Lígia Mara Dolce de Lemos

Prevalência da infecção por HIV em parturientes de maternidades vinculadas ao SUS

OBJETIVO: avaliar a prevalencia do HIV nas parturientes de maternidades vinculadas ao SUS, pela utilizacao do teste rapido. METODOS: estudo transversal realizado em maternidades conveniadas ao SUS no Estado de Sergipe, apos treinamento realizado com os profissionais de saude dessas maternidades. As parturientes foram submetidas ao teste rapido imunocromatografico para HIV, independente de ja o terem realizado no pre-natal, apos aconselhamento e assinatura do termo de consentimento livre e esclarecido. O teste utilizado foi DetermineTM - Abbott Laboratorios do Brasil. Utilizou-se o esquema de profilaxia da transmissao vertical para todos os casos, segundo o protocolo recomendado pelo Ministerio da Saude. Foi criado banco de dados no Epi-Info 2002 e calculada a prevalencia em relacao a todos os testes realizados no periodo de janeiro de 2003 a marco de 2004, por meio de analise estatistica descritiva. RESULTADO: apos realizacao de 9.215 testes rapidos, foram detectadas 39 (0,42%) soropositivas para HIV, das quais 23 (59%) nao conheciam a sua soropositividade. Duas gestantes que ja eram sabidamente HIV positivas nao relataram aos profissionais sua condicao no momento da admissao. O numero de parturientes que referiram ter frequentado o servico de pre-natal foi alto (89%), mas somente 32,5% destas foram submetidas ao teste para HIV na gestacao. CONCLUSAO: a prevalencia detectada (0,42%) neste estudo e semelhante a nacional. E alta a prevalencia de parturientes que desconhecem sua soropositividade para HIV, o que indica inadequado funcionamento de cuidados pre-natais dispensados. Na situacao atual e necessaria a triagem no momento do parto, para garantia de intervencoes adequadas neste momento crucial da transmissao do HIV.

Maternal risk factors for HIV infection in infants in northeastern Brazil

INTRODUCTION While the rate of vertically transmitted HIV infection has fallen in most regions of Brazil, there have been no similar decreases in northern and northeastern Brazil. OBJECTIVE The objective of this study was to evaluate the risk factors associated with vertical transmission in the state of Sergipe in northeastern Brazil. METHODS This was a retrospective cohort study. We recorded clinic and registry data for all HIV-infected pregnant women and exposed children diagnosed in Sergipe from 1990 to 2011. RESULTS We identified 538 deliveries and 561 HIV-exposed infants (23 sets of twins). One hundred one (18.9%) infants were HIV-infected. In the multivariate analysis, infant antiretroviral prophylaxis was a significant protective factor (adjusted odds ratio (aOR) 0.07, 95% confidence interval (CI) 0.01-0.41, p=0.003). Breastfeeding was marginally associated with an increased odds of perinatal transmission (aOR 4.52, 95% CI 0.78-26.17, p = 0.092). The attributable risk percentage for breastfeeding over the study period was 91.0%. Transmission decreased from 91 per 100 live births before 1997 to 2 per 100 in 2011 following the adoption of the prevention protocol. CONCLUSION Transmission declined over the study period. The screening of pregnant women and timely initiation of prophylaxis and therapy are issues that require further attention.

Evaluation of preventive measures for mother-to-child transmission of HIV in Aracaju, State of Sergipe, Brazil

