Otitis Media Is Better Treated with Antibiotics Than Observation

Este es un tema que es controversial en los servicios de atención primaria , aqui les dejo algunos artículos y sus links sobre el manejo de la Otitis Media en niños.

Saludos 

Dr. Carlos Erazo 

"In children with acute otitis media, two placebo-controlled trials establish that antibiotic treatment with amoxicillin-clavulanate is superior to watchful waiting. The trials appear in the New England Journal of Medicine.
Researchers in Finland and the U.S. separately randomized a total of some 600 children under age 3 years to roughly 10 days of double-blind treatment with either amoxicillin-clavulanate or placebo. All children had been diagnosed with acute otitis media according to strict standards.
In both trials, treatment failure was at least twice as frequent among placebo recipients. Rash and diarrhea were more common among those receiving antibiotics.
An editorialist writes that the trials provide "the best data yet" to answer the question: Is acute otitis media treatable? "The answer is yes," he writes."

Podemos revisar los siguientes artículos del NEJM  gratuitos en pdf estos son los links :

Treatment of Acute Otitis Media in Children under 2 Years of Age : http://www.nejm.org/doi/pdf/10.1056/NEJMoa0912254

A Placebo-Controlled Trial of Antimicrobial Treatment for Acute Otitis Media :http://www.nejm.org/doi/pdf/10.1056/NEJMoa1007174

Is Acute Otitis Media a Treatable Disease? : http://www.nejm.org/doi/full/10.1056/NEJMe1009121

El H1N1 puede contener la clave para una vacuna universal contra la gripe

Artículo de interés y de actualidad.

Saludos

Dr. Carlos Erazo

JANO.es y agencias · 10 Enero 2011 15:16

"Investigadores de Estados Unidos descubren que algunos afectados por esta cepa han desarrollado anticuerpos que les protegen del resto de virus de la gripe.

Investigadores de la Facultad de Medicina y el Centro de Vacunas de la Universidad de Emory, en Estados Unidos, aseguran que el virus A/H1N1 -que se expandió por todo el mundo en 2009- puede ser el punto de partida para desarrollar una vacuna universal contra la gripe, ya que algunos afectados por esta cepa han sido capaces de desarrollar anticuerpos que les protegen del resto.

Según explica en el último número del Journal of Experimental Medicine el autor de esta investigación, el profesor Jens Wrammert, "la protección que han demostrado estos anticuerpos rara vez se había visto en quienes pasaban la gripe estacional".

Para identificarlos, se seleccionaron nueve pacientes que habían tenido la gripe A el año de su aparición con diferentes grados de intensidad, que iban desde casos más leves en que los síntomas desaparecieron a los pocos días, a otros más graves que requirieron hospitalización, incluso de dos meses. La mayoría de los participantes tenía entre 20 y 30 años, y a todos ellos se les tomó sangre unos 10 días después de la aparición de los primeros síntomas.

Gracias a estos análisis, los investigadores identificaron los glóbulos blancos de la sangre de los pacientes que desarrollaron protección contra el virus y, a continuación, aislaron los genes de estos anticuerpos para analizarlos individualmente. Tras esto, utilizaron los genes para producir nuevos anticuerpos mediante cultivo celular -hasta un total de 86 variedades- y, luego, trataron de comprobar si las cepas de gripe reaccionaban en contra.

Así, identificaron cinco anticuerpos aislados capaces de doblegar a todas las cepas de la gripe estacional de la última década, la cepa de la conocida como 'gripe española' de 1918 y también a un patógeno de la cepa H5N1 de la gripe aviar.

Hemaglutinina, base de una futura vacuna

Uno de los problemas de las vacunas contra la gripe es que la aparición de nuevas cepas impide una protección universal contra nuevas variantes que puedan surgir, como sucedió en 2009. Sin embargo, en esta ocasión algunos anticuerpos identificados han demostrado su capacidad para adherirse a una parte del virus inactivo que incluye la vacuna, gracias a una proteína llamada hemaglutinina, que según estos expertos puede ser la base de una futura vacuna con una protección más amplia.

Tras este trabajo de microscopio, los investigadores probaron si tres de los anticuerpos aislados podían proteger a los ratones contra la cepa A/H1N1 de 2009 y otras dos cepas de laboratorio. Dos de estos anticuerpos demostraron su capacidad inmunitaria, incluso cuando el anticuerpo se aplicó 60 h después de la infección, aunque sólo uno ofreció protección contra la cepa pandémica.

Además, los investigadores comprobaron que dicho anticuerpo procedía del paciente con la enfermedad más grave. "El resultado es algo así como el Santo Grial de la investigación en vacunas de la gripe", explica Patrick Wilson, coautor del estudio. A su juicio, pese a haber tanta diversidad en las cepas de la gripe, este hallazgo demuestra que "hacer una sola vacuna con inmunidad permanente para todas las gripes es algo cada vez más factible".

 LINK:

http://www.jano.es/jano/actualidad/ultimas/noticias/janoes/agencias/h1n1/puede/contener/clave/vacuna/universal/contra/gripe/_f-11+iditem-12520+idtabla-1?utm_source=MailingList&utm_medium=email&utm_campaign=Jano+Diario+%2811%2F01%2F2011%29

No Concurrence in Identifying Cutaneous Abscesses

Este artículo es muy interesante sobre la diferencia entre absceso y celulitis y como tratarlo.

Saludos 

Dr. Carlos Erazo

"Physician agreement on the presence of abscess and the need for drainage was only fair to moderate.

Most cutaneous abscesses require incision and drainage but not systemic antibiotics. By contrast, patients with cellulitis need systemic antibiotics, but incision and drainage are unnecessary and sometimes harmful. Distinguishing between these two disorders, therefore, is important, but how often do clinicians agree in their diagnoses of these conditions?

In this study from an emergency department in an urban, tertiary-care, pediatric hospital, 349 immunocompetent children with 394 lesions affecting the abdomen, legs, buttocks, or arms were evaluated for presence of an abscess and for the necessity for drainage. Each patient was independently examined by two physicians from a pool of 62 clinicians. The amount of agreement among the physicians was assessed by kappa statistic (poor, <0.0; slight, 0.0–0.20; fair, 0.21–0.40; moderate, 0.41–0.60; substantial, 0.61–0.8; nearly perfect, 0.81–1.00). The kappa value for agreement was 0.39 on the presence of an abscess (fair) and 0.43 on the necessity for drainage (moderate). More-experienced examiner pairs did not have better agreement than less seasoned physicians.

Comment: This study demonstrates a substantial and disturbing lack of agreement among clinicians about fundamental issues in children with apparent skin infections — namely, whether a cutaneous abscess was present and whether drainage was required. The relevance of this study to adult patients is uncertain but deserves investigation. My own experience in adults suggests that results might be similar, for I have seen many cutaneous abscesses misdiagnosed as cellulitis by emergency department physicians, internists, and even surgeons, who prescribed antibiotics without benefit. Better training in distinguishing between these entities may improve both the accuracy of diagnosis and the appropriate management of these common skin infections."

