Lump On Bull Dog Throat

World Congress in Cologne 2009 (Comment Uruguay)

FUNDAMENTAL CONGRESS LOOKING AHEAD

in different languages \u200b\u200bAuthors of papers and posters presented at the XXIII World Congress of hydatidosis described the current disease situation within those considered by health authorities around the world, whether governments or international organizations. The English language called "A Neglected disease, a disease that is forgotten, neglected or overlooked. So did our authorities health. Dr. Christine Budke, University of Texas, a study on the losses that this condition results in man and animal production, as well as DALYS (Disability Adjusted Life Year or Years from DALYs) lost , providing still very conservative figures, partial and provisional, put at U.S. $ 763:000.000 year in human loss and U.S. $ 2.200:000.000 year in losses to the livestock, collecting information from some countries known, but in fact in this area have the same vision of the iceberg is just the eighth of its total volume, which remains under water for hydatid ignorance.

A WORLD PANORAMA

The President of the AIH (Prof. Dr. Antonio Menezes da Silva, Chief General Hospital Pulido Valente, Lisbon, Portugal) in his inaugural lecture defined the situation in these terms :
echinococcosis is a zoonosis caused by larval forms (metacestodes) parasites of the genus Echinococcus. Of the two known species are of particular medical importance: E. granulosus and E. multilocularis, respectively responsible for Cystic Echinococcosis (CE) and echinococcosis alveolaris (EA). The annual incidence of AD is generally low in most endemic areas (0.03 - 1.2 per 100,000 population), yet the mortality of patients untreated or inadequately treated, is over 90% in the 10 to 15 years of diagnosis. The annual incidence of EQ can range from less than 1 case to 200 cases per 100,000 population in several endemic regions. The mortality rate (about 2-4%) of the EQ is lower than that of EA, but may increase substantially if the treatment and care are not adequate. In view of public health significance of the EQ and EA in different countries, WHO launched in 1981, a multicenter clinical study on medical treatment of human echinococcosis because individual studies conducted since 1977 were unreliable results. Progress and problems in the treatment of human echinococcosis were discussed by the Informal Group on Echinococcosis WHO and presented in the WHO Bulletin 1996.

Despite the public health impact, Echinococcosis is a neglected disease, for several reasons:

• zoonosis is a chronic, difficult to detect and treat;
• mainly affects poor , marginal and underdeveloped areas;
• is dependent on many aspects: social, cultural and behavioral;
• The transmitters and large reservoirs (dogs and other canines, but also domestic and wild cats in some areas) are asymptomatic;
• control the disease is very difficult, very expensive and very long time.

For these reasons, governments and politicians do not consider a priority the fight against this disease, which is obviously not the case of Uruguay.

In monitoring and control of disease is necessary to act in different areas. Are key factors for success:

• and legislation support de las autoridades;
• La educación sanitaria con la participación de la comunidad
• El control de los perros;
• Registro de los perros y detección y tratamiento de perros infectados;
• Control de los perros vagabundos (eliminación?/castración?)
• Control en los mataderos.

Para conseguir este éxito es necesario:

• Tener estabilidad política y seguridad;
• Considerar la enfermedad una prioridad de salud pública;
• Tener una financiación adecuada para, al menos 5 años;
• Having the support of the Ministry of Agriculture and cooperation of veterinary services;
• Obtain acceptance and participation of people in the struggle
• Apply the rules regarding control programs established by Michael Gemmel, many years .

Although a delayed disease, eradication is possible. For this we need the collaboration of all, authorities, universities, scientists and scientific associations, governmental and nongovernmental organizations.

NEWS, SUCCESSES AND FAILURES

A critical analysis of strategies for control of the EQ and use of praziquantel (an anthelmintic for dogs, which has replaced more than 30 years old arecoline), presented by Larrieu and Zanini (of Black River, and Tierra del Fuego, Argentina) , said that in the region (Argentina, Uruguay, Chile, Peru and southern Brazil) is more than 2,000 new human cases reported each year. Where sheep farming associated with holding large numbers of dogs and the habit of fishing for own consumption adult sheep by feeding the dog with infected viscera, create ideal conditions for maintaining the disease cycle. The study ultrasound of human populations in various communities affected asymptomatic showed infection rates of 5.5% (1986, Black River, Argentina), 14.2% (1988, Loncohué, Neuquén, Argentina), 1.6% (1990 , Tacuarembó, Uruguay), 1.6% (1997, Florida, Uruguay), 3.6% (1998, Durazno, Uruguay) and 5.1% (1999, Vichaycocha, Peru), indicative that the EQ is really a serious health problem in parts of South America.