INTRODUCTION The main route of human immunodeficiency virus (HIV) infection in children is from mother to child. The preventive measures established for the Aids Clinical Trial Group protocol 076 (ACTG 076) significantly reduces HIV vertical transmission rates. This study aims to evaluate the implementation of the ACTG 076 protocol in the maternity units of State of Sergipe, Brazilian northeast. METHODS This is a descriptive, retrospective study with a quantitative approach, with HIV positive women and children exposed, attending a Maternity reference for high-risk pregnancies. Data were obtained from patient records registered in the years 1994 to 2010. RESULTS Amongst the 110 pregnant women and exposed newborns, the ACTG 076 protocol was fully utilized in only 31.8% of the participants. During the prenatal period, zidovudine (ZDV) was taken by 79.1% of the pregnant women. Only 49.1% of HIV seropositive patients used ZDV during delivery. Two (1.8%) children were considered infected and 50 (45.5%) do not have a conclusive diagnosis to date. CONCLUSIONS There were significant deficiencies in the prevention of mother-to-child transmission of HIV, including lack of compliance with the three phases of the ACTG 076 protocol; inadequacies in prenatal care; inappropriate mode of delivery and lack of adequate follow up of exposed children.

Vamos cuidar com brinquedos

Given the importance of play in the everyday life of hospitalized children, the purpose of the study was to identify the perception of the nursing team in the preparation of children and adolescents for hospital procedures at university hospital in Aracaju. We used exploratory search with a qualitative approach with the nursing staff of the pediatric unit. It is that professionals do not perform the techniques with the plays in their daily activities, but know the importance of this resource. For evidence, it is necessary to insert the toy in the treatment of pediatric nursing care. Beware of play is one of the most efficient means of assisting a child in hospital.Dada la importancia de desempenar en la vida cotidiana de los ninos hospitalizados, el objetivo del estudio fue identificar la percepcion del equipo de enfermeria en la preparacion de los ninos, ninas y adolescentes para los procedimientos del hospital en un hospital universitario en Aracaju. Se utilizo una encuesta exploratoria con enfoque cualitativo con el personal de enfermeria de la unidad pediatrica. Es que los profesionales que no realizan las tecnicas con los juguetes en sus actividades cotidianas, pero sabemos la importancia de este recurso. Para las pruebas, es necesario insertar el juguete en el tratamiento de la atencion de enfermeria pediatrica. Cuidado de los juguetes es uno de los medios mas eficaces de ayudar a um nino em el hospital.Given the importance of play in the everyday life of hospitalized children, the purpose of the study was to identify the perception of the nursing team in the preparation of children and adolescents for hospital procedures at university hospital in Aracaju. We used exploratory search with a qualitative approach with the nursing staff of the pediatric unit. It is that professionals do not perform the techniques with the plays in their daily activities, but know the importance of this resource. For evidence, it is necessary to insert the toy in the treatment of pediatric nursing care. Beware of play is one of the most efficient means of assisting a child in hospital.

Clinical variables associated with disability in leprosy cases in northeast Brazil

INTRODUCTION The clinical outcomes of leprosy include complications such as physical disabilities and deformities that vary according to the degree of impairment of nerve trunks. Knowledge of the factors that lead to the development of these complications is important for disability prevention programs. This study aimed to evaluate clinical factors associated with the occurrence of physical disability in leprosy cases. METHODOLOGY This was a retrospective study of 2,358 cases of leprosy in Aracaju, northeast Brazil, between 2001 and 2011. Analysis was done using the Chi-square test and logistic regression model. RESULTS Significant factors associated with disability were found to be male gender, having more than two affected nerves, multibacillary leprosy classification, leprosy reaction, and lepromatous leprosy. The multivariate analysis revealed that the associated factors included having more than two affected nerves, leprosy reaction (adjusted odds ratio [aOR]: 2.02, 95% confidence interval [CI]: 1.36 to 3.01), the multibacillary form (aOR: 2.74, 95% CI: 1.84 to 4.08), and lepromatous leprosy (aOR: 4.87, 95% CI: 2.86 to 16.08). CONCLUSIONS The number of affected nerves, leprosy reaction, operational classification, and clinical presentation were identified as the main factors associated with the development of disability in leprosy patients.

