Kohn C.G.,Saint - Joseph University |
Mearns E.S.,University of Connecticut |
Parker M.W.,Hartford Hospital |
Hernandez A.V.,Cleveland Clinic Lerner Research Institute |
And 2 more authors.
Chest | Year: 2015
BACKGROUND: Studies suggest outpatient treatment or early discharge of patients with acute pulmonary embolism (aPE) is reasonable for those deemed to be at low risk ofearly mortality. We sought to determine clinical prediction rule accuracy for identifying patients with aPE at low risk for mortality. METHODS: We performed a literature search of Medline and Embase from January 2000 to March 2014, along with a manual search ofreferences. We included studies deriving/validating a clinical prediction rule for early post-aPE all-cause mortality and providing mortality data over at least the index aPE hospitalization but ≤ 90 days. A bivariate model was used to pool sensitivity and specificity estimates using a random-effects approach. Traditional randomeff ects meta-analysis was performed to estimate the weighted proportion of patients deemed at low risk for early mortality and their ORs for death compared with high-risk patients. RESULTS: Forty studies (52 cohort-clinical prediction rule analyses) reporting on 11 clinical prediction rules were included. The highest sensitivities were observed with the Global Registry of Acute Coronary Events (0.99, 95% CI 5 0.89-1.00), Aujesky 2006 (0.97, 95% CI 5 0.95-0.99), simplified Pulmonary Embolism Severity Index (0.92, 95% CI 5 0.89-0.94), Pulmonary Embolism Severity Index (0.89, 95% CI 5 0.87-0.90), and European Society of Cardiology (0.88, 95% CI 5 0.77-0.94) tools, with remaining clinical prediction rule sensitivities ranging from 0.41 to 0.82. Of these five clinical prediction rules with the highest sensitivities, none had a specificity. 0.48. They suggested anywhere from 22% to 45% of patients with aPE were at low risk and that low-risk patients had a 77% to 97% lower odds of death compared with those at high risk. CONCLUSIONS: Numerous clinical prediction rules for prognosticating early mortality in patients with aPE are available, but not all demonstrate the high sensitivity needed to reassure clinicians. © 2015 American College of Chest Physicians.
Gavilan R.G.,University of Santiago de Compostela |
Gavilan R.G.,Institute for Scientific Research and Technology Services INDICASAT |
Zamudio M.L.,Instituto Nacional Of Salud |
Martinez-Urtaza J.,University of Santiago de Compostela |
Martinez-Urtaza J.,U.S. Center for Disease Control and Prevention
PLoS Neglected Tropical Diseases | Year: 2013
Vibrio parahaemolyticus is a foodborne pathogen that has become a public health concern at the global scale. The epidemiological significance of V. parahaemolyticus infections in Latin America received little attention until the winter of 1997 when cases related to the pandemic clone were detected in the region, changing the epidemic dynamics of this pathogen in Peru. With the aim to assess the impact of the arrival of the pandemic clone on local populations of pathogenic V. parahaemolyticus in Peru, we investigated the population genetics and genomic variation in a complete collection of non-pandemic strains recovered from clinical sources in Peru during the pre- and post-emergence periods of the pandemic clone. A total of 56 clinical strains isolated in Peru during the period 1994 to 2007, 13 strains from Chile and 20 strains from Asia were characterized by Multilocus Sequence Typing (MLST) and checked for the presence of Variable Genomic Regions (VGRs). The emergence of O3:K6 cases in Peru implied a drastic disruption of the seasonal dynamics of infections and a shift in the serotype dominance of pathogenic V. parahaemolyticus. After the arrival of the pandemic clone, a great diversity of serovars not previously reported was detected in the country, which supports the introduction of additional populations cohabitating with the pandemic group. Moreover, the presence of genomic regions characteristic of the pandemic clone in other non-pandemic strains may represent early evidence of genetic transfer from the introduced population to the local communities. Finally, the results of this study stress the importance of population admixture, horizontal genetic transfer and homologous recombination as major events shaping the structure and diversity of pathogenic V. parahaemolyticus. © 2013 Gavilan et al.
Ramirez J.D.,University of Los Andes, Colombia |
Montilla M.,Instituto Nacional Of Salud |
Cucunuba Z.M.,Instituto Nacional Of Salud |
Florez A.C.,Instituto Nacional Of Salud |
And 2 more authors.