— Jan V. Hirschmann, MD

Published in Journal Watch Dermatology January 7, 2011

Inhaled Corticosteroids Might Provoke Diabetes

"Randomized trials have not shown a connection between use of inhaled corticosteroids (ICS) and risk for diabetes; however, these studies might have been underpowered to detect this association. In a new study, researchers evaluated risk for developing diabetes among nearly 400,000 residents of Quebec, Canada, who did not have diabetes when they began ICS treatment between 1990 and 2005.
During a mean follow-up of 5.5 years, 30,000 people initiated treatment for diabetes. After adjustment for multiple factors, including respiratory disease severity and comorbid conditions, incidence of diabetes was 34% higher among people who were currently receiving ICS than among those who were not. A dose–response association also was detected (rate ratios, 1.18 for low-dose ICS; 1.64 for high-dose ICS). Use of ICS also was associated with 34% higher risk for insulin therapy.
Comment: This population-based observational study showed a significantly higher incidence of diabetes and more-rapid diabetes progression (defined as initiating insulin therapy) among individuals who received ICS. Current guidelines recommend close monitoring of patients who receive high-dose ICS for development of osteoporosis or cataracts; this study suggests that diabetes could be added to this list. The findings also remind us to follow asthma and chronic obstructive pulmonary disease guidelines on when to initiate inhaled corticosteroid therapy and on using the lowest effective dose."
— Jamaluddin Moloo, MD, MPH

Artículo interesante encontrado sobre el uso de corticoides inhalados y diabetes.

Saludos


Dr. Carlos Erazo

Herpes Zoster Vaccine Found Effective in Community Setting

Buenos días con todos, aquí algo interersante sobre el Herpes Zoster....la vacuna.

Saludos 

Dr. Carlos Erazo

A study conducted in a clinical practice setting confirms the effectiveness of herpes zoster vaccine, according to a report in JAMA.
In a retrospective cohort study of health plan members, researchers examined the incidence of herpes zoster among some 75,000 vaccinees aged 60 and older and 225,000 age-matched controls who did not receive the vaccine. After a follow-up averaging about 2 years, the incidence of herpes zoster was twice as high among controls as among vaccinees (13.0 vs. 6.4 per 1000 person-years). The difference remained after adjustment for sex, race, presence of chronic disease, and health care utilization. There was also a significant reduction in risk for ophthalmic herpes zoster.
The authors estimate that one episode of herpes zoster would be prevented for every 71 patients vaccinated. They write that their results "support recommendations to offer herpes zoster vaccine to eligible patients of all ages, including the oldest population."

JAMA article (Free abstract)

HIV/AIDS Clinical Care for January 10, 2011

Buenos días este es una copia de los temarios recibidos sobre VIH/SIDA, publicados en Journal Watch, que quiero compartir con ustedes.

Cada uno de los artículos tienen sus referencias para que puedan buscarlos y leerlos. 

Saludos 

Dr. Carlos Erazo

 

"SUMMARY AND COMMENT

Curing HIV? Free!

January 10, 2011 | Rajesh T. Gandhi, MD

An HIV-infected man who underwent stem-cell transplantation for leukemia continues to be free of the virus more than 3.5 years later, without any antiretroviral therapy.

Reviewing: Allers K et al. Blood 2010 Dec 8;

DRUG WATCH

New Formulation of Etravirine; Label Changes for Darunavir and d4T

January 10, 2011 | Paul E. Sax, MD

Etravirine is now available in a 200-mg tablet, darunavir is approved for once-daily dosing in some treatment-experienced patients, and the d4T label no longer calls for dose reduction to prevent toxicity.

SUMMARY AND COMMENT

Structural Cardiac Abnormalities Appear to Persist Despite ART

January 10, 2011 | Abigail Zuger, MD

Echocardiographic abnormalities were prevalent but mostly mild in a cohort of HIV-infected patients, the majority of whom were receiving ART.

Reviewing: Mondy K et al. Clin Infect Dis 2011 Feb 1; 52:378

SUMMARY AND COMMENT

Antiretrovirals and Cognitive Function

January 10, 2011 | Rajesh T. Gandhi, MD

The extent to which individual antiretrovirals penetrate the central nervous system may influence whether those drugs improve cognitive function, but the jury's still out.

Reviewing: Smurzynski M et al. AIDS 2010 Nov 30;""

Pandemic Flu Offers Clue to Better Vaccines

Buenos días 

Este es un artículo sobre la gripe pandémica publicado en http://www.medpagetoday.com, interesante en cuanto a la vacuna.

 Al final tenemos el link donde fué publicado originalmente y pueden ver un video sobre el tema.

Saludos 

Dr. Carlos Erazo

By Michael Smith, North American Correspondent, MedPage Today Published: January 10, 2011 Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

The pandemic H1N1 influenza may have helped researchers solve a long-standing problem: how to make a flu vaccine that protects against multiple strains. Such a vaccine is "the holy grail of influenza vaccinology," according to Patrick Wilson, PhD, of the University of Chicago, and colleagues. But researchers have been frustrated because each influenza strain is just different enough from previous strains that a new vaccine has been needed every year, he told MedPage Today. On the face of it, the 2009 pandemic strain was no improvement -- it was markedly different from all earlier H1N1 strains, and vaccines had to be painstakingly developed in the same way the seasonal flu vaccines are made. Action Points   Explain that researchers found broadly cross-reactive antibodies to more than the rapidly changing hemagglutinin protein when analyzing blood from patients who had H1N1 pandemic influenza infection. Note that the investigators suggested that these antibodies arose from memory B cells and could provide an avenue for development of a cross-protective influenza vaccine that might not have to be administered yearly. But, Wilson and colleagues reported in the Jan. 10 issue of the Journal of Experimental Medicine, the very novelty of the virus may have opened the door to better vaccines. An analysis of immune responses of a handful of patients infected with the pandemic strain, Wilson and colleagues reported, allowed the researchers to isolate and clone antibodies that not only neutralized the 2009 virus, but also a range of other H1N1 strains, including the highly pathogenic 1918 strain. "The surprise was, when we made these antibodies, that they were unusually broadly reactive," Wilson said. Current vaccines target a section of the viral hemagglutinin protein, the so-called globular head, which is highly variable. But more than half of the antibodies found by the researchers bound to regions in the stalk of the protein, which is thought to be more highly conserved, Wilson said. Interestingly, however, some antibodies found in the study did bind to the head of the protein and even they were broadly neutralizing, suggesting that their binding regions are also highly conserved over time, Wilson said. Using those highly conserved regions, it might be possible to create a flu vaccine that would protect year after year, he said. "With the proper immunogen," the researchers argued, "the long-sought development of a pan-influenza vaccine might be possible." Wilson and colleagues are currently analyzing immune responses to the monovalent H1N1 vaccine to see if the vaccinated people have similar antibodies to those who actually had the infection, he said. The origin of the antibodies, the researchers think, may be memory B cells in the patients that were created during previous exposures to different flu strains -- a small part of a host of responses to various antigens, including the usual suspects on the globular head. Evidence for that, they said, may be the fact that the cells have highly mutated immunoglobulin genes, indicating extensive affinity maturation, the process that over time improves how well antibodies match an antigen. The novel pandemic strain, however, was sufficiently different that only the rare antibodies to the conserved regions had targets, so they were preferentially amplified. Interestingly, Wilson and colleagues said, the one antibody they found that is highly specific for the pandemic strain was derived from the patient with the most severe illness. The specificity combined with the severity of the illness suggests, they said, that he had no preexisting immunity to previous strains. As a sidelight on the discovery, the monoclonal antibodies created by the researchers appear to have both preventive and therapeutic possibilities in mice. Given before infection, the researchers found, they were highly effective at preventing death in animals from a lethal dose of a mouse-adapted version of the H1N1 pandemic strain. On the other hand, mice injected with a lethal dose of the pandemic strain could be rescued by a bolus of antibodies, even as much as 60 hours after infection, and well after they had developed symptoms, the researchers reported. In one experiment, mice were given the antibodies 48 hours after infection. But six days after infection, the virus was either undetectable or barely detectable. Meanwhile, control animals had all died by day seven or eight, they reported. The study was supported by the National Institutes of Health, the Northeast Biodefense Center, and the National Foundation for Cancer Research. The authors said they had no financial or commercial conflicts of interest.

