Mônica Elinor Alves Gama

Nível de conhecimentos sobre Leishmaniose Tegumentar Americana (LTA) e uso de terapias alternativas por populações de uma área endêmica da Amazônia do Maranhão, Brasil

Realizou-se estudo visando identificar e comparar que conhecimentos basicos e uso de terapias alternativas relativos a Leishmaniose Tegumentar Americana (LTA), tem populacoes residentes em cinco areas rurais (Sexta Vicinal, Quinta Vicinal, Trilha 410, Vila Uniao e Buritizinho) pertencentes ao municipio de Buriticupu, Maranhao. No periodo de setembro de 1997 a janeiro de 1998, aplicou-se questionarios com perguntas abertas e fechadas, abordando aspectos epidemiologicos, modos de prevencao, clinica e terapeutica alternativa. A populacao estudada foi de 378 (19%) individuos de um total de 1980 habitantes. Na Sexta Vicinal (35 individuos), Quinta Vicinal (63), Trilha 410 (96), Vila Uniao (85) e Buritizinho (99). Dos entrevistados, 72% tinham poucos conhecimentos dos modos de transmissao, 96,9% ja ouviram falar da doenca, a maioria obteve informacoes com amigos, 60,7% conheciam a LTA como lesh. O Glucantime foi a droga mais citada para o tratamento, 29,6% relataram uso de plantas no local da lesao. O Citrus limon (limao) foi a planta mais citada (15,4%) dos entrevistados, o modo de uso mais frequente era o po espalhado sobre a lesao. Conclui-se que o nivel de conhecimento sobre LTA foi incipiente, principalmente na prevencao e terapeutica, situacao similar nas cinco areas estudadas.

Avaliação do nível de conhecimento que populações residentes em áreas endêmicas têm sobre leishmaniose visceral, Estado do Maranhão, Brasil

A prospective study was performed to identify knowledge concerning visceral leishmaniasis (VL) in endemic areas of Maranhao, amongst the rural population of the Codo township and in a peripheral urban area (an old settlement, Maracana, on the outskirts of the city of Sao Luis, and Vila Nova/Bom Viver, Paco do Lumiar township). A total of 283 persons were interviewed, including 53 from Maracana, 103 from Vila Nova/Bom Viver, and 127 from Codo. The sites presented favorable conditions for the development and maintenance of VL. Some 93.8% of those interviewed had heard of kala-azar. In Maracana, 50.9% referred to sandflies as responsible for the transmission of VL, while 87.2% knew that dogs are the main link in the epidemiological cycle of the disease. Some 77.8% of those interviewed did not know how to control the disease. As regards manifestations of the disease, they largely associated it with fever, anemia, weight loss, and an enlarged abdomen. Only five individuals knew that Glucantime® is used to treat VL. We conclude that knowledge is poor with regard to all aspects of VL in both the rural and peripheral urban area.

O escore de risco ajustado para cirurgia em cardiopatias congênitas (RACHS-1) pode ser aplicado em nosso meio?

OBJECTIVE: The aim of this study was to evaluate the applicability of the RACHS-1 (Risk Adjustment in Congenital Heart Surgery) as a predictor of surgical mortality in a pediatric population of a public hospital of the Northeast of Brazil. METHODS: From June 2001 through June 2004, 145 patients undergone surgical treatment of CHD in our institution of whom 62% were female, and the mean age was 5.1 years. The RACHS-1 was used to classify the surgical procedures into categories of risk 1 to 6, and logistic regression analysis was used to identify the risk factors related to surgical death. RESULTS: Age, type of CHD, pulmonary flow, surgical procedure, pump time and cross clamp time were identified as a risk factor for postoperative mortality (p<0.001). There was a linear correlation between the categories of the RACHS-1 and the mortality rate; however, the observed mortality was greater than the predicted figures by that scoring system. CONCLUSION: Although the RACHS-1 is easily applicable, it can not be applicable in our scenario because it takes into account only the surgical procedure as a categorized variable, not considering others factors presented in our scenario that could interfere in the final surgical result.OBJECTIVE The aim of this study was to evaluate the applicability of the RACHS-1 (Risk Adjustment in Congenital Heart Surgery) as a predictor of surgical mortality in a pediatric population of a public hospital of the Northeast of Brazil. METHODS From June 2001 through June 2004, 145 patients undergone surgical treatment of CHD in our institution of whom 62% were female, and the mean age was 5.1 years. The RACHS-1 was used to classify the surgical procedures into categories of risk 1 to 6, and logistic regression analysis was used to identify the risk factors related to surgical death. RESULTS Age, type of CHD, pulmonary flow, surgical procedure, pump time and cross clamp time were identified as a risk factor for postoperative mortality (p<0.001). There was a linear correlation between the categories of the RACHS-1 and the mortality rate; however, the observed mortality was greater than the predicted figures by that scoring system. CONCLUSION Although the RACHS-1 is easily applicable, it can not be applicable in our scenario because it takes into account only the surgical procedure as a categorized variable, not considering others factors presented in our scenario that could interfere in the final surgical result.

