OBJECTIVE: To identify the main strengths, weaknesses, and challenges of the Ecuador-Peru "peri-border" health care program and to analyze the legislative, managerial, and organizational arrangements adopted to integrate the two country's national health systems in the border area. METHODS: A descriptive, qualitative case study was carried out using three complementary methods: literature review and analysis of official Peruvian and Ecuadoran national and binational documents, 18 semi-structured interviews of key informants, and a survey of the entire health worker population of the Suyo-Macará binational micro-network. RESULTS: The key program challenge was the absence of reciprocity; Peruvian citizens were entitled to free health care services in Ecuador but Ecuadoran citizens did not receive the same benefit in Peru. The need for improvements in the binational system's human resources was also identified. The program's main strength was its organizational structure, which is designed mainly for the implementation of 1) the binational network and 2) a patient referral / counter-referral system that includes the transfer of patient clinical information. CONCLUSIONS: Notwithstanding considerable challenges, peri-border programs are feasible and replicable. Program success seems to be highly dependent on the completion of a number of steps, including 1) consolidation of the original binational memorandum into a binding binational agreement between the two countries; 2) achievement of similar standards in both countries for the provision and quality of health care services, focusing on complementarities; and 3) development of an integrated binational information system.

OBJETIVO: Determinar los principales puntos fuertes y débiles, y las dificultades del programa de atención de salud en la zona fronteriza entre Ecuador y Perú, y analizar las disposiciones legislativas, de gestión y de organización adoptadas para integrar los sistemas nacionales de salud de ambos países en la zona fronteriza. MÉTODOS: Se llevó a cabo un estudio de casos descriptivo y cualitativo mediante el empleo de tres métodos complementarios: la revisión bibliográfica y el análisis de documentos oficiales peruanos y ecuatorianos, nacionales y binacionales; 18 entrevistas semiestructuradas a informantes clave; y una encuesta dirigida a todo el personal sanitario de la microrred binacional Suyo-Macará. RESULTADOS: La principal dificultad del programa estribó en la ausencia de reciprocidad; los ciudadanos peruanos tenían derecho a servicios de atención de salud gratuitos en Ecuador, pero los ciudadanos ecuatorianos no recibían la misma prestación en Perú. También se señaló la necesidad de mejoras en materia de recursos humanos del sistema binacional. La principal fortaleza del programa fue su estructura organizativa, diseñada principalmente para la implantación de 1) la red binacional; y 2) un sistema de referencia y contrarreferencia de los pacientes que incluye la transferencia de la información clínica de los pacientes. CONCLUSIONES: A pesar de las considerables dificultades, los programas de atención de salud en zonas fronterizas son factibles y reproducibles. El éxito de los programas parece depender en gran medida de que se cumplan una serie de condiciones tales como 1) la consolidación del memorándum binacional original mediante un acuerdo binacional vinculante entre ambos países; 2) la consecución de estándares similares en ambos países en cuanto a la provisión y la calidad de los servicios de atención de salud, con especial hincapié en la complementariedad; y 3) la creación de un sistema binacional de información integrado.

Foram estudadas 60 biopsias cutâneas de 58 pacientes nicaraguenses com leishmaniose tegumentar e ainda não em tratamento terapêutico. Quase todas as biopsias foram classificadas nos grupos histopatológicos de Ridley: 36 (60%) foram incluídas no grupo B ("diffuse necrosis"), 14 (23%) no grupo C ("focal necrosis"), 7 (11.6%) no grupo D ("reactive tuberculoid"). Somente 3 biopsias ficaram sem classificação. Não se achou nenhum caso que se pudesse classificar nos grupos A e E. Em 18 casos, usando método imunohis-toquímico, foram observados corpúsculos de Russel. Destes 18 casos 17 eram IgM positivos e só 1 IgG positivo. Não se descobriu correlação entre os grupos histopatológicos e a presença de corpúsculos de Russel. Todavia se imagina que os corpúsculos de Russel possam ter um significado diagnóstico (como um critério adjunto). Pode-se supor também uma correlação entre as numerosas alterações morfológicas e as diferentes espécies de leishmanias.

Sixty skin biopsies of fifty-eight non-treated patients with cutaneous leishmaniasis from Nicaragua were studied. Biopsies were classified according to Ridley's histopathologic groups: 36 (60%) were included in group B (diffuse necrosis), 14 in group C (focal necrosis), 7 (11.6%) in group D (reactive tuberculoid). Only three biopsies remained unclassified. None of our cases could be included in groups A and E. Immunohistochemistry disclosed in 17 cases Russel's bodies secreting IgM and only one IgG positive. There was no correlation between the histopathologic groups and the presence of Russel's bodies. However, we believe the presence of Russel's bodies help the diagnosis of leishmaniasis. Correlation between morphological patterns and the different leishmania species was also considered.