http://www.medpagetoday.com/InfectiousDisease/SwineFlu/24253?utm_content=GroupCL&utm_medium=email&impressionId=1294731282824&utm_campaign=DailyHeadlines&utm_source=mSpoke&userid=188864

Human Immunodeficiency Virus (HIV) types Western blot (WB) band profiles as potential surrogate markers of HIV disease progression and predictors of vertical transmission in a cohort of infected but antiretroviral therapy naive pregnant women in Harare, Zimbabwe

Este artículo es muy interesante, espero que lo disfruten.
Saludos

Dr. Carlos Erazo


"Abstract
Background: Expensive CD4 count and viral load tests have failed the intended objective of
enabling access to HIV therapy in poor resource settings. It is imperative to develop simple,
affordable and non-subjective disease monitoring tools to complement clinical staging efforts
of inexperienced health personnel currently manning most healthcare centres because of brain
drain. Besides accurately predicting HIV infection, sequential appearance of specific bands of
WB test offers a window of opportunity to develop a less subjective tool for monitoring
disease progression.
Methods: HIV type characterization was done in a cohort of infected pregnant women at 36
gestational weeks using WB test. Student-t test was used to determine maternal differences in
mean full blood counts and viral load of mothers with and those without HIV gag antigen
bands. Pearson Chi-square test was used to assess differences in lack of bands appearance
with vertical transmission and lymphadenopathy.
Results: Among the 64 HIV infected pregnant women, 98.4 % had pure HIV-1 infection and
one woman (1.7%) had dual HIV-1/HIV-2 infections. Absence of HIV pol antigen bands was
associated with acute infection, p=0.002. All women with chronic HIV-1 infection had
antibody reactivity to both the HIV-1 envelope and polymerase antigens. However, antibody
reactivity to gag antigens varied among the women, being 100%, 90%, 70% and 63% for p24,
p17, p39 and p55, respectively. Lack of antibody reactivity to gag p39 antigen was associated
with disease progression as confirmed by the presence of lymphadenopathy, anemia, higher
viral load, p=0.010, 0.025 and 0.016, respectively. Although not statistically significant,
women with p39 band missing were 1.4 times more likely to transmit HIV-1 to their infants.Conclusion: Absence of antibody reactivity to pol and gag p39 antigens was associated with
acute infection and disease progression, respectively. Apart from its use in HIV disease
diagnosis, WB test could also be used in conjunction with simpler tests like full blood counts
and patient clinical assessment as a relatively cheaper disease monitoring tool required prior
to accessing antiretroviral therapy for poor resource settings. However, there is also need to
factor in the role of host-parasite genetics and interactions in disease progression."
 Este es el link para acceder el pdf completo y gratuito.

http://www.biomedcentral.com/content/pdf/1471-2334-11-7.pdf

Dynamics and Constraints of Early Infant Diagnosis of HIV Infection in Rural Kenya.

Buenos días con todos, aqui un  nuevo artículo realcionado con VIH/SIDA.

Saludos 

Dr. Carlos Erazo

AIDS Behav. 2011 Jan 7. [Epub ahead of print]

Hassan AS, Sakwa EM, Nabwera HM, Taegtmeyer MM, Kimutai RM, Sanders EJ, Awuondo KK, Mutinda MN, Molyneux CS, Berkley JA.

Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, 80108, Kenya.

Abstract

A cohort design was used to determine uptake and drop out of 213 HIV-exposed infants eligible for Early Infant Diagnosis (EID) of HIV. To explore service providers and care givers knowledge, attitudes and perceptions of the EID process, observations and in-depth interviews were conducted. 145 (68%) infants enrolled after 2 months of age. 139 (65%) dropped out before follow up to 18 months old. 60 (43%) drop outs occurred within 2 months of enrolment. Maternal factors associated with infant drop out were maternal loss to follow up (48 [68%] vs. 8 [20%], P < 0.001) and younger maternal age (27.2 vs. 30.1 years, P = 0.033). Service providers and caregivers had inadequate training, knowledge and understanding of EID. Poverty and lack of social support were challenges in accessing EID services. EID should be more closely aligned within PMTCT services, integrated with routine mother and child health (MCH) activities and its implementation more closely monitored.

Link:    http://www.ncbi.nlm.nih.gov/pubmed/21213034

Novel HIV Drug a 'Trade-Off'

