RESUMO
Chagas disease was described in Ecuador in 1930 in the province of Guayas and thereafter in various provinces. Triatomine were reported in the province of Esmeraldas but no human infection has been described. Here we report the first evidence that the disease does exist in the province of Esmeraldas. In indigenous Awá communities located in the northwest jungle of the Esmeraldas province, 144 individuals were tested using ELISA and PCR for T.cruzi of which 5 (3.47%) were positive. Twenty eight triatomine were collected, 27 were Triatoma dispar and 1 Pastrongylus rufotuberculatus, T.cruzi was detected in 11 (42.3%) of 26 insects.
Assuntos
Doença de Chagas/epidemiologia , Trypanosoma cruzi/isolamento & purificação , Adulto , Animais , Doença de Chagas/parasitologia , Equador/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Populacionais , Triatominae/parasitologia , Adulto JovemRESUMO
OBJECTIVES: To explore the predictive power of a risk stratification method for people with hypertension based on "essential" procedures (that is, available in economically less developed areas of the world), comparing it in the same population with the results given by the method suggested by the 1999 World Health Organization-International Society of Hypertension (WHO-ISH) guidelines. DESIGN: Prospective cohort study of outcomes according to cardiovascular risk profile at baseline. SETTING: Primary care in a poor rural area of the Ecuadorian forest. PARTICIPANTS: 504 people with hypertension prospectively monitored for a mean of 6.7 (SD 2.3) years. INTERVENTIONS: Essential data included blood pressure, medical history, smoking, age, sex, and diagnosis of diabetes; the WHO-ISH methods additionally included measurement of fasting blood glucose, total cholesterol, and creatinine, urinalysis, and electrocardiography. MAIN OUTCOME MEASURES: Cardiovascular events and total deaths. RESULTS: With both methods there was a highly significant association between the level of predicted risk and the incidence of cardiovascular events and of total deaths: up to three quarters of all cardiovascular events and two thirds of all deaths were reported among people classified as at high or very high risk with either method. The predictive discrimination of the essential method is comparable with the WHO-ISH with C statistics (95% confidence interval) of 0.788 (0.721 to 0.855) and 0.744 (0.673 to 0.815), respectively, for cardiovascular events and 0.747 (0.678 to 0.816) and 0.705 (0.632 to 0.778) for total mortality. CONCLUSIONS: The risk stratification of patients with hypertension with an essential package of variables (that is, available and practicable even in the economically less developed areas of the world) serves at least as well as the more comprehensive method proposed by WHO-ISH.
Assuntos
Países em Desenvolvimento , Hipertensão/diagnóstico , Adolescente , Adulto , Idoso , Transtornos Cerebrovasculares/epidemiologia , Equador/epidemiologia , Métodos Epidemiológicos , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Áreas de Pobreza , Saúde da População RuralRESUMO
Cardiovascular diseases are widespread in developing countries, but little is known about cardiovascular risk profiles in rural communities. To assess the importance of arterial hypertension in a rural district of Ecuador, we screened 4284 of the 8876 adults who lived in the area. 1542 (36%) individuals had hypertension, only four (0.3%) of whom were well controlled by treatment. We monitored all deaths for 2.5 years, and noted that cardiovascular diseases were the primary cause of death in the adult population. Furthermore, of the individuals who died of a cardiovascular disease, four out of five had a history of hypertension. Our findings indicate that in this rural area of Ecuador the high prevalence of uncontrolled hypertension is a major cause of total mortality.