Altacílio Aparecido Nunes

Perfil epidemiológico da hanseníase em um município brasileiro, no período de 2000 a 2006

INTRODUCTION: Leprosy is considered to be a major public health problem in developing countries. It is estimated that notifications are issued only in relation to 1/3 of the patients and that, among these patients, many undergo irregular treatment or drop out, thus increasing the impact of the disease. The objective this paper was to describe the epidemiological profile of the population with a diagnosis of leprosy in the municipality of Uberaba, State of Minas Gerais, Brazil, between 2000 and 2006. METHODS: This was a retrospective study using data from notifications of leprosy cases in the Notifiable Disease Information System of the Brazilian Ministry of Health. RESULTS: There were 455 recorded cases of leprosy, and 55.4% of these were among males. The most affected age group was 34 to 49 years (31.4%), while nine cases of leprosy (2%) were found in children under the age of 15 years. The commonest clinical form was the borderline type (69.1%) and the operational class was multibacillary (87%). These findings are a matter of concern, considering that the age group that is most economically active is potentially the principal group spreading the disease. CONCLUSIONS: The finding that 87% of the cases were multibacillary indicates that the diagnoses were late. It is therefore necessary to decentralize the leprosy care services and train more professionals to enable earlier diagnosis and treatment.

Fatores associados à procura por serviços de saúde numa perspectiva relacional de gênero

Male culture values involve risk behaviors to health, since the way men perceive and experience their masculinity is one of the most influential shapers of falling sick and dying. The scope of this study was to identify the factors associated with the demand for health services and differences between the sexes by selecting users of health services. The dependent variables were sex of the user (cultural indicator) and failure to seek out health services. Independent variables included socio-demographic and clinical-epidemiological characteristics. The Prevalence Ratio studied by univariate and multivariate analysis was used in the analysis of the association between variables. The factors associated with non-demand for health services included: being male, hours of operation of health care facilities, working hours of the user and not having any disease. By multivariate analysis the factors facilitating demand for health services (protection) were: being female aged 26 to 49 years. Effective consolidation of a health care model that questions the contradiction that exists between the epidemiological data regarding mens health and the position of the health services using common sense regarding the apparent invulnerability of men to falling sick is of great relevance.

Vagus nerve stimulation in pediatric patients: Is it really worthwhile?

Vagus nerve stimulation (VNS) seems to be effective in the management of selected cases of pharmacoresistant epilepsy in children. This was a case-control prospective study of children with refractory epilepsy submitted to vagal nerve stimulator implantation and a control group with epilepsy treated with antiepileptic drugs. Patients under 18years of age who underwent clinical or surgical treatment because of pharmacoresistant epilepsy from January 2009 to January 2012 were followed and compared with an age-matched control group at final evaluation. Statistically significant differences were observed considering age at epilepsy onset (VNS group - 1.33±1.45years; controls - 3.23±3.11; p=0.0001), abnormal findings in neurological examination (p=0.01), history of previous ineffective epilepsy surgery (p=0.03), and baseline seizure frequency (p=0.0001). At long-term follow-up, 55.4% of the patients in the VNS group had at least 50% reduction of seizure frequency, with 11.1% of the patients presenting 95% reduction on seizure frequency. Also, a decrease in traumas and hospitalization due to seizures and a subjective improvement in mood and alertness were observed. The control group did not show a significant modification in seizure frequency during the study. In this series, VNS patients evolved with a statistically significant reduction of the number of seizures, a decreased morbidity of the seizures, and the number of days in inpatient care. In accordance with the current literature, VNS has been proven to be an effective alternative in the treatment of pediatric patients with drug-resistant epilepsy.

A family history of serious complications due to BCG vaccination is a tool for the early diagnosis of severe primary immunodeficiency

Severe Combined Immunodeficiency (SCID) is one of the most severe forms of primary immunodeficiency (PID). Complications of BCG vaccination, especially disseminated infection and its most severe forms, are known to occur in immunodeficient patients, particularly in SCID. A carefully taken family history before BCG injection as well as delaying vaccination if PID is suspected could be a simple and effective method to avoid inappropriate vaccination of an immunodeficient child in some cases until the prospect of newborn screening for SCID has been fully developed. We describe a patient with a very early diagnosis of SCID, which was suspected on the basis of the previous death of two siblings younger than one year due to severe complications secondary to the BCG vaccine. We suggest that a family history of severe or fatal reactions to BCG should be included as a warning sign for an early diagnosis of SCID.