Este artículo, salió publicado en http://www.medpagetoday.com/MeetingCoverage/ICAAC/22219?shield=0;  y habla de una nueva droga , pero también nos menciona que debemos ser cautos en su lectura e intrerpretación, hasta que sea publicado el artículo.  Espero que les sea útil. Dr. Carlos Erazo Action Points   Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. Clinicians should note that when TMC278 was compared with efavirenz in naive patients, both taken with two nucleoside reverse transciptase agents, overall results were similar but adherence was especially critical to TMC278's efficacy in those with baseline HIV RNA over 100,000. Clinicians should note that TMC278 appeared to be better tolerated than efavirenz in these head-to-head studies. Note that mutational patterns developing on treatment were different in the two study groups. BOSTON -- In HIV patients starting therapy, an investigational non-nucleoside reverse transcriptase inhibitor had a higher rate of virologic failure than a standard medication, researchers said here. But treatment with TMC278 (rilpivirine) also caused fewer adverse events and led to fewer dropouts for such events than efavirenz (Sustiva), according to Joseph Eron, MD, of the University of North Carolina Chapel Hill. In both arms of two nearly identical phase III trials, virologic failure was more common in those with a higher baseline viral load and suboptimal adherence, Eron said during an oral presentation here at the Interscience Conference on Antimicrobial Agents and Chemotherapy. But the effect was more apparent among those taking the novel drug, he said. In the two trials -- dubbed THRIVE and ECHO -- a total of 1,368 treatment-naive patients were randomly assigned to get either TMC278 or efavirenz, combined with two other anti-HIV medications. In the ECHO trial, all patients also got the combination of tenofovir and emtricitabine (Truvada), but in THRIVE, physicians could choose any two nucleoside reverse transcriptase inhibitors. The main goal of the study was to see if the TMC278 regimens were noninferior to the efavirenz regimens, and researchers reported at the International AIDS Conference in Vienna that that was the case. (See IAC: New HIV Drug Matches Old Standard) At the AIDS meeting, Tibotec -- the developer of the drug and the sponsor of the two trials -- announced it was filing for approval of the drug. Here, Eron was filling in some of the gaps, including how and why some patients failed to respond to the drugs. In a pooled analysis of data from the two trials, the researchers found that 84.3% of TMC278 patients had a viral load of fewer than 50 copies of HIV RNA per milliliter of serum after 48 weeks of therapy, compared with 82.3% of efavirenz patients. The result met criteria for noninferiority, he said. When the patients were analyzed on the basis of baseline viral load, the two drugs were also noninferior among those starting with more than 100,000 copies, but TMC278 was actually better among those with a viral load below that cutoff with 90% responding, compared with 84%. The proportion of patients who suffered a grade 2,3, or 4 adverse event regarded as possibly related to treatment was 16% among TMC278 patients and 31% among efavirenz patients (P<0.0001), Eron said. Moreover, only 3% of TMC278 patients dropped out because of adverse events, compared with 8% of those taking efavirenz (P=0.0005). Neurological adverse events were also significantly more common (P<0.0001) among those taking efavirenz. The incidence of virologic failure -- defined as never having suppressed HIV or having rebounded after initial success -- was 10% among TMC278 patients and 6% among those taking efavirenz. Much of the difference was driven by patients with initial viral loads greater than 100,000 copies whose adherence to therapy was poor, Eron said. Among TMC278 patients, he said, there were 42 who met both criteria and 26 of them failed therapy. Among efavirenz patients, 38 met the criteria, but only 12 failed. Among those who failed therapy, Eron reported, 63% of TMC278 patients had developed at least one mutation that was associated with resistance to non-nucleoside reverse transcriptase inhibitors, compared with 54% of efavirenz patients. Each drug had a distinct pattern of resistance-associated mutations, he said, with only one seen in both groups. "The most important new information was that patients with both a high viral load at baseline and suboptimal adherence had a higher risk of failure on TMC278 than on efavirenz," said Paul Sax, MD, of Brigham and Women's Hospital in Boston, who co-moderated the session but was not involved in the research. On the other hand, he told MedPage Today, for patients who are easier to treat -- those with a low viral load when they start therapy -- "it did better." From the clinical point of view, he said, "it's a trade-off." His co-moderator, Jens Lundgren, MD, of the University of Copenhagen, commented that it's not surprising to see fewer TMC278 patients dropping out because of adverse effects, since efavirenz is known to have central nervous system impacts that many patients find difficult to tolerate "and TMC278 doesn't have that." But the bottom line, he said, may be that TMC278 is slightly less potent, but easier to take. The study was supported by Tibotec, which is developing the drug. Eron has disclosed financial relationships with GlaxoSmithKline, Bristol-Myers Squibb, Virologic, Boehringer Ingelheim, Virco, Abbott, and Merck. Some authors were employees of Tibotec. Sax reported financial links with a range of pharmaceutical companies. Lundgren said he had no disclosures.

Primary source: Interscience Conference on Antimicrobial Agents and Chemotherapy Source reference: Rimsky L, et al "Characterization of the resistance profile of TMC278: 48-week analysis of the phase III studies ECHO and THRIVE" ICAAC 2010.

LINK:  http://www.medpagetoday.com/MeetingCoverage/ICAAC/22219?shield=0

The Pattern of Indeterminate Human Immunodeficiency Virus Test and Follow-Up Evaluation in Pregnant Women.

Este arículo es interesante, el link esta al final de esta entrada para que ustedes puedan obtener más información. 

Dr. Carlos Erazo

Am J Perinatol. 2010 Dec 6. [Epub ahead of print]

Jain S, Basraon S, Loeffelholz MJ, Patel JA.

Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas.

Abstract

We studied the pattern of indeterminate HIV serological tests among pregnant women with follow-up testing in the postpartum period. Medical records of pregnant women were reviewed over a 2-year period. Of 16,596 pregnant women, 127 (0.8%) had positive HIV enzyme-linked immunoassay (ELISA) result. With Western blot (WB) test, 54 (0.33%) were positive, 43 (0.26%) were negative, and 30 (0.18%) were indeterminate. One of the 30 women (3.3%) with indeterminate WB converted to positive WB during pregnancy. White and black women were more likely to have an unconfirmed positive ELISA (indeterminate or negative WB) than Hispanics ( P = 0.021). The positive WB rate for black women was significantly higher ( P < 0.001) than other racial/ethnic groups. The postpartum follow-up testing of 14 women with indeterminate WB varied between 4 to 20 weeks; 16 did not have any postpartum follow-up test. The common bands in indeterminate WB were P24, P18, and nonviral proteins. The pattern of indeterminate WB result and its follow-up was variable during pregnancy and postpartum period. There is a need for development of national standards of care for indeterminate WB mothers and their infants in the postpartum period. Additional studies are needed to determine the cause of indeterminate tests, reducing their occurrence in the testing process, and the optimum time for testing in the postpartum period.

LINK :  http://www.ncbi.nlm.nih.gov/pubmed/21136348

Approach to Dyslipidemia, Lipodystrophy, and Cardiovascular Risk in Patients with HIV Infection.

Pensando en la Atención Integral de los pacientes con VIH /SIDA , me parece interesante este tipo de artículos.

Les dejo aqui el abstract y el link en la parte inferior para que puedan acceder a más información.

Saludos

Dr. Carlos Erazo

Curr Atheroscler Rep. 2010 Dec 23. [Epub ahead of print]

Troll JG.

Touro University College of Osteopathic Medicine, 1310 Club Drive, Vallejo, CA, 94592, USA, greg.troll@tu.edu.

Abstract

There is a significant prevalence (20%-80% depending on the population and the study) of lipid disorders and other cardiovascular risk factors in people living with HIV infection. This review focuses on HIV and HIV treatment-associated metabolic and cardiovascular concerns, including dyslipidemias, lipodystrophy syndromes, endothelial dysfunctions, and associated metabolic events such as insulin resistance. Emerging hypotheses of the underlying pathophysiology of these issues, with impact on selection of specific antiretroviral treatment (ART) strategies, therapy, and preventive approaches to decreasing cardiovascular risk and other problems associated with these syndromes are discussed. Screening for cardiovascular risk as part of the decision of starting antiretroviral therapy, and during care of patients with HIV regardless of ART therapy status, is suggested with particular areas of focus. Statins, other hyperlipidemic therapies, treatment for specific problems arising due to lipodystrophy, and implications on ART selection to avoid drug interactions and adverse effects are also discussed.