Leprosy and Disability in Children Younger Than 15 Years in an Endemic Area of Northeast Brazil

Background: Leprosy in children is still a frequent but sometimes unrecognized public health problem and an important cause of disability. Establishing the risk factors that lead to the development of disability is important for the development of suitable prevention programs. We describe the incidence of leprosy and the prevalence and degree of associated disabilities in children <15 years of age at the time of first presentation to the health services in Aracaju, Sergipe, Northeast Brazil. Methods: A retrospective case series of 266 cases of leprosy in children under 15 years old of Aracaju from 2001 to 2012. Logistic regressions were performed to identify factors for disability. Results: The average detection rate was 16.5/100,000 children under 15 years old per year over the study period. Physical disability was associated with the presence of affected nerves and multibacillary leprosy. Conclusions: The detection rate of leprosy in children is still high in Aracaju, Northeast Brazil. Having affected nerves and multibacillary leprosy are associated with the development of disability in children.

Functional Activity Limitation and Quality of Life of Leprosy Cases in an Endemic Area in Northeastern Brazil

Background Few studies have evaluated the association between quality of life (QoL) and functional activity limitations (FAL) of leprosy patients as determined by the Screening of Activity Limitation and Safety Awareness scale (SALSA). Aim To identify the association between FALs and the QoL of patients during and post leprosy treatment. Materials and Methods Cross-sectional survey of 104 patients with leprosy followed in specialist reference centres in Sergipe, Brazil, between June and October 2014. QoL was evaluated using the World Health Organization-QoL-BREF (WHOQoL-BREF) questionnaire. The SALSA scale was used to measure FALs. Results Low SALSA scores were present in 76% of patients. QoL scores were lower for the physical and environmental domains, with median (interquartile range (IQR)) scores of 53.6 (32.1–67.9) and 53.1 (46.9–64.8), respectively. There was a statistical association between increasing SALSA scores and lower QoL as measured by the WHOQoL-BREF. Conclusion Functional limitations are associated with lower QoL in leprosy patients, especially in the physical and environmental WHOQoL-BREF domains.

Estimating the number of HIV-positive pregnant women in Sergipe, Brazil, using capture-recapture.

The objective of the study was to estimate the population of HIV-seropositive pregnant women in the State of Sergipe between 2000 and 2010, using the capture–recapture method (CRC). Three databases were used as independent lists: The Brazilian Case Registry Database (SINAN), Laboratory Test Control System (SISCEL) and medical data records of the STD/HIV/AIDS service of Sergipe (CEMAR). For analysis, a log-linear regression model was used to ascertain the total population size. We identified 729 HIV-seropositive pregnant women from the three lists. Among them, only 317 (43.5%) were included in SINAN, 646 (88.6%) were included in SISCEL and 274 (37.6%) appeared in the CEMAR database. Using CRC, we estimated that there were in total 1110 HIV-seropositive pregnant women; therefore, 381 (34.3%) women were not captured by any of the three systems. The CRC method is a potentially useful and important tool in the evaluation of official reporting systems in Brazil.

Let us care with plays

Given the importance of play in the everyday life of hospitalized children, the purpose of the study was to identify the perception of the nursing team in the preparation of children and adolescents for hospital procedures at university hospital in Aracaju. We used exploratory search with a qualitative approach with the nursing staff of the pediatric unit. It is that professionals do not perform the techniques with the plays in their daily activities, but know the importance of this resource. For evidence, it is necessary to insert the toy in the treatment of pediatric nursing care. Beware of play is one of the most efficient means of assisting a child in hospital.Dada la importancia de desempenar en la vida cotidiana de los ninos hospitalizados, el objetivo del estudio fue identificar la percepcion del equipo de enfermeria en la preparacion de los ninos, ninas y adolescentes para los procedimientos del hospital en un hospital universitario en Aracaju. Se utilizo una encuesta exploratoria con enfoque cualitativo con el personal de enfermeria de la unidad pediatrica. Es que los profesionales que no realizan las tecnicas con los juguetes en sus actividades cotidianas, pero sabemos la importancia de este recurso. Para las pruebas, es necesario insertar el juguete en el tratamiento de la atencion de enfermeria pediatrica. Cuidado de los juguetes es uno de los medios mas eficaces de ayudar a um nino em el hospital.Given the importance of play in the everyday life of hospitalized children, the purpose of the study was to identify the perception of the nursing team in the preparation of children and adolescents for hospital procedures at university hospital in Aracaju. We used exploratory search with a qualitative approach with the nursing staff of the pediatric unit. It is that professionals do not perform the techniques with the plays in their daily activities, but know the importance of this resource. For evidence, it is necessary to insert the toy in the treatment of pediatric nursing care. Beware of play is one of the most efficient means of assisting a child in hospital.