The expectation, somewhat naive, since Praziquantel appeared in 1977, finally have a safe and effective drug, would bring rapid progress in disease control, as was obtained in the island territories taken as a model (Tasmania, New Zealand). After 30 years of implementing a drug 100% effective and safe, no endemic area in South America has reached the stage of eradication and only two programs (the XII Region of southern Chile and Uruguay) sustained phases of attack consistent with Gemmel forecasts made in 1986. Thus, the use of Praziquantel has yielded modest results in the control of echinococcosis and have little impact on the prevalence of the disease in man. Clearly, the availability of drugs has not ensured their effective use. But mostly, this strategy has not proved economical and sustainable politically endemic regions usually are among the poorest in each country.

On the contrary, the experience of Tierra del Fuego in Argentina and Black River alternatives pose simple, inexpensive and feasible based primarily on the continuation of field activities and sustainable by the community to be financed, and were successful in achieving strong decreases in transmission to man, the central aim of the health sector. In light of these results, these authors considered that the use of the EG95 vaccine, which came into industrial production stage to apply to sheep and goats, for a project of scientific cooperation between Australia, New Zealand and Patagonia Argentina, which according to its authors can reach 100% effectiveness with three successive applications will require, in addition to specific funds for acquisition, a strong infrastructure for vaccination and revaccination field every year thousands of sheep and a strong support given to producers from endemic areas to take responsibility for its use. If this does not happen, probably would face new results disappointing.

Irabedra
Pilar, a veterinarian and epidemiologist at the CNZ (National Committee on Zoonoses, Uruguay), who participated in the conduct of major studies commissioned by FAO to determine the economic impact of this disease, which are published on the internet, showed how to redesign strategies, as applied to 2005 based almost exclusively on praziquantel administration did not produce the expected results, despite the illusory figures disseminated in good faith but not taking into account the marginal populations, growing in Uruguay, concentrators infected human and canine populations largely out of control and parasitized. It began using complementary lines of action in line with local realities, implemented since 2007 a Strategic Plan based on a "risk approach", identifying areas favorable the introduction and / or maintenance of endemic cycles, building the epidemiological stratification of the disease, leading to the risk areas without neglecting the general promotion and disease prevention. The redesign included the strengthening of the dosage canine, human ultrasound screening to detect asymptomatic carriers, and the development and promotion of programs for responsible pet ownership including population control through sterilization (castration) surgical male and female canine . Coupled with this development agreements with the UDELAR and other organizations for applied research, training of professionals on zoonoses and other tools from Educational Psychology. The CNZ and showed some of his most resounding successes, achieved not without professional competitions with great tenacity.

VACCINES FOR DOGS

Notable progress has been made in cooperative experiences between scientists from Xinjiang, China, and Queensland, Australia, in the development of vaccination against Echinococcus granulosus in dogs using three genes EgM4, EgM9 and EgM123 from the mature adult worm. Chinese scientific groups, collaborating with Japanese colleagues, French, British and Australians develop molecular biology techniques for genetic differentiation, which would act on the inhibition of early growth and development of the tapeworm in the dog. Cooperative projects between scientists from various universities in Japan and Switzerland advance in the design of tests to identify eggs of different species of tapeworms of the genus Echinococcus (granulosus, multilocularis, vogeli) .

THE CONTRIBUTION OF IMAGING AND NON-INVASIVE SURGERY

A remarkable panel discussion took place to show the detection of QH at various stages of life or suffering, whether death of the parasite, using ultrasound, CT and MRI, with key contributions of Uruguay and Luis Dibarboure Henry Cohen, José Remis de Tucumán, Argentina, and Carlos Mercapide of Argentina.

As serological screening methods by John Abin, Uruguay. The collaboration of gastroenterologists with instrumental cholangioscopy can solve in a bloodless QH breaks open bile duct drainage or QH communicating with the bile duct, in certain favorable locations.