LINK:     http://www.ncbi.nlm.nih.gov/pubmed/21181310

TB and HIV in children - advances in prevention and management.

Interesante artículo, debemos pensar un poco más en la Co- infección. Aqui les mando el abstract y el link, este no esta disponible sin subscripción. Pero pueden pedirlo y comprarlo a quien esté interesado.

Paediatr Respir Rev. 2011 Mar;12(1):39-45. Epub 2010 Oct 18.

Marais BJ, Rabie H, Cotton MF.

Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, South Africa. bjmarais@sun.ac.za

Abstract

The human immunodeficiency virus (HIV) epidemic has had a major impact on the age and gender profile of adult tuberculosis (TB) patients, resulting in increased exposure of HIV-infected and uninfected children at a very young age. Young and/or HIV-infected children are extremely vulnerable to develop severe forms of TB following recent exposure and infection. There is an urgent need to implement safe and pragmatic strategies to prevent TB in children, especially in TB endemic areas where they suffer the greatest burden of disease. The management of TB in HIV-infected children poses multiple challenges, but recent advances in the implementation of prevention of mother to child transmission (PMTCT) strategies and HIV care of infants offer hope. These include HIV testing and access to PMTCT for all pregnant women, routine testing of all HIV exposed infants and rapid initiation of antiretroviral treatment irrespective of clinical or immunological disease staging. In addition, careful scrutiny for TB exposure should occur at every health care visit, with provision of isoniazid preventive therapy (IPT) following each documented exposure event. Knowing the HIV infection status of child TB suspects is essential to optimize case management. Although multiple difficulties remain, recent advances demonstrate that the management of children with TB and/or HIV can be vastly improved by well focused interventions using readily available resources.
2010 Elsevier Ltd. All rights reserved.

 

Link: http://www.ncbi.nlm.nih.gov/pubmed/21172674

Molecular Epidemiology of HIV Type 1 in Ecuador, Peru, Bolivia, Uruguay, and Argentina.

AIDS Res Hum Retroviruses. 2002 Dec 10;18(18):1339-50.

 

Hierholzer J, Montano S, Hoelscher M, Negrete M, Hierholzer M, Avila MM, Carrillo MG, Russi JC, Vinoles J, Alava A, Acosta ME, Gianella A, Andrade R, Sanchez JL, Carrion G, Sanchez JL, Russell K, Robb M, Birx D, McCutchan F, Carr JK.

U.S. Military HIV Research Program, Henry M. Jackson Foundation, Rockville, Maryland 20850, USA.

Abstract

Surveillance for HIV infection among people at increased risk was conducted in five countries in South America. Seroprevalence studies were conducted in more than 36,000 people in Ecuador, Peru, Boliva, Uruguay, and Argentina, along with genetic analysis of the HIV-1 strains. In all countries, the prevalence of HIV-1 among men who have sex with men (MSM) was high (3-30%), whereas the prevalence among female commercial sex workers (FCSMs) was low (0.3-6%). By envelope heteroduplex mobility assay, subtype B predominated in MSM communities and in FCSWs in Ecuador, Bolivia, and Peru. A new genetic screening assay, the multiregion hybridization assay for subtypes B and F (MHA-bf), was developed to improve large-scale genetic screening in South America. MHA-bf can screen four regions of the genome for subtype B or subtype F, and thus can detect most recombinants. The sensitivity of MHA-bf when applied to a panel of pure subtypes and CRF12_BF was 100%, and 88% of unique recombinants were also detected as recombinant. Using MHA-bf, more than 80% of samples from Ecuador, Peru, and Bolivia were classified as pure subtype B, whereas in Uruguay and Argentina this proportion was only 30 to 40%. BF recombinants were the most prevalent form of HIV-1 in Uruguay and Argentina. Subtype B is the most common subtype in countries lacking injecting drug use (IDU) epidemics, whereas BF recombinants are more common in countries where extensive IDU epidemics have been documented, suggesting the ontogeny of recombinant strains in particular risk groups in South America.

PMID: 12487805 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/12487805

Dr. Carlos Erazo

Seroprevalence of and risk factors for HIV-1 infection among South American men who have sex with men.

Sex Transm Infect. 2004 Dec;80(6):498-504.

Bautista CT, Sanchez JL, Montano SM, Laguna-Torres VA, Lama JR, Sanchez JL, Kusunoki L, Manrique H, Acosta J, Montoya O, Tambare AM, Avila MM, Viñoles J, Aguayo N, Olson JG, Carr JK.

US Military HIV Research Program and Henry M Jackson Foundation, 1 Taft Court, Suite 250, Rockville, MD 20850, USA. cbautista@hivresearch.org

Abstract

"OBJECTIVES: Sex among men constitutes an important route of transmission for HIV type 1 (HIV-1) in Latin America. Seeking better understanding of risk behaviours in this region, we determined the seroprevalence, potential risk factors, and geographic distribution of HIV-1 among groups of men who have sex with men (MSM).
METHODS: Seroepidemiological, cross sectional studies of 13,847 MSM were conducted in seven countries of South America during the years 1999-2002. Volunteers were recruited in city venues and streets where anonymous questionnaires and blood samples were obtained. HIV-1 infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot (WB) confirmatory tests.
RESULTS: HIV-1 seroprevalence varied widely (overall 12.3%, range 11.0%-20.6%). The highest HIV-1 seroprevalence was noted in Bolivia (20.6%) and the lowest in Peru (11.0%). Predictors of HIV-1 infection varied among countries; however, a history of previous sexually transmitted disease (STD) was associated with a consistent increased risk (ORs=1.9-2.9, AORs=1.8-2.7). Multiple weekly sexual contacts was found to represent a secondary risk factor in Ecuador, Peru, and Argentina (ORs=1.6-2.9, AORs=1.6-3.1), whereas use of drugs such as cocaine was found to increase risk in Bolivia, Uruguay, and Paraguay (ORs=2.5-6.5, AORs=2.6-6.1).
CONCLUSION: The results of this study illustrate an elevated HIV-1 seroprevalence among MSM participants from Andean countries. A previous STD history and multiple partners predicted HIV-1 infection in the seven countries of South America. In Southern Cone countries, HIV-1 infection was also associated with use of illegal drugs such as cocaine".

Para más información sobre este asrtículo entrar en el siguiente link:  http://www.ncbi.nlm.nih.gov/pubmed/15572623



Dr. Carlos Erazo

Improving the safety of the blood supply in Ecuador through external performance evaluation of serological screening of blood donors.

Este artículo, esta copiado del Pubmed, y tiene acceso a el total del mismo de forma libre, pueden acceder por medio del link colocado al final de este y entrar por el PUBMED al artículo completo.

J Clin Virol. 2005 Dec;34 Suppl 2:S47-52.

Grijalva MJ, Chiriboga RF, Vanhassel H, Arcos-Teran L.

