Maria Carolina Pereira da Rocha

A febre maculosa no Brasil

Embora no Brasil o numero de casos confirmados de febre maculosa esteja em declinio desde 2005, a taxa de mortalidade (20 a 30%) ainda e muito alta quando comparada a outros paises. Esse alto indice de mortalidade tem estreita relacao com a dificuldade em fazer o diagnostico e estabelecer a terapia apropriada. Apenas dois grupos de antibioticos tem comprovada eficacia clinica, o cloranfenicol e as tetraciclinas. Ate pouco tempo atras, as tetraciclinas eram reservadas aos pacientes adultos em virtude das alteracoes dentarias e osseas em criancas. Recentemente, entretanto, a Academia Americana de Pediatria e diversos autores tem recomendado a utilizacao da doxiciclina tambem em criancas. Em casos mais severos, a falta de experiencia com uma tetraciclina injetavel no Brasil faz com que se opte pelo cloranfenicol injetavel. Como o pronto diagnostico e a escolha adequada do farmaco sao fatores determinantes de um prognostico positivo, todos os profissionais da saude devem estar melhor preparados para reconhecer e tratar a febre maculosa.

Paracoccidioidomycosis: evaluation of treatment and patient profile

Paracoccidioidomycosis (PCM) is a fungal disease, chronic and endemic, especially in Latin America.1 Aiming to acquire more information about the effectiveness of the treatment employed, this study aimed to describe the profiles of patients with paracoccidioidomycosis and compare treatments used in patients with PCM cared for at the Clinic of Tropical Medicine of the “Conjunto Hospitalar de Sorocaba” (CHS) regarding efficacy, safety and adherence to treatment. The present study evaluated treatment used and the profile of 45 patients with PCM diagnosis. We conducted a retrospective, epidemiological, quantitative, cross-sectional and observational study through analysis of data from medical records of 45 patients diagnosed with PCM. We found a patient profile very similar to that described in the literature, i.e., adult men (77.7%), aging 51.5 years.2 Regarding occupational activity, as in other studies, patients were mostly farmers (57.7%) or civil construction workers (11.1%).2 Three treatments evaluated were: trimoxazole {1600 + 800 mg/day} (SXT), amphotericin B {1 mg/kg/day} followed by trimoxazole for maintenance {1600 + 800 mg/day} (SXT + ANPH), and itraconazole {200 mg/day} (ITZ). To compare the treatments efficacy, each drug regimen was associated with clinical improvement (in days) defined as the absence of signs and symptoms and overall treatment time (in months) defined as a negative serology. The mean time to clinical improvement showed no difference between the three tested treatments (p = 0.714). Table 1 shows the results. Regarding the overall treatment time, the group treated with SXT finished treatment with medical discharge in 15.2 months. For the ANPH + SXT group, mean time was 13.3

Ampliação do acesso à saúde na região mais vulnerável do estado de São Paulo, Brasil: reflexo do Programa Mais Médicos?

The Mais Médicos (More Doctors) Program seeks to broaden access to health by providing medical professionals, investments in health units and multi-professional integration geared to the Family Health Strategy. Vale do Ribeira includes 25 cities and is among the most vulnerable regions in São Paulo. It has been allocated 41 physicians from the Program. This study is to evaluate access to health, comparing health indicators before and after the Program. We collected data from DATASUS, SIAB, and the Ministry of Health. There was a marked increase in the number of appointments for infants under one year of age, adults, the elderly, STD/HIV patients and group patient care. There was a decrease in appointments outside the catchment area, as well as hospital admissions for other causes, mothers exclusively breastfeeding their infants up to four months. We concluded that after deployment of the Program, there was an increase in health access and health promotion focused on an area that presents an enormous challenge for Primary Health Care (PHC). It would seem that, since this is a high vulnerability area with a large area for care, hospital admissions for PHC care-sensitive conditions, as well as referrals for secondary services, did not decrease.The Mais Medicos (More Doctors) Program seeks to broaden access to health by providing medical professionals, investments in health units and multi-professional integration geared to the Family Health Strategy. Vale do Ribeira includes 25 cities and is among the most vulnerable regions in Sao Paulo. It has been allocated 41 physicians from the Program. This study is to evaluate access to health, comparing health indicators before and after the Program. We collected data from DATASUS, SIAB, and the Ministry of Health. There was a marked increase in the number of appointments for infants under one year of age, adults, the elderly, STD/HIV patients and group patient care. There was a decrease in appointments outside the catchment area, as well as hospital admissions for other causes, mothers exclusively breastfeeding their infants up to four months. We concluded that after deployment of the Program, there was an increase in health access and health promotion focused on an area that presents an enormous challenge for Primary Health Care (PHC). It would seem that, since this is a high vulnerability area with a large area for care, hospital admissions for PHC care-sensitive conditions, as well as referrals for secondary services, did not decrease.

Perfil de prescritores e prescrição de antimicrobianos nas infecções das vias aéreas superiores em Pediatria

