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Asunción, Paraguay

Baskin J.L.,Childrens Center for Cancer and Blood Diseases | Baskin J.L.,University of Southern California | Lezcano E.,Institute Prevision Social | Lezcano E.,Instituto Nacional Of Cancer | And 12 more authors.
Neuro-Oncology | Year: 2013

Cure rates among children with brain tumors differ between low-income and high-income countries. To evaluate causes of these differences, we analyzed aspects of care provided to pediatric neuro-oncology patients in a low middle-income South American country. Methods. Three methods were used to evaluate treatment of children with brain tumors in Paraguay: (1) a quantitative needs assessment questionnaire for local treating physicians, (2) site visits to assess 3 tertiary care centers in Asunción and a satellite clinic in an underdeveloped area, and (3) interviews with health care workers from relevant disciplines to determine their perceptions of available resources. Treatment failure was defined as abandonment of therapy, relapse, or death. Results. All 3 tertiary care facilities have access to chemotherapy and pediatric oncologists but lack training and tools for neuropathology and optimal neurosurgery. The 2 public hospitals also lack access to appropriate radiological tests and timely radiotherapy. These results demonstrate disparities in Paraguay, with rates of treatment failure ranging from 37% to 83% among the 3 facilities. Conclusions. National and center-specific deficiencies in resources to manage pediatric brain tumors contribute to poor outcomes in Paraguay and suggest that both national and center-specific interventions are warranted to improve care. Disparities in Paraguay reflect different levels of governmental and philanthropic support, program development, and socio-economic status of patients and families, which must be considered when developing targeted strategies to improve management. Effective targeted interventions can serve as a model to develop pediatric brain tumor programs in other lowand middle-income countries.© The Author(s) 2012. Source


Sanchez S.C.,Institute Prevision Social | Chedraui P.,Catholic University of Santiago de Guayaquil | Perez-Lopez F.R.,University of Zaragoza | Ortiz-Benegas M.E.,Institute Prevision Social | Palacios-De Franco Y.,University Catolica Of Asuncion
Climacteric | Year: 2016

Abstract: Background There are scant data related to sexuality assessed among mid-aged women from Paraguay. Objective To assess sexual function in a sample of mid-aged Paraguayan women. Methods This was a cross-sectional study in which 265 urban-living women from Asunción (Paraguay) aged 40–65 years were surveyed with the six-item version of the Female Sexual Function Index (FSFI-6) and a questionnaire containing personal and partner data. Results The median age of the sample was 48 years, 48.2% were postmenopausal (median/interquartile range age at menopause 46/13 years), 11.3% used hormone therapy, 37.0% used psychotropic drugs, 44.5% had hypertension, 7.2% diabetes, 46.1% abdominal obesity and 89.4% had a partner (n = 237). Overall, 84.1% (223/265) of surveyed women were sexually active, presenting a median total FSFI-6 score of 23.0, and 25.6% obtained a total score of 19 or less, suggestive of sexual dysfunction (lower sexual function). Upon bivariate analysis, several factors were associated with lower total FSFI-6 scores; however, multiple linear regression analysis found that lower total FSFI-6 scores (worse sexual function) were significantly correlated to the postmenopausal status and having an older partner, whereas coital frequency was positively correlated to higher scores (better sexual function). Conclusion In this pilot sample of urban-living, mid-aged Paraguayan women, as determined with the FSFI-6, lower sexual function was related to menopausal status, coital frequency and partner age. There is a need for more research in this regard in this population. © 2016 International Menopause Society. Source


Papais-Alvarenga R.M.,Rio de Janeiro State Federal University | Papais-Alvarenga R.M.,Federal University of Rio de Janeiro | Vasconcelos C.C.F.,Rio de Janeiro State Federal University | Vasconcelos C.C.F.,Federal University of Rio de Janeiro | And 42 more authors.
PLoS ONE | Year: 2015

The idiopathic inflammatory demyelinating disease (IIDD) spectrum has been investigated among different populations, and the results have indicated a low relative frequency of neuromyelitis optica (NMO) among multiple sclerosis (MS) cases in whites (1.2%-1.5%), increasing in Mestizos (8%) and Africans (15.4%-27.5%) living in areas of low MS prevalence. South America (SA) was colonized by Europeans from the Iberian Peninsula, and their miscegenation with natives and Africans slaves resulted in significant racial mixing. The current study analyzed the IIDD spectrum in SA after accounting for the ethnic heterogeneity of its population. A cross-sectional multicenter study was performed. Only individuals followed in 2011 with a confirmed diagnosis of IIDD using new diagnostic criteria were considered eligible. Patients' demographic, clinical and laboratory data were collected. In all, 1,917 individuals from 22 MS centers were included (73.7% female, 63.0% white, 28.0% African, 7.0% Mestizo, and 0.2% Asian). The main disease categories and their associated frequencies were MS (76.9%), NMO (11.8%), other NMO syndromes (6.5%), CIS (3.5%), ADEM (1.0%), and acute encephalopathy (0.4%). Females predominated in all main categories. The white ethnicity also predominated, except in NMO. Except in ADEM, the disease onset occurred between 20 and 39 years old, early onset in 8.2% of all cases, and late onset occurred in 8.9%. The long-term morbidity after a mean disease time of 9.28±7.7 years was characterized by mild disability in all categories except in NMO, which was scored as moderate. Disease time among those with MS was positively correlated with the expanded disability status scale (EDSS) score (r=0.374; p=<0.001). This correlation was not observed in people with NMO or those with other NMO spectrum disorders (NMOSDs). Among patients with NMO, 83.2%showed a relapsing-remitting course, and 16.8%showed a monophasic course. The NMO-IgG antibody tested using indirect immunofluorescence (IIF) with a composite substrate of mouse tissues in 200 NMOSD cases was positive in people with NMO (95/162; 58.6%), longitudinally extensive transverse myelitis (10/30; 33.3%) and bilateral or recurrent optic neuritis (8/8; 100%). No association of NMO-IgG antibody positivity was found with gender, age at onset, ethnicity, early or late onset forms, disease course, or long-term severe disability. The relative frequency of NMO among relapsingremitting MS (RRMS) + NMO cases in SA was 14.0%. Despite the high degree of miscegenation found in SA, MS affects three quarters of all patients with IIDD, mainly white young women who share similar clinical characteristics to those in Western populations in the northern hemisphere, with the exception of ethnicity; approximately one-third of all cases occur among non-white individuals. At the last assessment, the majority of RRMS patients showed mild disability, and the risk for secondary progression was significantly superior among those of African ethnicity. NMO comprises 11.8% of all IIDD cases in SA, affecting mostly young African-Brazilian women, evolving with a recurrent course and causing moderate or severe disability in both ethnic groups. The South-North gradient with increasing NMO and non-white individuals from Argentina, Paraguay, Brazil and Venezuela confirmed previous studies showing a higher frequency of NMO among non-white populations. ©2015 Papais-Alvarenga et al. Source