Infectious Disease Research Laboratory, School of Biological Sciences, Catholic University, Quito, Ecuador. grijalva@ohio.edu

Abstract

BACKGROUND: The Ecuadorian National Blood System collects approximately 100 000 units of blood per year. Screening for infectious agents is conducted by 23 autonomous blood services using different methodologies and reagents.
OBJECTIVES: To evaluate the performance of serology testing by laboratories of the Ecuadorian National Blood Bank System.
STUDY DESIGN: Four proficiency panels were distributed between April 2003 and December 2004 containing samples that were characterized as either reactive or non-reactive for hepatitis B surface antigen (HBsAg), antibodies against hepatitis C virus (HCV), and antibodies against human immunodeficiency virus (HIV). Laboratories were classified according to the volume of blood units processed per year, as small (<5000), medium (5000-12000) and large (>12000).
RESULTS: Large and medium blood services consistently obtained better results than small ones. All of the 37 anti-HIV antibody false negative results and all of the 20 HBsAg false negative results were reported by small laboratories. False negative results were associated with the use of rapid tests. Laboratories using rapid tests and certain lots of an enzyme-linked immunosorbent assay (ELISA) failed to detect HCV reactive sera in December 2004.
CONCLUSION: The high number of incorrect results in most small blood services indicates serious weaknesses in blood screening that require urgent corrective action. The National Blood System has implemented on-site audits, training, technical assistance, and increased oversight. The long-term proposal is to centralize blood testing in two large blood centers. The results presented here underline the importance of strengthening the regulatory framework and oversight in Ecuador and highlight the role of external performance evaluation programs for blood safety improvement.

PMID: 16461240 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/16461240

Dr. Carlos Erazo

CCR5delta32, CCR2-64I, and SDF1-3'A polymorphisms related to resistance to HIV-1 infection and disease in the Ecuadorian population.

Este artículo no tiene acceso al texto libre, pero les coloco aquí para que ustedes sepan que existe esta investigación y para quienes quieran adquirirlo esta aquí la copia completa revisada en el PUBMED. 

Hum Biol. 2005 Aug;77(4):521-6.

Paz-y-Mino C, Morillo SA, Celi AP, Witte T, Muñoz Guijarro MJ, Collantes JC, Leone PE.

Laboratorio de Genética Molecular y Citogenética Humana, Escuela de Ciencias Biológicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.

Abstract

The aim of this study was to determine the allele frequencies of genetic variants CCR5delta32, CCR2-64I, and SDF1-3'A (SDF1 801 A), which influence susceptibility to HIV-1 infection. We also investigated the effect of these variants on the general Ecuadoran population and on a group of HIV-infected individuals to determine the frequency of these genetics variants.

PMID: 16485782 [PubMed - indexed for MEDLINE]

Dr. Carlos Erazo

Inconsistent condom use among sexual workers in Ecuador: results from a behavior survey

"OBJECTIVE: Whilst existing data suggests that the HIV epidemic in Ecuador is concentrated amongst men who have sex with men (MSM), there is very little available information on the situation of key populations, i.e. those most at risk of HIV infection and/or transmitting the infection. In particular, there is very little known about sex workers (SWs), their rate of condom use and other behaviors and characteristics with respect to the risk of acquiring sexually transmitted infections (STIs). This study presents findings from a survey carried out with SWs in eight cities in Ecuador.
MATERIAL AND METHODS: Using a cross-sectional design, a questionnaire focusing on behaviours, attitudes and socio-economic and demographic characteristics was administered to SWs in eight cities in Ecuador. These eight cities together account for the majority of the population in the country, and they were also identified as the locations with high reported levels of HIV.
RESULTS: Information from a total of 2867 SWs was obtained, the majority were captured in their workplaces. Most of SWs interviewed carry out their activities in closed settings dedicated to sex work (i.e. not in the street). The average age of respondents was 28 (95%CI 27-29), and around half of them live with a male partner (married or not). The rate of condom use with the last client was 88% (82% consistently with the last three), whilst with regular partners it was 6%. A high index of life-skills, high socio-economic status and having an official document that allows them to work, were positively associated with condom use with clients (PR [CI95%] 1.40 [1.40-1.40], 1.37 [1.36-1.37], y 7.26 [6.87-7.46], respectively).
CONCLUSIONS: Whilst condom use with clients amongst Ecuadorian SWs is high, this diminishes if one analyzes consistent condom use and is notably low with respect to regular partners. Condom use appears to be related to variables that can be linked to interventions, e.g. life-skills and official permission to carry out sex work. It is, therefore, important to tailor interventions for this population so they maximize the likelihood to increase consistent condom use."

Salud Publica Mex. 2006 Mar-Apr;48(2):104-12.

http://www.ncbi.nlm.nih.gov/pubmed/16619867


Dr. Carlos Erazo

Correlates of condom use in a sample of MSM in Ecuador.

Gutiérrez JP, Molina-Yepez D, Morrison K, Samuels F, Bertozzi SM.


"BACKGROUND: In Ecuador, the prevalence of HIV in the general population is approximately 0.3%. However, up to 17% prevalence has been reported among specific groups of homosexual and bisexual men. The objective of this study is to explore correlates of condom use among men who have sex with men (MSM) across eight cities in Ecuador.
METHODS: A cross-sectional survey design was used. A questionnaire including variables on sexual behaviour, demographics, and socio-economic characteristics was distributed to a sample of MSM in eight Ecuadorian cities.
RESULTS: Information was obtained for 2,594 MSM across the eight cities. The largest subcategory of self-identification was active bisexuals (35%), followed by those who described themselves as "hombrados" (masculine gays, 22%). The mean age was 25 years, and the majority were unmarried (78%), with a median of 10 years of schooling (IQR 7 - 12). Regarding condom use, 55% of those interviewed had unprotected penetrative sex with each of their last three partners, and almost 25% had never used a condom. The most important correlates of condom use were single status, high life-skills rating, and high socio-economic status (RP 5.45, 95% CI 4.26 - 6.37; RP 1.84, 95% CI 1.79 - 1.86, and RP 1.20, 95% CI 1.01 - 1.31, respectively).
CONCLUSION: Our data illustrate the urgent need for targeted HIV-prevention programs for MSM populations in Ecuador. MSM have the highest HIV prevalence in the country, and condom use is extremely low. It is imperative that prevention strategies be re-evaluated and re-prioritized to more effectively respond to the Ecuadorian epidemic."

BMC Public Health. 2006 Jun 12;6:152.

http://www.ncbi.nlm.nih.gov/pubmed/16768794


Dr. Carlos Erazo

Low educational level: a risk factor for sexually transmitted infections among commercial sex workers in Quito, Ecuador.

"Few studies have assessed the effect of educational level on sexually transmitted infections (STIs) and risk-taking behaviours among commercial sex workers (CSWs). This study analysed this association among female CSWs in Quito, Ecuador. Eighty-five CSWs were given a Spanish-language questionnaire on behaviours, socioeconomics and demographics. The correlation between years of education and number of prior STIs was calculated. Three groups of varying education level were formed and risk factors were analysed by Chi-square tests and analysis of variances. Lower educational level was associated with more STIs (r= -0.36; F=4.2; P=0.04), poorer knowledge of HIV/AIDS (P=0.03), earlier first prostitution (P=0.05) and first sex (P=0.00), willingness to engage in group sex (P=0.05) and work on the street (P=0.02), and presence of non-paying sexual partners (P=0.05). CSWs with lower educational levels were disproportionately afflicted with STIs and participated in more high-risk behaviours. Low educational level may predispose CSWs to STIs and associated risk factors."