PLoS Neglected Tropical Diseases | Year: 2013
Background: Trypanosoma cruzi, the causative agent of Chagas disease, displays significant genetic variability revealed by six Discrete Typing Units (TcI-TcVI). In this pathology, oral transmission represents an emerging epidemiological scenario where different outbreaks associated to food/beverages consumption have been reported in Argentina, Bolivia, Brazil, Ecuador and Venezuela. In Colombia, six human oral outbreaks have been reported corroborating the importance of this transmission route. Molecular epidemiology of oral outbreaks is barely known observing the incrimination of TcI, TcII, TcIV and TcV genotypes. Methodology and Principal Findings: High-throughput molecular characterization was conducted performing MLMT (Multilocus Microsatellite Typing) and mtMLST (mitochondrial Multilocus Sequence Typing) strategies on 50 clones from ten isolates. Results allowed observing the occurrence of TcI, TcIV and mixed infection of distinct TcI genotypes. Thus, a majority of specific mitochondrial haplotypes and allelic multilocus genotypes associated to the sylvatic cycle of transmission were detected in the dataset with the foreseen presence of mitochondrial haplotypes and allelic multilocus genotypes associated to the domestic cycle of transmission. Conclusions: These findings suggest the incrimination of sylvatic genotypes in the oral outbreaks occurred in Colombia. We observed patterns of super-infection and/or co-infection with a tailored association with the severe forms of myocarditis in the acute phase of the disease. The transmission dynamics of this infection route based on molecular epidemiology evidence was unraveled and the clinical and biological implications are discussed. © 2013 Ramírez et al.
Sanchez-Abanto J.,Instituto Nacional Of Salud
Revista Peruana de Medicina Experimental y Salud Publica | Year: 2012
Child chronic malnutrition is one of the main problems of Public Health in Peru, according to WHO's reference values, national prevalence is 19.5% in children under five. Child chronic malnutrition has a negative impact on people throughout their lives, limits the development of society and hinders poverty eradication. To attain the goal of reducing chronic malnutrition in children to 10% by 2016, the Peruvian government will continue to strengthen, mainly, the efficient use of economic resources, the assessment of interventions, the implementation of investigations that help define causal relations and provide information for the design of public policies, health capacity building and the articulation of different government levels. This article goes over the main interventions implemented in the country.
Firacative C.,University of Sydney |
Firacative C.,Instituto Nacional Of Salud |
Trilles L.,University of Sydney |
Trilles L.,Institute Pesquisa Clinica Evandro Chagas |
Meyer W.,University of Sydney
PLoS ONE | Year: 2012
Background: The Cryptococcus neoformans/C. gattii species complex comprises two sibling species that are divided into eight major molecular types, C. neoformans VNI to VNIV and C. gattii VGI to VGIV. These genotypes differ in host range, epidemiology, virulence, antifungal susceptibility and geographic distribution. The currently used phenotypic and molecular identification methods for the species/molecular types are time consuming and expensive. As Matrix-Assisted Laser Desorption Ionization-Time-of-Flight Mass Spectrometry (MALDI-TOF MS) offers an effective alternative for the rapid identification of microorganisms, the objective of this study was to examine its potential for the identification of C. neoformans and C. gattii strains at the intra- and inter-species level. Methodology: Protein extracts obtained via the formic acid extraction method of 164 C. neoformans/C. gattii isolates, including four inter-species hybrids, were studied. Results: The obtained mass spectra correctly identified 100% of all studied isolates, grouped each isolate according to the currently recognized species, C. neoformans and C. gattii, and detected potential hybrids. In addition, all isolates were clearly separated according to their major molecular type, generating greater spectral differences among the C. neoformans molecular types than the C. gattii molecular types, most likely reflecting a closer phylogenetic relationship between the latter. The number of colonies used and the incubation length did not affect the results. No spectra were obtained from intact yeast cells. An extended validated spectral library containing spectra of all eight major molecular types was established. Conclusions: MALDI-TOF MS is a rapid identification tool for the correct recognition of the two currently recognized human pathogenic Cryptococcus species and offers a simple method for the separation of the eight major molecular types and the detection of hybrid strains within this species complex in the clinical laboratory. The obtained mass spectra provide further evidence that the major molecular types warrant variety or even species status. © 2012 Firacative et al.
[Social representations of motherhood and pregnancy in adolescents attending their first pregnancy and adolescents with more than one pregnancy]. [Representaciones sociales del embarazo y la maternidad en adolescentes primigestantes y multigestantes en Bogotá]
Gomez-Sotelo A.,Instituto Nacional Of Salud
Revista de salud pública (Bogotá, Colombia) | Year: 2012
Characterizingze the social representations of motherhood and pregnancy in two groups, adolescents who are attending their first pregnancy and adolescents with more than one pregnancy. The study used a design based on interpretative and qualitative research method. Our data were collected as a network of associations, depth interviews and participant observation. Individual methodological triangulation from the groups of participants and the whole group were performed. Social representations of pregnancy and childbearing among adolescents in both groups converges on: new social status, fear of family rejection and important decisions. And while the exclusive social representations of the adolescents in their first pregnancy are: the postponement of studies, family and economic dependence and the figure of the father as a provider; those adolescents with more than one pregnancy are linked to school dropout, family and economic independence and the father of the child being the emotional container. Besides, baby ranks a distintic place in both groups. While the figurative nucleous attached wih love is present in women with more than one pregnancy, this is not the care center and such importance becomes relegated to different representation contents. The study absolutely show that it isn't through ignorance or lack of information that teenagers become pregnant. Teenage pregnancy is a complex phenomenon and the prevention of it should focus on the construction of the subjects to whom specific interventions are targeted.