Visceral leishmaniasis in pregnancy: a case report.

Visceral leishmaniasis (VL) is endemic in the island of São Luis, State of Maranhão, Brazil. Despite an increase in the number of VL cases, the frequency of the disease is low among pregnant women. We present here the case of a pregnant woman followed up by our group, who was treated with amphotericin B with excellent outcome.

Clinical and laboratory profile of children living with vertically transmitted HIV/AIDS in a city in northeastern Brazily

INTRODUCTION Vertical transmission constitutes the main route for child infection by the HIV-1 virus (human immune deficiency virus). This study aimed to investigate the clinical and laboratory evolution of children with vertically transmitted HIV/AIDS. METHODS This was a retrospective descriptive study based on data gathered from the medical records of all the children who were seen at a specialized care unit between January 1998 and June 2006. RESULTS Eighty children who met the inclusion criteria were evaluated. In the cases 56 (70%) of the children, their mothers were diagnosed as HIV-positive after childbirth. The delivery was vaginal for 44 (55%) of the children. Fifty-six children (70%) were breastfed by their mothers for periods ranging from one to more than 12 months. Failure to use or incomplete use of the ACTG 076 protocol was documented in 63 (78.5%) of the cases. CONCLUSIONS The findings from our study are a cause for considerable concern and show failures of medical care for mothers and children, particularly with regard to prevention of transmission.

Caracterização da cobertura do pré-natal no Estado do Maranhão, Brasil

El objetivo de este estudio fue caracterizar la cobertura de atencion prenatal en el Estado de Maranhao. Un estudio de base poblacional en 30 municipios del Estado de Maranhao, con 2.075 mujeres en edad fertil, con el embarazo anterior, entre julio de 2008 enero de 2009. Los resultados mostraron que las unidade de salud de la familia fueron responsables de un 45,9% de la atencion de la mujer embarazada y que el 46,8% indicaron que hacian seis o mas visitas a la atencion prenatal durante su ultimo embarazo y el 64,6% comenzo la atencion prenatal sigue siendo en el 1er trimestre. La cobertura de atencion prenatal fue de 85,6%, sin embargo, cuando se considera la cobertura de atencion prenatal adecuada, esto fue un 43,4%, de acuerdo con las recomendaciones del Ministerio de Salud (Brasil). Aunque la cobertura de atencion prenatal por encima del 80%, menos de la mitad se considera satisfactoria, con una brecha en la calidad de la atencion primaria.The purpose of the study was to characterize the coverage of prenatal care in the State of Maranhão. A population-based study, descriptive in 30 municipalities of the State of Maranhão, with 2075 women of childbearing age, with previous pregnancy, from July 2008 to Januray 2009. The results demonstrated that the units of family health accounted for 45.9% of the care of pregnant women and that 46.8% reported carrying out consultations six or more prenatal care during last pregnancy and 64.6% started prenatal in the first three months of pregnancy. The coverage of prenatal care, without regard to adequacy, was 85.6%, however, when considering the coverage of adequate prenatal as established by Brazilian Health Ministry was 43.4%. Although coverage of prenatal above 80%, less than half is considered adequate, showing a gap in primary care quality.

