In functional tests, an average reduction of FVC (70.9%) and DLCO (53.7%) was detected. 72% received at least one antifibrotic drug (pirfenidone or nintedanib) and 11.2% of the patients had an acute exacerbation, of which 38 (45.2%) died from this cause. Conclusions: Like other registries, we found that there is difficulty in the recognition and excessive delay in the diagnosis of IPF in Latin America. Most of the patients in REFIPI received antifibrotics; these were well tolerated and associated with fewer adverse events than those reported in clinical trials. (AU)

Latin American Registry of Idiopathic Pulmonary Fibrosis (REFIPI): Clinical Characteristics, Evolution and Treatment.

INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a progressive, irreversible and frequently fatal disease. Currently there are national and multinational registries in Europe, United States, Australia and China to better understand the magnitude of the problem and the characteristics of the IPF patients. However, there are no national or regional registries in Latin America, so the objective of this study was to carry out a Latin American registry that would allow the identification of IPF patients in our region. METHODOLOGY: A system consisting of 3 levels of control was designed, ensuring that patients met the diagnostic criteria for IPF according to international guidelines ATS/ERS/ALAT/JRS 2011. Demographic, clinical, serological, functional, tomographic, histological and treatment variables were recorded through a digital platform. RESULTS: 761 IPF patients from 14 Latin American countries were included for analysis, 74.7% were male, with a mean age of 71.9+8.3 years. In general there was a long period of symptoms before definitive diagnosis (median 1 year). In functional tests, an average reduction of FVC (70.9%) and DLCO (53.7%) was detected. 72% received at least one antifibrotic drug (pirfenidone or nintedanib) and 11.2% of the patients had an acute exacerbation, of which 38 (45.2%) died from this cause. CONCLUSIONS: Like other registries, we found that there is difficulty in the recognition and excessive delay in the diagnosis of IPF in Latin America. Most of the patients in REFIPI received antifibrotics; these were well tolerated and associated with fewer adverse events than those reported in clinical trials.

[In vitro susceptibility of streptococcus pneumoniae strains isolated from lower respiratory infections in Instituto Nacional del Tórax (INT)]. / Estudio de sensibilidad in vitro de cepas de Streptococcus pneumoniae de infecciones respiratorias bajas en el Instituto Nacional del Tórax (INT).

BACKGROUND: The rising antimicrobial resistance of streptococcus pneumoniae, requires permanent surveillance. Antimicrobial treatments of invasive infections must be modified accordingly. AIM: To assess the in vitro antimicrobial susceptibility of streptococcus pneumoniae strains isolated from lower respiratory infections. MATERIAL AND METHODS: Seventy five strains isolated during three periods in consecutive years were studied. In vitro susceptibility towards penicillin, erythromycin and ceftriaxone was studied using E-test technique minimal inhibitory concentrations. RESULTS: Five percent of strains were penicillin resistant and 11% had an intermediate sensitivity. Erythromycin resistance was observed in 1.3% of strains. Eight percent of strains had an intermediate sensitivity towards ceftriaxone and no resistance was observed. Comparing susceptibility in the three studied periods, it remained low and stable. CONCLUSIONS: High and intermediate resistance of Streptococcus pneumoniae towards penicillin is less prevalent than in other countries. A close surveillance must be maintained (Rev Méd Chile 2002; 130: 304-8).