Henry Maia Peixoto

Clinical complications of G6PD deficiency in Latin American and Caribbean populations: systematic review and implications for malaria elimination programmes

BackgroundAlthough G6PDd individuals are generally asymptomatic throughout their life, the clinical burden of this genetic condition includes a range of haematological conditions, including acute haemolytic anaemia (AHA), neonatal jaundice (NNJ) and chronic non-sphaerocytic anaemia (CNSA). In Latin America (LA), the huge knowledge gap regarding G6PDd is related to the scarce understanding of the burden of clinical manifestation underlying G6PDd carriage. The aim of this work was to study the clinical significance of G6PDd in LA and the Caribbean region through a systematic review.MethodsA systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Only original research was included. All study designs were included, as long as any clinical information was present. Studies were eligible for inclusion if they reported clinical information from populations living in LA or Caribbean countries or about migrants from these countries living in countries outside this continent.ResultsThe Medline search generated 487 papers, and the LILACS search identified 140 papers. After applying the inclusion criteria, 100 original papers with any clinical information on G6PDd in LA were retrieved. Additionally, 16 articles were included after reading the references from these papers. These 116 articles reported data from 18 LA and Caribbean countries. The major clinical manifestations reported from LA countries were those related to AHA, namely drug-induced haemolysis. Most of the published works regarding drug-induced haemolysis in LA referred to haemolytic crises in P. vivax malaria patients during the course of the treatment with primaquine (PQ). Favism, infection-induced haemolysis, NNJ and CNSA appear to play only a minor public health role in this continent.ConclusionHaemolysis in patients using PQ seems to be the major clinical manifestation of G6PDd in LA and contributes to the morbidity of P. vivax infection in this continent, although the low number of reported cases, which could be linked to under-reporting of complications. These results support the need for better strategies to diagnose and manage G6PDd in malaria field conditions. Additionally, Malaria Control Programmes in LA should not overlook this condition in their national guidelines.

G6PD deficiency in Latin America: systematic review on prevalence and variants

Plasmodium vivax radical cure requires the use of primaquine (PQ), a drug that induces haemolysis in glucose-6-phosphate dehydrogenase deficient (G6PDd) individuals, which further hampers malaria control efforts. The aim of this work was to study the G6PDd prevalence and variants in Latin America (LA) and the Caribbean region. A systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Low prevalence rates of G6PDd were documented in Argentina, Bolivia, Mexico, Peru and Uruguay, but studies from Curaçao, Ecuador, Jamaica, Saint Lucia, Suriname and Trinidad, as well as some surveys carried out in areas of Brazil, Colombia and Cuba, have shown a high prevalence (> 10%) of G6PDd. The G6PD A-202A mutation was the variant most broadly distributed across LA and was identified in 81.1% of the deficient individuals surveyed. G6PDd is a frequent phenomenon in LA, although certain Amerindian populations may not be affected, suggesting that PQ could be safely used in these specific populations. Population-wide use of PQ as part of malaria elimination strategies in LA cannot be supported unless a rapid, accurate and field-deployable G6PDd diagnostic test is made available.

Serological diagnosis of canine visceral leishmaniasis in Brazil: systematic review and meta‐analysis

To evaluate the quality and accuracy of serological diagnosis of canine visceral leishmaniasis in the Americas.

Prevalência e fatores associados à depressão entre idosos institucionalizados: subsídio ao cuidado de enfermagem

The objective of this study was to verify depression among institutionalized elderly individuals. The cross-section method and Yesavages Geriatric Depression Scale were utilized in five geriatric long-term care facilities located in the Federal District to verify symptoms of depression. A total of 299 individuals were studied, 181 of whom did not meet the inclusion criteria. Sixteen individuals declined to participate. Considering the 102 individuals found suitable to participate in the study, 49.0% presented symptoms of depression; 36.3% suffered from mild to moderate depression and 12.7% showed symptoms of severe depression. Associations were found between depression symptoms and increased age, female gender, physical limitations/dependence and dissatisfaction with the institution. A significant association was also found between depression and insomnia, tachycardia, paresthesias, dizziness and excessive sweating. Depression is highly prevalent among institutionalized elderly individuals, more common among women, and correlated with a series of signs and symptoms that may help in making an early diagnosis, thus offering support to providing more effective nursing care.Se objetivo verificar la depresion en ancianos institucionalizados. Se empleo el metodo transversal, utilizando la Escala de Depresion Geriatrica de Yesavage en cinco hogares geriatricos del Distrito Federal, para verificar sintomatologia depresiva. Fueron estudiados en total 299 individuos, 181 no atendieron los criterios de inclusion y 16 recusaron su participacion. De los 102 ancianos participantes del estudio, 49,0% presentaba depresion: 36,3% de leve a moderada, 12,7% depresion severa. Se verificaron asociaciones entre sintomas depresivos y aumento etario, sexo femenino, limitacion/dependencia e insatisfaccion con la institucion. Existio inclusive asociacion significativa entre depresion e insomnio, taquicardia, parestesia, mareos y sudoracion excesiva. La depresion es altamente prevalente entre ancianos institucionalizados, es mas comun entre las mujeres, y se relaciona a una serie de signos y sintomas que pueden cooperar a un diagnostico precoz, facilitandose una atencion de enfermeria mas efectiva.Este estudo teve como objetivo a verificacao de depressao entre idosos institucionalizados. Empregou-se o metodo transversal utilizando-se a Escala de Depressao Geriatrica de Yesavage em cinco instituicoes de longa permanencia do Distrito Federal para verificar sintomas de depressao. Foram estudados ao todo 299 individuos. Destes, 181 nao atenderam os criterios de inclusao e 16 se recusaram a participar do estudo. Dos 102 idosos com condicoes de participar do estudo, 49,0% apresentavam depressao. Destes, 36,3% com depressao leve a moderada e 12,7% com depressao severa. Verificou-se associacoes entre sintomas de depressao e aumento da idade, sexo feminino, limitacao/dependencia e insatisfacao com a instituicao. Houve ainda associacao significativa entre depressao e insonia, taquicardia, parestesia, tontura e suor excessivo. A depressao e altamente prevalente entre idosos institucionalizados, e mais comum entre as mulheres, e relaciona-se a uma serie de sinais e sintomas que podem auxiliar em um diagnostico precoce, subsidiando uma assistencia de enfermagem mais efetiva.