Endemic hepatitis b and c virus infection in a brazilian eastern amazon region

CONTEXT Hepatitis B and hepatitis C infection has been an important cause of morbidity and mortality around the world. However there are few investigations regarding the prevalence and possible risk factors for these diseases in Brazil, particularly in Amazon region, where there are some endemic focus. OBJECTIVES To determine the prevalence of hepatitis B and hepatitis C in the city of Buriticupu, MA, located in the Brazilian Eastern Amazon region, and try to explore the risk factors for these infections in that area. METHODS Two hundred forty three subjects (46.5% male and 53.5% female) were investigated. RESULTS The prevalence of past or current infection of hepatitis B and C virus was, respectively, 40.74% and 5.76%. Positivity for HBsAg was found in 2.88% of the subjects. The prevalence of current infection or chronic virus carriers found was 2.88% (HBsAg). There was a statistically significant relationship between the sera-prevalence of anti-HBc and the distance of the residence from the city center which may reflect an indirect association between the infection and precarious conditions of existence. Individuals with age equal or greater than 60 years were also more likely to be anti-HBc positive which could only reflect that older people have a longer history of exposure to hepatitis B infection. The prevalence of hepatitis C is higher than the worldwide estimate. CONCLUSION Buriticupu may be considered endemic for hepatitis B and C. Hepatitis B infection could be related to precarious living conditions and old age. Hepatitis C was not associated with the variables investigated in the present investigation.

Severe visceral leishmaniasis in children: the relationship between cytokine patterns and clinical features

INTRODUCTION The relationship between severe clinical manifestations of visceral leishmaniasis (VL) and immune response profiles has not yet been clarified, despite numerous studies on the subject. This study aimed to investigate the relationship between cytokine profiles and the presence of immunological markers associated with clinical manifestations and, particularly, signs of severity, as defined in a protocol drafted by the Ministry of Health (Brazil). METHODS We conducted a prospective, descriptive study between May 2008 and December 2009. This study was based on an assessment of all pediatric patients with VL who were observed in a reference hospital in Maranhão. RESULTS Among 27 children, 55.5% presented with more than one sign of severity or warning sign. Patients without signs of severity or warning signs and patients with only one warning sign had the highest interferon-gamma (IFN-γ) levels, although their interleukin 10 (IL-10) levels were also elevated. In contrast, patients with the features of severe disease had the lowest IFN-γ levels. Three patients who presented with more than two signs of severe disease died; these patients had undetectable interleukin 2 (IL-2) and IFN-γ levels and low IL-10 levels, which varied between 0 and 36.8pg/mL. CONCLUSIONS Our results showed that disease severity was associated with low IFN-γ levels and elevated IL-10 levels. However, further studies with larger samples are needed to better characterize the relationship between disease severity and cytokine levels, with the aim of identifying immunological markers of active-disease severity.

Estado nutricional de adolescentes do Maranhão, Brasil, por critérios nacional e internacional

This study sought to compare national and international criteria for assessing the nutritional status of adolescents. A cross-sectional analytical study was conducted in the period from July 2007 to January 2008 with a representative sample comprised of 1256 adolescents from the state of Maranhao. Body mass index (BMI) for age and gender was used to diagnose underweight, normal weight and overweight, using the criteria proposed by Conde and Monteiro and the World Health Organization (WHO). Chi-square, McNemar concordance and Spearman correlation tests were applied. According to the criteria of Conde and Monteiro and the WHO, there were significant differences among the boys with respect to low weight and obesity. It was observed that there was no significant divergence between the two criteria, and a significant positive correlation (0.011) between the two criteria was detected. With this analysis it can be seen that there are many divergences between the criteria used, therefore the best option and the advantage of using one or the other cannot be singled out. However, it should be stressed that the national criterion can also be used more, since there are no significant differences with the criteria advocated by the Ministry of Health of the WHO.

Rastreamento oportunístico do câncer de mama entre mulheres jovens no Estado do Maranhão, Brasil

Although breast cancer is infrequent in women under 40 years of age, it deserves attention, since diagnosis requires a high rate of clinical suspicion. Thus, preventive practices should be emphasized in childbearing-age women, with opportunistic screening as a relevant strategy. This study focused on breast cancer prevention practices adopted by young women in Maranhao State, Brazil. This was a population-based descriptive study conducted from June 2007 to January 2008. The majority of the women had low income (42.1%) and fewer than eight years of schooling (62.6%). Some 30% reported breast self-examination. Among women older than 35, 71.6% had never had a mammogram. The most common preventive measure was clinical examination (35.2%), which had increased by 11.5% in the previous ten years. Such information on opportunistic breast cancer screening in Maranhao should help produce specific public health policies for the State.