THE TREATMENT OF ALVEOLAR

ECHINOCOCCOSIS

A group Medical Besancon, Grenoble, France, led by Dominique Mantion Georges Vuitton in collaboration with Akira Ito, Japan and Wen Hao of China, achieved encouraging results for medical and surgical treatment of AD, including prolonged administration of albendazole and including liver transplantation in severe cases, a condition that previously had a mortality approaching 100%, which is in decline. Eduardo Caldas, Brazil, was the result of recent research from the Ministry of Health, making a map of the distribution of EQ in Rio Grande do Sul, on the border with Uruguay, vast areas of EA in the Amazon region and the Northeast , with more recent data.

LAPAROSCOPIC TREATMENT IN CHILDREN AND ADULTS

surgeons and Paysandu (Bettina Cochi, Hediber Odone), Carmelo (Raul Maglione), Spain (Carlos Franco), Argentina (Ricardo Pettinari, Chubut) and Morocco (Fadma Abi) showed its successful results and experience in the management of complications or prevention in children and adults by laparoscopic surgical technique that leaves minimal wall sequelae compared with multiple large incisions that once sailed in addresses all the wombs of multi-operated patients. While showing technical excellence, high ethical commitment to achieve the best outcomes for their patients, looking at the future of these children and young people should look for a future life free of complications or psychologically affected by their aesthetic referrals.

SURGICAL EXPERIENCE URUGUAYA

Two round tables were the main attraction of the surgeons and all those present, where the greatest exponents of the current Uruguayan surgery, led by Sonia Boudrandi, Oscar Balboa, Russian and Hector Luis Geninazzi , Gerardo Bruno, pluck Tchekmedyian endoscopists and Eduardo Calleri, Portuguese Antonio Menezes da Silva and German Peter Kern, addressed various aspects. From the historical review of long experience of old masters to publications that are epitome of world literature, throughout the twentieth century, to the wonders of laparoscopic surgery to address complex clinical situations with skill, expertise and adequate instrumentation, primarily QH complicated forms of chest, abdomen and transit hepato-biliary-bronchial. His stunning performances of videos of surgeries performed, some for over twenty years, demonstrated the quality of their work, with a permanent recognition for their Masters: Larghero, Ugón Armand, Luis Praderi, among others. Were also excellent presentation of various experiences of a large number of patients in the older Chinese surgeons in radical surgery of hepatic hydatidosis, as the case of Yu Xin Pen, Xinjiang, or teacher Hao Wen, just west province China, one of the most heavily populated nation.

INTERNATIONAL COOPERATION

should be noted the widespread international cooperation that has allowed groups to form in recent years by jumping geographies and differences of political organization, have enabled great progress. We refer to projects cooperative Chinese and French scientists in Moroccan and Peruvian, Japanese, Australian and Chinese, or Japanese and Swiss, Argentine, Australian and New Zealand, Brazil and Uruguay, Argentina and Chile in the southern region of South America. And that opens cooperation with colleagues in Peru and Bolivia, interested in achieving the most successful programs to encourage their populations most affected by this endemic hydatid.
What better tribute to the visionaries who founded the IAH, to see this current situation, full of promise and success, with key progress but can not eradicate the disease, give us clues to strategize with faith and hope, founded realities that apply advanced technologies and close collaboration within narrow limits. With the globalization of communications and the wide availability of information that we maintain and reinforce through these non-governmental organizations, and greater support from Governments and the Ministries of Health and Livestock and Agriculture, may be expected in the medium and long term to realize the dream of eradicating the disease from the face of the Earth, as called for by French Master Dévé Félix (1872-1951) who was so attached to his colleagues on Rio de la Plata first and Basin Mediterranean then generously giving their expertise, and was repeatedly noted in the historical revisions. As were our Master Uruguayan Velarde Perez Fontana (1897-1975) and Victor Ugón Armand (1900-1972) projection Colonia two prominent leader in this field.

IN SUM

A high-level scientific conference, at the confluence of developments in molecular biology, with innovative solutions for the biochemical diagnosis, immunology provides both an optimistic expectation if achieved State policies to support the campaigns and provide the necessary resources, and developments in the surgical treatment that are increasingly globalized, showing that the medicine does not recognize borders and doctors are a universal brotherhood, as he has spoken almost 70 years ago, the Pan American Medical Confederation in its founding statutes. The union will make us strong, but also make us free.

The next World Congress of hydatidosis, to be held within two years, will take China as host, and those attending will have the opportunity to meet this awakening giant.