[Prevalence and factors associated with depression among institutionalized elderly individuals: nursing care support].

The objective of this study was to verify depression among institutionalized elderly individuals. The cross-section method and Yesavages Geriatric Depression Scale were utilized in five geriatric long-term care facilities located in the Federal District to verify symptoms of depression. A total of 299 individuals were studied, 181 of whom did not meet the inclusion criteria. Sixteen individuals declined to participate. Considering the 102 individuals found suitable to participate in the study, 49.0% presented symptoms of depression; 36.3% suffered from mild to moderate depression and 12.7% showed symptoms of severe depression. Associations were found between depression symptoms and increased age, female gender, physical limitations/dependence and dissatisfaction with the institution. A significant association was also found between depression and insomnia, tachycardia, paresthesias, dizziness and excessive sweating. Depression is highly prevalent among institutionalized elderly individuals, more common among women, and correlated with a series of signs and symptoms that may help in making an early diagnosis, thus offering support to providing more effective nursing care.Se objetivo verificar la depresion en ancianos institucionalizados. Se empleo el metodo transversal, utilizando la Escala de Depresion Geriatrica de Yesavage en cinco hogares geriatricos del Distrito Federal, para verificar sintomatologia depresiva. Fueron estudiados en total 299 individuos, 181 no atendieron los criterios de inclusion y 16 recusaron su participacion. De los 102 ancianos participantes del estudio, 49,0% presentaba depresion: 36,3% de leve a moderada, 12,7% depresion severa. Se verificaron asociaciones entre sintomas depresivos y aumento etario, sexo femenino, limitacion/dependencia e insatisfaccion con la institucion. Existio inclusive asociacion significativa entre depresion e insomnio, taquicardia, parestesia, mareos y sudoracion excesiva. La depresion es altamente prevalente entre ancianos institucionalizados, es mas comun entre las mujeres, y se relaciona a una serie de signos y sintomas que pueden cooperar a un diagnostico precoz, facilitandose una atencion de enfermeria mas efectiva.Este estudo teve como objetivo a verificacao de depressao entre idosos institucionalizados. Empregou-se o metodo transversal utilizando-se a Escala de Depressao Geriatrica de Yesavage em cinco instituicoes de longa permanencia do Distrito Federal para verificar sintomas de depressao. Foram estudados ao todo 299 individuos. Destes, 181 nao atenderam os criterios de inclusao e 16 se recusaram a participar do estudo. Dos 102 idosos com condicoes de participar do estudo, 49,0% apresentavam depressao. Destes, 36,3% com depressao leve a moderada e 12,7% com depressao severa. Verificou-se associacoes entre sintomas de depressao e aumento da idade, sexo feminino, limitacao/dependencia e insatisfacao com a instituicao. Houve ainda associacao significativa entre depressao e insonia, taquicardia, parestesia, tontura e suor excessivo. A depressao e altamente prevalente entre idosos institucionalizados, e mais comum entre as mulheres, e relaciona-se a uma serie de sinais e sintomas que podem auxiliar em um diagnostico precoce, subsidiando uma assistencia de enfermagem mais efetiva.

Validation of the rapid test Carestart(tm) G6PD among malaria vivax-infected subjects in the Brazilian Amazon.