Gonzalez C.,University of Los Andes, Colombia |
Paz A.,Instituto Alexander von Humboldt |
Ferro C.,Instituto Nacional Of Salud
Acta Tropica | Year: 2013
Visceral leishmaniasis (VL) is caused by the trypanosomatid parasite Leishmania infantum (=Leishmania chagasi), and is epidemiologically relevant due to its wide geographic distribution, the number of annual cases reported and the increase in its co-infection with HIV. Two vector species have been incriminated in the Americas: Lutzomyia longipalpis and Lutzomyia evansi. In Colombia, L. longipalpis is distributed along the Magdalena River Valley while L. evansi is only found in the northern part of the Country. Regarding the epidemiology of the disease, in Colombia the incidence of VL has decreased over the last few years without any intervention being implemented. Additionally, changes in transmission cycles have been reported with urban transmission occurring in the Caribbean Coast. In Europe and North America climate change seems to be driving a latitudinal shift of leishmaniasis transmission. Here, we explored the spatial distribution of the two known vector species of L. infantum in Colombia and projected its future distribution into climate change scenarios to establish the expansion potential of the disease. An updated database including L. longipalpis and L. evansi collection records from Colombia was compiled. Ecological niche models were performed for each species using the Maxent software and 13 Worldclim bioclimatic coverages. Projections were made for the pessimistic CSIRO A2 scenario, which predicts the higher increase in temperature due to non-emission reduction, and the optimistic Hadley B2 Scenario predicting the minimum increase in temperature. The database contained 23 records for L. evansi and 39 records for L. longipalpis, distributed along the Magdalena River Valley and the Caribbean Coast, where the potential distribution areas of both species were also predicted by Maxent. Climate change projections showed a general overall reduction in the spatial distribution of the two vector species, promoting a shift in altitudinal distribution for L. longipalpis and confining L. evansi to certain regions in the Caribbean Coast. Altitudinal shifts have been reported for cutaneous leishmaniasis vectors in Colombia and Peru. Here, we predict the same outcome for VL vectors in Colombia. Changes in spatial distribution patterns could be affecting local abundances due to climatic pressures on vector populations thus reducing the incidence of human cases. © 2013 The Authors.
Roda T.B.,Instituto Nacional Of Salud
Revista Peruana de Medicina Experimental y Salud Publica | Year: 2016
This article compiles the conclusions and results of several studies conducted by global and intergovernmental organizations involved in the research and promotion of policies and strategies for a successful and efficient management of the negative effects of climate change in public health. It is also a call for awareness the health community regarding their protagonist and strategic role to be assumed in relation to this global phenomenon which requires the coordinated cross-sectoral and inter-institution collaboration to achieve true social and environmental resilience. © 2016, Instituto Nacional de Salud. All Rights Reserved.
Instituto Nacional Of Salud | Date: 2011-11-25
The invention relates to a method for evaluating kits for rapid diagnosis of malaria, in order to determine or to test the sensitivity and specificity thereof. To that end, the reactive strips of the diagnostic kits are exposed to different concentrations of the malaria parasite in a method that allows data on sensitivity and specificity indicated on the technical sheet of the kit to be ascertained.
Reducing the burden of disease caused by alcohol use in Peru: Evidence- based approaches [Reduciendo la carga de enfermedad generada por el consumo de alcohol en el Perú: Propuestas basadas en evidencia]
Fiestas F.,Instituto Nacional Of Salud
Revista Peruana de Medicina Experimental y Salud Publica | Year: 2012
Alcohol use is one the most important risk factors for illness and early death in Peru. Measures aimed at decreasing or controlling the great impact caused by alcohol in the Peruvian society are urgently needed. This article identifes and promotes the implementation of public health measures supported by sound scientifc evidence of effectiveness or, in some cases, cost-effectiveness. The 10 evidence-based public health measures identifed and described here represent a set if measures with high probability of success if implemented, as they are supported by scientifc evidence. We recommend that governments, at the national or local levels, apply these measures not individually, but in combination, arranging them into a plan or roadmap, where the framework in which they will be applied must be established according to each context. Considering the available resources, some of these measures could be implemented in the short and medium term while the others can be set in the long-term.