Oertell J.,Institute Prevision Social | Caballero C.,Institute Patologia e Investigacion | Iglesias M.,Institute Prevision Social | Chaux A.,Institute Patologia e Investigacion | And 7 more authors.
Histopathology | Year: 2011

Aims: About 10-20% of all penile squamous cell carcinomas (SCCs) originate in the foreskin, but knowledge about preputial precursor and associated lesions is scant. The aims of the present study were to determine the prevalence of various precancerous and cancerous lesions exclusively affecting the foreskin, and to describe their pathological features. Methods and results: One hundred consecutive circumcision specimens from symptomatic patients living in a region of high penile cancer incidence were analysed. Clinical diagnoses included mostly phimosis and chronic balanoposthitis (40 and 35 cases, respectively), but also a tumour mass (11 cases). Histopathological lesions found included: squamous hyperplasia in 61 cases; lichen sclerosus in 53 cases; penile intraepithelial neoplasia (PeIN) in 30 cases (all differentiated PeIN, with two cases showing multicentric foci of basaloid and warty-basaloid PeIN); and invasive SCC in 11 cases (three usual, three pseudohyperplastic, two verrucous-pseudohyperplastic, and one case each of basaloid, papillary and mixed usual-basaloid carcinomas). Lichen sclerosus was present in all low-grade SCC cases. Patients with no lesions were younger (mean age 44years) than those with precursor lesions (mean age 54years) or with invasive SCC (mean age 68years). Immunohistochemistry for p16INK4a was performed in 19 precancerous lesions. All differentiated PeINs (18 lesions) were negative, and one basaloid PeIN was positive. Conclusions: The frequent coexistence of lichen sclerosus, squamous hyperplasia, differentiated PeIN and low-grade SCC suggests a common non-human papillomavirus related pathogenic pathway for preputial lesions, and highlights the importance of circumcision in symptomatic patients for the prevention of penile cancer. © 2011 Blackwell Publishing Limited. Source


Chaves G.,Institute Prevision Social | Britez N.,Institute Prevision Social | Maciel V.,Institute Prevision Social | Klinkhof A.,University of Heidelberg | Mereles D.,University of Heidelberg
Revista Panamericana de Salud Publica/Pan American Journal of Public Health | Year: 2015

Objective. Cardiovascular diseases are the leading cause of mortality in the world. Although most of them are preventable, their prevalence continues to increase. The objective of this study was to estimate the prevalence of cardiovascular risk factors in an urban ambulatory adult hospital population in Asunción, Paraguay. Methods. A cross-sectional study was undertaken in the population of patients enrolled in the AsuRiesgo prospective study on the prevention of cardiovascular disease, which focuses on promoting a healthy lifestyle. Patients 18 years of age or older who were encountered in doctors' waiting rooms in a tertiary care hospital were invited to participate. Each patient's clinical history, body measurements, and laboratory test results were obtained. Results. A total of 18 287 patients aged 51 ± 16 years were recruited. Of this group, 67.5% were female, with an average bodyweight of 77.5 ± 16.2 kg and a body mass index 29.7 ± 5.9 kg/m2. The prevalence rates of a history of myocardial infarction, stroke, diabetes mellitus, and hypertension were 2.6%, 3%, 13.3%, and 53%, respectively, and the rates of smoking, unhealthy diet, sedentary lifestyle, and psychological stress were 29.3%, 41.2%, 58.2%, and 56.6%. The overall prevalence of obesity and overweight was 79.6%; the rates of prehypertension and systemic hypertension were 39% and 25%, respectively; and the prevalence of metabolic syndrome was 34.7%. Conclusions. Although the prevalence rates of smoking, systemic hypertension, and diabetes mellitus were low, those for obesity, sedentary lifestyle, psychological stress, unhealthy diet, and metabolic syndrome were very high. This finding demonstrates the need for global action to prevent disability and death from ischemic heart and cerebrovascular disease. It is urgent to implement programs to address these challenges on a national scale. Source

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