INTRODUCTION In the Brazilian Amazon, malaria infections are primarily caused by Plasmodium vivax. The only drug that kills the hypnozoite form of P. vivax is primaquine, thereby preventing relapse. However, treating glucose-6-phosphate dehydrogenase (G6PD)-deficient individuals with primaquine can lead to severe hemolysis. G6PD deficiency (G6PDd) affects approximately 400 million people worldwide, most of whom live in malaria-endemic areas. Therefore, clinicians need tools that can easily and reliably identify individuals with G6PDd. This study estimated the accuracy of the Carestart(tm) G6PD rapid test (Access Bio) in the diagnosis of G6PDd in male participants with and without P. vivax acute malaria. METHODS Male participants were recruited in Manaus. Malaria diagnosis was determined by thick blood smear. G6PD quantitative analysis was performed spectro photometrically at a wave length of 340nm. The Carestart(tm) G6PD test was performed using venous blood. Genotyping was performed for individuals whose samples had an enzyme activity less than 70% of the normal value. RESULTS Six hundred and seventy-four male participants were included in this study, of whom 320 had a diagnosis of P. vivax malaria. In individuals with enzyme activity lower than 30% (n=13), the sensitivity, specificity, positive predictive value, and negative predictive value of the Carestart(tm) G6PD test were as follows: 61.5% (95%CI: 35.5%-82.3%), 98.3% (95%CI: 97.0%-99.1%), 42.1% (95%CI: 23.1%-63.7%), and 99.2% (95%CI: 98.2%-82.3%), 98.3% (95%CI: 97.0%-99.1%), 42.1% (95%CI: 23.1%-63.7%), and 99.2% (95%CI: 98.2%-99.7%), respectively. Increases in sensitivity were observed when increasing the cut-off value. CONCLUSIONS Despite low sensitivity, Carestart(tm) G6PD remains a good alternative for rapid diagnosis of G6PDd in malaria-endemic regions.

Cost-effectiveness of diagnostic for malaria in Extra-Amazon Region, Brazil

BackgroundRapid diagnostic tests (RDT) for malaria have been demonstrated to be effective and they should replace microscopy in certain areas.MethodThe cost-effectiveness of five RDT and thick smear microscopy was estimated and compared. Data were collected on Brazilian Extra-Amazon Region. Data sources included the National Malaria Control Programme of the Ministry of Health, the National Healthcare System reimbursement table, laboratory suppliers and scientific literature. The perspective was that of the Brazilian public health system, the analytical horizon was from the start of fever until the diagnostic results provided to patient and the temporal reference was that of year 2010. Two costing methods were produced, based on exclusive-use microscopy or shared-use microscopy. The results were expressed in costs per adequately diagnosed cases in 2010 U.S. dollars. One-way sensitivity analysis was performed considering key model parameters.ResultsIn the cost-effectiveness analysis with exclusive-use microscopy, the RDT CareStart™ was the most cost-effective diagnostic strategy. Microscopy was the most expensive and most effective, with an additional case adequately diagnosed by microscopy costing US

G6PD deficiency in male individuals infected by Plasmodium vivax malaria in the Brazilian Amazon: a cost study

35,550.00 in relation to CareStart™. In opposite, in the cost-effectiveness analysis with shared-use microscopy, the thick smear was extremely cost-effective. Introducing into the analytic model with shared-use microscopy a probability for individual access to the diagnosis, assuming a probability of 100% of access for a public health system user to any RDT and, hypothetically, of 85% of access to microscopy, this test saw its effectiveness reduced and was dominated by the RDT CareStart™.ConclusionThe analysis of cost-effectiveness of malaria diagnosis technologies in the Brazilian Extra-Amazon Region depends on the exclusive or shared use of the microscopy. Following the assumptions of this study, shared-use microscopy would be the most cost-effective strategy of the six technologies evaluated. However, if used exclusively for diagnosing malaria, microscopy would be the worst use of resources. Microscopy would not be the most cost-effective strategy, even when structure is shared with other programmes, when the probability of a patient having access to it was reduced. Under these circumstances, the RDT CareStart™ would be the most cost-effective strategy.

Estratégias de aprendizagem utilizadas por graduandos e pós-graduandos em disciplinas semipresenciais da área de saúde

BackgroundDeficiency of the enzyme G6PD (G6PDd) is caused by mutations in the gene G6PD, which plays an important role in protecting the red blood cell against oxidizing agents; it is linked to chromosome X, and it may affects both sexes. The clinically relevant manifestations, such as acute haemolytic anaemia, mainly occur in men, however. The 8-aminoquinoline primaquine, which is the medication used in the radical treatment of malaria caused by Plasmodium vivax, represents the main factor that triggers complications associated with G6PDd. The current study aims to estimate the costs of G6PDd among male individuals infected by P. vivax in the Brazilian Amazon.MethodsThis is an economic analysis developed within the Brazilian National Health System perspective for the years of 2009, 2010 and 2011. Direct medical and non-medical costs were estimated for G6PDd in the Brazilian Amazon, considering among those suffering from the deficiency the costs of diagnosing infection by P. vivax, its treatment and severe adverse events that require hospitalization and were connected to the use of primaquine.ResultsThe estimates of the average costs of diagnosing vivax malaria, of its treatment and of severe adverse events after using primaquine among the carriers of G6PDd, over the three evaluated years, corresponded to US

Aspects related to the permanence of undergraduate and graduate students in semi-presential classes

739,410.42; US