Prevalence of Rotavirus in Acute Diarrhea and its Association with Clinical Signs and Symptoms

Rotaviruses are the main etiological agents of acute infectious diarrhea in children. Thus, the objective of this study is to contribute to the information about the rotavirus variants circulating in Brazil. A cross-sectional study was conducted on 124 fecal samples collected from children up to the age of 5 years, with acute gastroenteritis. Thirty-one samples were positive for rotavirus A. Regarding the G genotyping, 16 (80%) were classified as G1 and regarding P genotyping all strains were classified as P[8]. The determination of the prevalence of rotavirus infection and the characterization of the viral strains circulating are expected to contribute to the information we have about the molecular biology and epidemiology of disease.

Impact of the antipneumococcal conjugate vaccine on the occurrence of infectious respiratory diseases and hospitalization rates in children

INTRODUCTION In 2010, to reduce the occurrence of serious pneumococcal disease, the Ministry of Health in Brazil incorporated the 10-valent pneumococcal vaccine in the immunization schedule of children younger than two years of age. The objective of this study was to evaluate the impact of vaccination on the incidence of infectious respiratory diseases in infants before and after the introduction of the 10-valent pneumococcal vaccine. METHODS This cross-sectional study involved primary care and hospital networks from a city in Minas Gerais State, Brazil, between 2009 and 2012. RESULTS A 40% reduction in the prevalence of community-acquired pneumonia (CAP) was observed after introducing the pneumococcal conjugate vaccine. Male children were 28% more likely to develop the disease. The prevalence ratio ([PR] = 1.96, 95% CI: 1.52 to 2.53, p < 0.05) suggested that not being vaccinated was associated with the occurrence of pneumonia. The prevalence of CAP was 70% lower (PR 0.30, 95% CI: 0.24 to 0.37, p<0.05) in children vaccinated as recommended compared to children with delayed vaccination, suggesting that the updated vaccine schedule improves protection. CONCLUSIONS Immunization with the 10-valent pneumococcal vaccine appeared to reduce the number of pneumonia cases in children during the study period. Prospective studies are needed to confirm the efficacy of the vaccine against the occurrence of pneumococcal pneumonia.

Resolubilidade da estratégia saúde da família e unidades básicas de saúde tradicionais: contribuições do Pet-Saúde

O Programa de Educacao pelo Trabalho para a Saude (PET-Saude) materializa uma politica indutora de novas relacoes entre instituicoes de ensino de nivel superior e a rede assistencial a saude. A Universidade de Sao Paulo - Campus de Ribeirao Preto e a Secretaria de Saude do municipio, selecionadas pelo PET-Saude/2009, avaliaram a resolubilidade das Unidades Basicas de Saude (UBS) e das Unidades de Estrategia Saude da Familia (ESF), como forma de contribuir para a qualificacao da Atencao Basica. Foi realizado um estudo transversal em 13 Unidades de Saude (oito ESF e cinco UBS), com a participacao de 216 alunos dos cursos da area da saude, 30 preceptores (profissionais) da rede publica de saude e cinco tutores (docentes). Foram coletados dados de 12.494 atendimentos, sendo 7.129 (58,9%) em ESF e 4.963 (41,1%) em UBS, compostos por 4.059 (33,6%) pessoas do sexo masculino e 8.035 (66,4%) do feminino.As UBS referenciaram mais pacientes do que as Unidades de ESF (OR = 1,67; IC 95% 1,46 - 1,90; [p < 0,05]). As especialidades com maior demanda por encaminhamentos foram oftalmologia, cardiologia e ortopedia. A ESF apresenta-se como modelo assistencial com maior resolubilidade, e o PET-Saude e uma iniciativa importante, considerando-se que estimula a ampliacao desse modelo.

