RESUMO
As a result of globalization and constant migratory flows, Chagas disease is now present in almost all continents. The management and treatment of the disease is often influenced by the economic and social context of the societies that host patients. In this manuscript, we aim to provide a comparative review of approaches to patients with Chagas disease in the Americas and Europe.
Assuntos
Doença de Chagas , América , Doença de Chagas/tratamento farmacológico , Europa (Continente) , HumanosRESUMO
Abstract Vascular ulcers (VU) constitute a major cause of pain and disability, and significantly compromise quality of life. VU have a natural tendency to become chronic and in many cases exhibit anunsatisfactoryresponse to many of the standard therapeutic options.The case of a 73 year-old Caucasian female with severe pain and poorly-controlled pain (Visual Analogic Scale-VAS- of 8-9) due to three lower leg long-standing VUs is reported and discussed herein. The patient was treated with topical instillations of undiluted sevoflurane as per institutional off-label protocol (starting doses of 1mL/cm2 twice a day, and up-titrated according to response to a maximum of 7 mL twice daily). The VAS score dropped to 0-1 shortly after initiation of therapy and remained stable throughout treatment up until the closure of the observations. Subsequently, opioid therapy was gradually tapered down and ultimately abandoned.Sevoflurane application resulted on adequate and sustained pain management of refractory VU, with no significant side effects. On account of its beneficial effectivity and safety profiles, topical sevoflurane emerges as an add-on alternative for the long-term management of VU, and potentially other painful conditions.
Assuntos
Humanos , Feminino , Idoso , Dor/tratamento farmacológico , Úlcera Varicosa , Relatório de Pesquisa , Sevoflurano/análise , Redução da Medicação/métodos , Analgésicos Opioides/agonistas , Pacientes/classificação , Manejo da Dor/classificaçãoRESUMO
As a result of globalization and constant migratory flows, Chagas disease is now present in almost all continents. The management and treatment of the disease is often influenced by the economic and social context of the societies that host patients. In this manuscript, we aim to provide a comparative review of approaches to patients with Chagas disease in the Americas and Europe.
RESUMO
BACKGROUND: Imported strongyloidiasis is increasingly being diagnosed in non-endemic areas. The aim of this study was to describe the epidemiological, clinical and microbiological characteristics of patients with imported strongyloidiasis in Spain. METHODOLOGY: This is an observational retrospective study that included all patients diagnosed of strongyloidiasis registered in the +REDIVI Collaborative Network from 2009 to 2017. Demographic, epidemiological and clinical information was collected from the +REDIVI database, and extra information regarding microbiological techniques, treatment and follow-up was requested to participant centers. FINDINGS: Overall, 1245 cases were included. Most of them were immigrants (66.9%), and South America was the most frequent area of origin. Detection of larvae in stool samples was observed in 21.9% of the patients, and serological tests allowed making the diagnosis in the rest of the cases. Eosinophilia was present in 82.2% of cases. Treatment with ivermectin (compared with albendazole) was the most strongly associated factor to achieve the cure (OR 2.34). CONCLUSIONS: Given the long latency of the infection and the risk of developing a severe presentation, screening of S. stercoralis infection should be mandatory in patients coming from or had traveling to endemic areas, especially in those with immunosuppressant conditions.
Assuntos
Anti-Helmínticos/uso terapêutico , Estrongiloidíase/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albendazol/uso terapêutico , Animais , Criança , Pré-Escolar , Emigrantes e Imigrantes/estatística & dados numéricos , Eosinofilia/etiologia , Feminino , Humanos , Lactente , Ivermectina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , América do Sul , Espanha/epidemiologia , Strongyloides stercoralis/efeitos dos fármacos , Strongyloides stercoralis/isolamento & purificação , Strongyloides stercoralis/fisiologia , Estrongiloidíase/complicações , Estrongiloidíase/diagnóstico , Estrongiloidíase/parasitologia , Viagem , Adulto JovemRESUMO
Buruli ulcer (BU) is a chronic and destructive infection of the skin and soft tissues caused by Mycobacterium ulcerans. Recently, population flows have triggered the appearance of several sporadic cases of BU in non-endemic countries. This represents a significant diagnostic challenge for clinicians and microbiologists. We describe the first case of BU imported to Spain. The patient was a Spanish woman who had stayed 5 months in the jungle of Peru.
Assuntos
Úlcera de Buruli/etiologia , Adulto , Úlcera de Buruli/tratamento farmacológico , Úlcera de Buruli/microbiologia , Úlcera de Buruli/transmissão , Feminino , HumanosRESUMO
Zika virus (ZIKV) and chikungunya virus (CHIKV) are currently circulating in overlapping areas in the American continents and may both be transmitted by Aedes spp. mosquitoes. The first documented case, to the authors' knowledge, of sequential CHIKV and ZIKV infections diagnosed in a nonendemic area in a returning traveler is reported. The implications for heightened clinical surveillance for these infections and specific patient recommendations are emphasized.
Assuntos
Febre de Chikungunya/diagnóstico , Infecção por Zika virus/diagnóstico , Adulto , Aspartato Aminotransferases/sangue , Proteína C-Reativa/metabolismo , Febre de Chikungunya/complicações , Febre de Chikungunya/virologia , Vírus Chikungunya , Feminino , Honduras , Humanos , Zika virus , Infecção por Zika virus/complicaçõesRESUMO
Chikungunya virus (CHIKV) is currently spreading in the Caribbean and America. Lymphadenopathy, described in infections with other alphaviruses, is not commonly reported in CHIKV infections. Painful lymphadenopathy was found in three of the first six CHIKV infections from the current outbreak diagnosed at a reference center in Madrid, Spain.