Int J STD AIDS. 2008 Apr;19(4):264-7.

http://www.ncbi.nlm.nih.gov/pubmed/18482947


Dr. Carlos Erazo

Preventing mother-to-child transmission in Guayaquil, Ecuador: HIV knowledge and risk perception.

"An important step in preventing mother-to-child transmission is testing pregnant women for HIV. Health literacy measures, such as HIV knowledge and risk perception, may determine which women are tested in prenatal clinics where routine opt-out testing is not available. A survey was conducted in Guayaquil, Ecuador in 2006 (n=485), where approximately 0.7% of HIV tests in prenatal clinics were positive. Pregnant women over the age of 18 were invited to complete the survey in the waiting rooms at four city hospitals. There were 67.2% of women reported being tested previously for HIV. The most notable finding was that women who perceived a risk were 1.74 times more likely to request testing (p=0.021), but a woman's risk perception was not related to established risk factors. In addition, a physician's recommendation would result in the testing of nearly all women (94.3%). This data suggest that interventions in prenatal care clinics should incorporate educational strategies to increase accurate perception of personal risk. These efforts must occur in conjunction with increasing the access to HIV tests to achieve the goal of universal prenatal testing.""


Glob Public Health. 2010 Nov;5(6):649-62.

http://www.ncbi.nlm.nih.gov/pubmed/19960396

Dr. Carlos Erazo

Conocimientos elementales sobre educación sexual en alumnos de una escuela secundaria básica urbana

 

 "La iniciación de las relaciones sexuales es cada vez más temprana en los jóvenes.Entre otras razones, esto se debe a cambios en la actitud social hacia la sexualidad y a una maduración sexual más temprana. La precocidad en las relaciones sexualesno ocurre paralelamente con una adecuada educación sexual que brinde al adolescente la información sobre las consecuencias de tal acto, para el cual no está preparado; los profesionales de la atención primaria de salud deben conocer la situación existente en su área para actuar convenientemente. Identificar el nivel de conocimientos elementales sobre educación sexual en adolescentes de la Escuela Secundaria Básica Urbana (ESBU). ubicada en nuestra área de salud. Se realizó una investigación descriptiva, transversal, en la ESBU "XI Festival de la Juventud y los Estudiantes" del Reparto Alamar, Municipio Habana del Este, ubicada en el área de salud atendida por nuestro policlínico 13 de marzo. El universo estuvo constituidopor 200 estudiantes. Se incluyeron todos los estudiantes de noveno grado, quienes voluntariamente desearon participar; no hubo criterios de exclusión. Se aplicó una encuesta para conocer: edad de comienzo de relaciones sexuales y conocimientos sobre riesgo del embarazo en la adolescencia, infecciones de transmisión sexual (ITS), métodos anticonceptivos, uso de anticonceptivos en la primera relación y vías de información sobre educación sexual. La información fue almacenada en una base de datos EPIINFO; los datos se organizaron en tablas y para su análisis se utilizó el método porcentual. Cerca de 60% de los encuestados habían tenido relaciones sexuales. Entre las ITS más conocidas se encontraron el VIH/SIDA, gonorrea y sífilis. A pesar de conocer de la existencia de métodos para la anticoncepción, 70% de los 114 jóvenes, quienes manifestaron haber tenido relaciones sexuales, acudieron a este primer evento sin ninguna protección. Las fuentes de mayor información sobre educación sexual fueron de manera general, TV, maestros y padres. Los varones recibieron información mayormente de TV (58.3%), padres (48.5%) y la radio (34.9%), mientras que las féminas la obtuvieron de maestros (54.6%), TV (44.3%) y médico y enfermera de la familia (39.2%). En estos jóvenes, los conocimientos elementales sobre educación sexual son aún insuficientes y la familia debe tener un mayor papel protagónico para ambos sexos,

pues mucha información proviene de otras fuentes."


Link para poder acceder al artículo:  http://scielo.sld.cu/pdf/rhcm/v9n4/rhcm18410.pdf

Dr. Carlos Erazo

Neurological Complications of HIV Disease

Buenos días, aquí les dejo otro artículo interesante.


"Mild neurological impairment remains common in HIV-infected patients.

Before the advent of potent combination antiretroviral therapy (ART), neurological disease, including HIV-associated dementia (HAD), was common in HIV-infected individuals. How prevalent is such disease in the current HIV treatment era? Baseline data from the NIH-supported CHARTER study provide some insight.
A total of 1555 HIV-infected patients at six U.S. academic centers underwent extensive neurocognitive testing and psychiatric evaluation; 71% were receiving combination ART. Patients were categorized according to whether they had comorbidities that could cause neurocognitive impairment: 15% had confounding comorbidities severe enough to preclude diagnosing HIV-associated neurological disease, 30% had potentially contributing comorbidities, and 54% had other or no comorbidities.
Overall, 814 patients (52%) had neurocognitive impairment — 83% of those with confounding comorbidities, 59% of those with contributing comorbidities, and 40% of those with other or no comorbidities. In the latter two groups, 33% of patients had neurocognitive impairment that did not influence their everyday functioning, 12% had mild neurocognitive impairment, and 2% had HAD.
HIV-associated factors were associated with neurocognitive impairment only in the group with the least comorbidity. In that group, neurocognitive impairment was associated with both an AIDS diagnosis and a lower nadir CD4-cell count. Patients on ART had a higher prevalence of neurocognitive disease than those not on ART. However, the lowest rate among patients on ART was in those with both a nadir CD4 count 200 cells/mm³ and an undetectable viral load.
Comment: This study documents a continued high prevalence of neurocognitive impairment in the HIV-infected population. Some of the impairment is likely attributable to the infection itself and some to common comorbidities. Longitudinal data from this study should help to define the effect of ART on neurological conditions."



Link para mayor informafción para el tema: http://infectious-diseases.jwatch.org/cgi/content/full/2010/1215/2?q=etoc_jwneuro

Dr. Carlos Erazo

Hormone Therapy and Dementia Risk: A Critical Window?

 Este artículo es interesante en cuanto al uso de Terapia Hormonal y la demencia. 





"A prospective cohort study reveals a decreased risk for dementia in women taking HT in midlife but an increased risk for those taking HT in later life. 