Qualidade de vida de pacientes hemofílicos acompanhados em ambulatório de hematologia

O objetivo deste trabalho foi caracterizar a qualidade de vida de pacientes hemofilicos em acompanhamento ambulatorial em servico especializado. Foi feita abordagem quantitativa da qualidade de vida (QV) de pacientes hemofilicos acompanhados em ambulatorio de hematologia de um hemocentro regional. A coleta de dados foi realizada por meio de entrevistas utilizando-se o Whoqol-bref e questionario adicional com variaveis sociodemograficas e clinico-epidemiologicas. Para analise dos dados utilizaram-se o Epi-info 6.04d e o SPSS, cujos resultados foram expressos atraves de distribuicao simples, medidas de tendencia central e dispersao, proporcoes e correlacao de Pearson entre facetas e dominios. Foram entrevistados 23 pacientes, com media de idade de 21 anos; todos moravam com familiares, 47,8% eram residentes na cidade sede do hemocentro. Do total, 78,3% eram solteiros, 69,6% estudavam, sendo que 45,5% possuiam o 1o grau incompleto e 82,6% nao trabalhavam. A maioria (91,3%) possuia hemofilia A. Quanto a avaliacao da QV, 47,8% responderam ser boa e 55% possuiam um bom nivel de satisfacao com a saude. O dominio psicologico apresentou o maior escore medio e o menor foi o do dominio meio ambiente. Com esse estudo conseguiu-se salientar a magnitude de alguns problemas dos hemofilicos.

Cost Evaluation of Metastatic Colorectal Cancer Treatment in the BrazilianPublic Healthcare System

Objective: The study aimed at evaluating and comparing healthcare-related costs for metastatic colorectal cancer treatment among patients receiving systemic (chemotherapy or biotherapy) therapy, considering both costs per treatment cycle and total costs per patient. Methods: This was a cross-sectional, econometric study conducted in a public, tertiary referral hospital in Brazil, which is supported by national and state level funding. Data were collected between January 01, 2009 and October 31, 2013. Micro-costing method was employed to estimate costs related to medication, laboratory tests, imaging tests, drug preparation and administration. Results: The XELOX plus bevacizumab therapy presented the highest average cost per cycle, 7,701 Brazilian reals, followed by FOLFIRI plus bevacizumab, with an average cost of 6,927 Brazilian reals. Costs of treatment regimens containing capecitabine and/or monoclonal antibody (capecitabine monotherapy, cetuximab, cetuximab plus irinotecan, FOLFIRI plus bevacizumab, XELIRI, XELIRI plus bevacizumab, XELOX and XELOX plus bevacizumab) had a greater impact on total cost of therapy. In the mFOLFOX6 and FOLFIRI regimens, the total cost of therapy was mostly influenced by the cost per cycle (51%) and the cost related to drug administration (50%). Conclusions: the Brazilian universal healthcare system does not cover monoclonal antibody therapies and the chemotherapy regimens FOLFIRI and mFOLFOX6 for colorectal cancer, since they surpass the monthly reimbursement amounts provided by the system. On the other hand, XELOX regimen fits within the budget established by the system, representing a promising alternative for colorectal cancer treatment, especially taking into account current economic limitations.

Análise dos fatores associados a quedas com fratura de fêmur em idosos: um estudo caso-controle

OBJECTIVE: To identify the main factors associated to falls and hip fractures in the elderly. METHODS: This is a case-control study (a group of cases and two control groups) in a 1: 1: 1 proportion, studying 135 individuals aged ≥60 years, matched by sex, from 2005 to 2012. Data were collected through interviews at the homes of participants, and information was gathered from medical records. To analyze the differences between proportions and means between groups, they employed the chi-square and Students t test, respectively. To study the association between variables, were performed univariate and multivariate analyzes using logistic regression. As effect measure, were employed odds ratio (OR) and its confidence interval at 95% (95%). In all analyzes, we considered a 5% significance level. RESULTS: After multivariate analysis, hip fracture protection factors were: listen well and have handrails on the stairs of their homes. Risk factors for hip fracture were: hypertension, sedentary lifestyle and have slippery surface in the residence. Protective factors for fall were: have handrails on the stairs of their homes, have osteoporosis and depression. Risk factor for falls was physical inactivity. CONCLUSION: Hip fractures are an important cause of morbidity in the elderly. Knowing the risk factors for post-fall fractures in the elderly is essential for planning individual and collective actions aimed at prevention of this disease and its consequences. Physical activities, more effective treatment plans and inadequacies correction in households of those individuals should be counseled and encouraged.