Objective: To describe the profile of physicians that care for children in Brazilian public and private health systems, and to verify how antimicrobials for upper respiratory airway infections are prescribed. Methods: Physicians in some cities of the state of Sao Paulo (Southeast Brazil) received an explanatory letter by mail or at the Primary Health Care Units about the research and a form with questions concerning: time of graduation, medical residency, workload and workplace, how they update their medical knowledge, factors considered when prescrib- ing antimicrobials, and clinical cases on upper respiratory infections. Personal information was related to the answers of the clinical cases. For statistical analysis, the Z and Tukey- Kramer tests were applied, being significant p<0.05. Results: The sample included 170 prescribers, out of whom 87% had medical residence in Pediatrics, 75% worked for the Public Health System, and 71% worked more than 40 hours per week. Physicians who graduated in the past ten years emphasized the pharmaceutical industry as a way of keeping themselves updated in comparison to the ones who had been graduated for more than 30 years; 33% of the public health system physicians cared for more than five patients per hour. Regarding clinical cases, the correct answers averaged 87%. Consulting medical entities as a way of continuous medical education was associated with correct answers, while using materials from the pharmaceutical industry was associated with the incorrect ones (p<0.05). There was a clear trend towards decreasing the quality of the prescription as the number of patients per hour increased. Conclusions: Efficient education and improvement of work load could reduce the prescription of antibiotics for upper airway infections in children.OBJETIVO: Tracar um perfil dos medicos que atendem criancas nos sistemas publico (Sistema Unico de Saude) e privado de saude e verificar como sao prescritos antimicrobianos nas infeccoes das vias aereas superiores. METODOS: Medicos de algumas cidades do interior do Estado de Sao Paulo receberam via correio ou nas Unidades Basicas de Saude uma carta explicativa sobre a pesquisa e o questionario, com perguntas sobre: tempo de graduacao, residencia medica, carga horaria e local de trabalho, forma de atualizacao, fatores que consideram ao prescrever antimicrobianos e casos clinicos sobre as infeccoes das vias aereas superiores. Os dados pessoais dos medicos foram relacionados com as respostas aos casos clinicos. Para analise estatistica, foram aplicados os testes Z e de Tukey-Kramer, sendo p<0,05 significante. RESULTADOS: A amostra foi composta por 170 prescritores: 86,5% possuiam residencia em Pediatria, 75% trabalhavam no Sistema Unico de Saude e 71% tinham carga horaria superior a 40 horas semanais. Os formados ha menos de dez anos valorizaram mais os laboratorios farmaceuticos como forma de atualizacao do que os graduados ha mais de 30 anos; 33% dos medicos do Sistema Unico de Saude atendem mais de cinco pacientes por hora. A media de acerto nos casos clinicos foi de 87%. O uso das entidades medicas como forma de atualizacao foi associado a respostas corretas, enquanto o uso de materiais de laboratorio estava ligado a respostas incorretas (p<0,05). Houve clara tendencia de diminuicao dos acertos conforme o numero de pacientes atendidos por hora aumentava. CONCLUSOES: Educacao adequada sobre o tema e melhora nas condicoes de trabalho podem ser eficientes para reduzir a prescricao de antibioticos para infeccoes das vias aereas superiores em criancas.

Perfil de prescriptores y prescripción de antimicrobianos en las infecciones de vías aéreas superiores en pediatría

Objective: To describe the profile of physicians that care for children in Brazilian public and private health systems, and to verify how antimicrobials for upper respiratory airway infections are prescribed. Methods: Physicians in some cities of the state of Sao Paulo (Southeast Brazil) received an explanatory letter by mail or at the Primary Health Care Units about the research and a form with questions concerning: time of graduation, medical residency, workload and workplace, how they update their medical knowledge, factors considered when prescrib- ing antimicrobials, and clinical cases on upper respiratory infections. Personal information was related to the answers of the clinical cases. For statistical analysis, the Z and Tukey- Kramer tests were applied, being significant p<0.05. Results: The sample included 170 prescribers, out of whom 87% had medical residence in Pediatrics, 75% worked for the Public Health System, and 71% worked more than 40 hours per week. Physicians who graduated in the past ten years emphasized the pharmaceutical industry as a way of keeping themselves updated in comparison to the ones who had been graduated for more than 30 years; 33% of the public health system physicians cared for more than five patients per hour. Regarding clinical cases, the correct answers averaged 87%. Consulting medical entities as a way of continuous medical education was associated with correct answers, while using materials from the pharmaceutical industry was associated with the incorrect ones (p<0.05). There was a clear trend towards decreasing the quality of the prescription as the number of patients per hour increased. Conclusions: Efficient education and improvement of work load could reduce the prescription of antibiotics for upper airway infections in children.OBJETIVO: Tracar um perfil dos medicos que atendem criancas nos sistemas publico (Sistema Unico de Saude) e privado de saude e verificar como sao prescritos antimicrobianos nas infeccoes das vias aereas superiores. METODOS: Medicos de algumas cidades do interior do Estado de Sao Paulo receberam via correio ou nas Unidades Basicas de Saude uma carta explicativa sobre a pesquisa e o questionario, com perguntas sobre: tempo de graduacao, residencia medica, carga horaria e local de trabalho, forma de atualizacao, fatores que consideram ao prescrever antimicrobianos e casos clinicos sobre as infeccoes das vias aereas superiores. Os dados pessoais dos medicos foram relacionados com as respostas aos casos clinicos. Para analise estatistica, foram aplicados os testes Z e de Tukey-Kramer, sendo p<0,05 significante. RESULTADOS: A amostra foi composta por 170 prescritores: 86,5% possuiam residencia em Pediatria, 75% trabalhavam no Sistema Unico de Saude e 71% tinham carga horaria superior a 40 horas semanais. Os formados ha menos de dez anos valorizaram mais os laboratorios farmaceuticos como forma de atualizacao do que os graduados ha mais de 30 anos; 33% dos medicos do Sistema Unico de Saude atendem mais de cinco pacientes por hora. A media de acerto nos casos clinicos foi de 87%. O uso das entidades medicas como forma de atualizacao foi associado a respostas corretas, enquanto o uso de materiais de laboratorio estava ligado a respostas incorretas (p<0,05). Houve clara tendencia de diminuicao dos acertos conforme o numero de pacientes atendidos por hora aumentava. CONCLUSOES: Educacao adequada sobre o tema e melhora nas condicoes de trabalho podem ser eficientes para reduzir a prescricao de antibioticos para infeccoes das vias aereas superiores em criancas.