Assuntos
Febre de Chikungunya , Vírus Chikungunya/isolamento & purificação , Surtos de Doenças , Doenças Linfáticas/etiologia , Neutropenia/etiologia , Viagem , Adulto , Febre de Chikungunya/sangue , Febre de Chikungunya/diagnóstico , Febre de Chikungunya/etiologia , Febre de Chikungunya/fisiopatologia , Febre de Chikungunya/terapia , República Dominicana/epidemiologia , Feminino , Haiti/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologiaRESUMO
OBJETIVO: Evaluar la factibilidad y la adecuación de la Guía REDEPICAN (Red Iberoamericana de Epidemiología y Sistemas de Información en Cáncer) a la situación actual de los Registros de Cáncer de Base Poblacional (RCBP) en América Latina y el Caribe como herramienta útil para mejorar dichos registros. MÉTODOS: La Guía fue diseñada por expertos en registros de cáncer y auditorías sanitarias, y se establecieron siete dominios para evaluarla. Para cada dominio se eligieron varios criterios con sus correspondientes estándares. Se determinaron tres niveles de cumplimiento del estándar. Se organizaron dos cursos de formación de evaluadores externos y tres paneles de discusión con expertos. La Guía se probó en seis RCBP de América Latina y España. RESULTADOS: La Guía contiene 68 criterios, 10 de ellos considerados esenciales para un RCBP. De acuerdo con la puntuación alcanzada, el registro se considera como aceptable (41-199), bueno (200-299) o excelente (300-350). El dominio sobre Métodos de registro representa el 25% de la puntuación, seguido por la Exhaustividad y validez (19%), la Difusión de resultados (19%), la Estructura (13%), la Confidencialidad y aspectos éticos (11%), la Comparabilidad (9%) y el Manual de procedimiento (3%). El proyecto piloto permitió: 1) perfeccionar criterios y estándares, 2) ampliar el concepto de calidad para incorporar las necesidades de los clientes y 3) potenciar la sección de Difusión de resultados. Dos registros latinoamericanos evaluados mejoraron su calidad hasta alcanzar el estándar de la Agencia Internacional de Investigación sobre el Cáncer. CONCLUSIONES: La guía REDEPICAN se ha elaborado teniendo en cuenta el contexto de los registros en América Latina y constituye una herramienta útil y novedosa para la mejora de la calidad de los RCBP. Además está preparada para ser utilizada en otros países y registros.
OBJECTIVE: Evaluate the feasibility of the REDEPICAN Guide (Red Iberoamericana de Epidemiología y Sistemas de Información en Cáncer) and its adaptation to the current situation of population-based cancer registries (PBCRs) in Latin America and the Caribbean as a useful tool to improve these registries. METHODS: Experts in cancer registries and health audits designed the guide and developed seven domains to evaluate in PBCRs. Several criteria were selected for each domain, with corresponding standards, scored according to three levels of compliance. Two training courses for external evaluators and three discussion panels for experts were organized. The guide was tested in six PBCRs in Latin America and Spain. RESULTS: The guide contains 68 criteria, 10 of which are considered essential for a PBCR. Based on its score, a registry is regarded as acceptable (41-199), good (200-299), or excellent (300-350). The registry methods domain accounts for 25% of the score, followed by completeness and validity (19%), dissemination of outcomes (19%), structure (13%), confidentiality and ethical aspects (11%), comparability (9%), and the procedures manual (3%). The pilot project enabled (1) enhancement of criteria and standards, (2) expansion of the quality concept to include client needs, and (3) strengthening the dissemination of outcomes section. Two of the Latin American registries that were evaluated improved their quality, meeting the standards of the International Agency for Research on Cancer. CONCLUSIONS: Development of the REDEPICAN Guide has taken into account the context of the registries in Latin America and is a useful and innovative tool for improving the quality of PBCRs. Furthermore, it is ready for use in other countries and registries.
Assuntos
Humanos , Guias como Assunto , Neoplasias/epidemiologia , Sistema de Registros/normas , Região do Caribe , Estudos de Viabilidade , América Latina , Projetos Piloto , Inquéritos e QuestionáriosAssuntos
Prontuários Médicos , Acreditação de Instituições de Saúde , Controle de Qualidade , Espanha , América do Norte , Prontuários Médicos , Acreditação de Instituições de Saúde , Controle de Qualidade , América do Norte , Guias como Assunto , Neoplasias , Sistema de Registros , América Latina , Projetos Piloto , Região do Caribe , Estudos de Viabilidade , Inquéritos e QuestionáriosRESUMO
Leptin, a peptide hormone secreted by adipose tissue, exhibits a large range of central and peripheral actions. It has been proposed that the participation of leptin in diseases such as obesity is due to, at least in part, its impaired transport across the blood-brain barrier (BBB). Since, the mechanisms by which brain takes up leptin remain unclear, we set out to study how leptin may cross the BBB. We have used different immunoassays and lentiviral vectors to analyze the role of megalin in the transport of leptin in rodents and humans. We demonstrate that circulating leptin is transported into the brain by binding to megalin at the choroid plexus epithelium. Indeed, the downregulation of megalin expression in physiological and pathological situations such as aging and Alzheimer's disease was correlated with poor entry of leptin into the brain. Moreover, amyloid beta (Abeta) deposits of choroid plexus could be disturbing megalin function. The present data indicate that leptin represents a novel megalin ligand of importance in the levels and therapeutic actions of leptin into the brain.