Several observational studies have demonstrated a reduced risk for dementia in women who use hormone therapy (HT). However, well-designed interventional trials of estrogen–progesterone combinations have revealed an increased risk for dementia, cancer, and vascular events associated with HT use. This prospective cohort study was designed to further investigate the critical window theory that estrogen is beneficial only immediately before and immediately after menopause and may have deleterious effects in later life. More than 5000 women without dementia at baseline had been screened between ages 40 and 55 and reported whether they used HT (i.e., midlife use). Thirty years later, the authors identified participants' HT use (i.e., later-life use) from pharmacy databases. Starting when the cohort reached a median age of 80, the authors identified dementia from ICD-9 coding of diagnoses by neurologists, neuropsychologists, and internists; dementia assessment lasted 7.5 years.
During dementia assessment, 27% of the cohort received a diagnosis of dementia. Women who reported taking HT at midlife but had no evidence of later-life HT use had a significantly decreased risk for dementia diagnosis (adjusted hazard ratio, 0.74). In contrast, those who did not report midlife HT use but had evidence of later-life use had a significant increase in risk (AHR, 1.48). Women who had used HT in both midlife and later life had similar risks to those of women who had no evidence of HT use.
Comment: This study is potentially confounded by self-report data in its early phase and by the limitations inherent in the accuracy of pharmacy records and diagnostic coding in its later phase. Nonetheless, the findings unify data from observational and interventional studies of women using hormone therapy. Moreover, the findings are consistent with animal modeling of a critical window of estrogen-related neuroprotection, which is reportedly associated with improved cerebral blood flow and glucose use and with reduced amyloid deposition in the brain. The bottom line clinically is that HT use around menopause may help protect against dementia, but later use may increase risk."

Link para leer más sobre este tema:  http://neurology.jwatch.org/cgi/content/full/2011/104/1?q=etoc_jwneuro

Saludos

Dr. Carlos Erazo

Eventos disposicionales que probabilizan la práctica de conductas de riesgo para el VIH/SIDA

 Este es un interesante estudio realizado en el 2004 .

"Resumen: Se presentan los resultados de un estudio que tuvo como objetivo principal evaluar la capacidad de predicción de eventos disposicionales (conocimientos, creencias, circunstancias sociales y motivos) sobre la práctica de cuatro conductas de riesgo para la infección por VIH en una muestra de estudiantes universitarios. De tales eventos, únicamente los motivos evidenciaron su poder de predicción sobre todas las conductas de riesgo. Se analizan los resultados en función de la importancia que reviste la incorporación de variables de tipo motivacional en el diseño y puesta en marcha de programas de prevención del SIDA dirigidos a ese sector de la población."


Link para bajarse el artículo:  http://revistas.um.es/analesps/article/view/27541/26711

Saludos

Dr. Carlos Erazo

Un modelo de prevención primaria de las enfermedades de transmisión sexual y del VIH/sida en adolescentes

Este estudio fue realizzado en el 2001, en la actual Provincia de Santo Domingo de los Tsachilas.  Aqui el Resumen del artículo y al final esta el link para que ustedes puedan bajarse todo el mismo en formato pdf.

"Objetivos. Desarrollar, aplicar y evaluar un modelo educativo de prevención primaria de
enfermedades de transmisión sexual (ETS) y síndrome de inmunodeficiencia adquirida (sida)
basado en los conocimientos, actitudes y prácticas (CAP) sexuales de los adolescentes y en sus
percepciones y conductas al respecto, con el objetivo final de contribuir al desarrollo de herramientas
educativas de prevención de las ETS y de la infección por virus de la inmunodeficiencia
humana (VIH).
Métodos. Se aplicó un modelo de prevención primaria de ETS y VIH/sida a escolares
adolescentes (12 a 15 años) de Santo Domingo de los Colorados, Ecuador. Se formaron dos grupos
con características similares: el grupo de intervención (grupo I, n = 358) y el grupo de control
(grupo C, n = 288). Las escuelas se seleccionaron por criterios de inclusión, y los adolescentes
de cada escuela, al azar. Se aplicó una guía de discusión a 16 grupos focales; con esta
información se elaboró una encuesta sobre conocimientos, actitudes y prácticas (CAP) que,
después de su validación, fue aplicada a ambos grupos. En el grupo I se implementó un
programa educativo de prevención dirigido a estudiantes y docentes. Ocho meses más tarde
se aplicó una segunda encuesta CAP a los dos grupos. Las diferencias en los CAP antes y
después de la intervención fueron evaluadas utilizando la prueba de la 2.
Resultados. No existieron diferencias significativas entre los dos grupos antes de la intervención,
pero después de ella las diferencias fueron estadísticamente significativas (P = 0,012);
se verificó un aumento de conocimientos sobre sexualidad y ETS/sida en el grupo I, aunque
todavía no se ha evaluado la modificación de conductas a largo plazo.
Conclusiones. Este estudio permitió validar un modelo multifactorial de prevención de
ETS/sida adecuado a la realidad de los adolescentes, y sugiere la posibilidad de extrapolar la experiencia
a escalas mayores en contextos similares a los de la población investigada.

Link para bajarse el artículo:    http://www.scielosp.org/pdf/rpsp/v10n2/5861.pdf


Saludos

Dr. Carlos Erazo

Misión y Visión del PNS:

•    Misión: Enfrentamos la epidemia del VIH-sida en el Ecuador como un problema de desarrollo impulsando una respuesta multisectorial, promoviendo y ejecutando políticas desde nuestro rol como ciudadanos, organizaciones sociales e instituciones públicas.

•    Visión: Al 2015 en Ecuador se ha disminuido la velocidad de crecimiento de la epidemia del VIH-sida gracias a una respuesta nacional, multisectorial, coordinada y con políticas públicas en ejecución que garantizan, con enfoque de género y derechos humanos, el acceso universal al a promoción, prevención y atención integral así como a la equidad y la igualdad de oportunidades para las persona viviendo con VIH-sida.

 

Fuente: Programa Nacional VIH/SIDA.MSP del Ecuador

PERFIL EPIDEMIOLOGICO DE LA INFECCIÓN POR EL VIRUS DE INMUNODEFICIENCIA HUMANA (VIH)

Este es un trabajo realizado en el 2003, pero siempre es interesante saber y visualizar los estudios llevados a cabo en nuestro país.

Les dejo aqui el link para visulizarlo

http://www.asical.org/es/todo/ATT1124550279-1.pdf

Saludos

Dr. Carlos Erazo

INFORMACIÓN DE LA SITUACION DEL VIH/SIDA EN EL ECUADOR EN LA PROVINCIA DE LOS RIOS 2007

En esta dirección podemos observar un documento en el que no se identifica el autor pero que podemos leerlo, sobre la situación del VIH/SIDA en el Ecuador en la provinicia de Los Ríos.

http://www.scribd.com/doc/21135310/El-Problema-Del-Sida-en-Ecuador-los-Rios

No s epude bajar el docuemnto en pdf , porque seria necesário pagar, pero permite leerlo.


Saludos

Dr. Carlos Erazo

BIENVENIDOS AL BLOG DE LA RED DE EPIDEMIOLOGOS DEL ECUADOR QUE TRABAJA CON VIH/SIDA E ITS DEL AREA PUBLICA DEL ECUADOR

Bienvenidos a todos los epidemiologos que trabajan con VIH/SIDA e ITS en el Ecuador.

Este blog intenta ser un mecanismo de comunicación y de formación médica continua sobre temas relacionados con la vigilancia epidemiológica y monitoreo de esta enfermedad.

Saludos

Dr. Carlos Erazo