Mortality of children following a diagnosis of HIV infection in northeastern Brazil

Globally HIV is the seventh leading cause of death among infants and children from 1 to 59 months of age. An estimated 230,000 children died from AIDS-related illnesses in 2011.1 Brazil has a mixed HIV epidemic, and pediatric cases are more common in the nine provinces of the north and northeast and survival after AIDS diagnosis is lower than in the rest of the country.2 The probability of survival at 60 months rose from 25% before 1988 to 88% in 2001–2002.3 To identify if the general improvement in survival was also extended to children in the Northeast region, we studied mortality in children with HIV infection in the state of Sergipe. A historical cohort of 101 HIV-infected children diagnosed from 1993 to 2011 was identified laboratory and surveillance databases, as well as from ambulatory medical records of the University Hospital and reference center. The starting date corresponds to the diagnosis of the first case of HIV in infants reported in Sergipe. We examined two outcome variables. The first was death, and the second was survival from birth, as a proxy for survival time from HIV infection. We chose not to examine survival from AIDS diagnosis to death because a substantial proportion of cases were diagnosed close to death or post-mortem. For children who had not died, the date of censoring was the last record time of contact with the medical center. We used logistic regression analysis and a purposeful covariate selection process to identify predictors associated with death. Using the Wald, we further explored the variables in a multivariate analysis using stepwise modeling techniques. We removed covariates if statistical significance was lost (p-value < 0.10) and the variable was found not to be a cofounder through its effect on other parameters in the models. Additionally, we performed a Kaplan–Meier survival analysis from birth, censoring data at death or last known day of follow-up. We conducted all analyses with the R 2.15.3 for Windows (R Development Core Team, Vienna, Austria). At the time we interviewed parents to complete data collection, we obtained informed consent. The study was approved by local ethical committee. Between 1990 and 2011, 101 infants and children were diagnosed with HIV infection in Sergipe. Sixty-two (61%) were female, and the median age at HIV diagnosis was 3.0 years (interquartile range [IQR], 1.5–5.6 years). Twenty-one (21%) died. The median age at death was 4.3 years (IQR, 1.5–5.6 years). Nine (43%) children who had died were diagnosed with AIDS in their final hospital admission or post mortem, and four (19%) were diagnosed within four weeks of death. The median survival time from birth was 52 months (IQR, 18–88 months). Clinical factors associated with death in univariate analysis were the presence of clinical AIDS symptoms, CDC stage C disease, being born in 2000 or earlier and having a history of hospital admission. Being treated with triple-drug combination ART was protective. In a subset of patients for whom full records were available, antiretroviral prophylaxis, mode of delivery and avoidance of breastfeeding were not associated with death. In multivariate analysis, after adjusting for current treatment, the risk of death was 57% lower for children born after 2000 compared to those born ≤ 2000 (adjusted relative risk [aRR] 0.43, p < 0.05). Similarly, after adjusting for birth cohort, the risk of death decreased by 44% for every incremental advancement in treatment from no treatment to monotherapy to dual therapy to triple therapy (aRR 0.56, p < 0.01). Lastly, the hazard ratio for death for children born after 2000 compared to those born ≤ 2000 was marginally reduced (HR = 0.42; p value = 0.054) (Fig. 1).