Raquel de Vasconcellos Carvalhaes de Oliveira

Treatment of Cutaneous Sporotrichosis With Itraconazole—Study of 645 Patients

BACKGROUND Itraconazole has become the first choice for treatment of cutaneous sporotrichosis. However, this recommendation is based on case reports and small series. The safety and efficacy of itraconazole were evaluated in 645 patients who received a diagnosis on the basis of isolation of Sporothrix schenckii in Rio de Janeiro, Brazil. METHODS A standard regimen of itraconazole (100 mg/day orally) was used. Clinical and laboratory adverse events were assessed a grades 1-4. A multivariate Cox model was used to analyze the response to treatment. RESULTS The median age was 43 years. Lymphocutaneous form occurred in 68.1% and fixed form in 23.1%. Six hundred ten patients (94.6%) were cured with itraconazole (50-400 mg/day): 547 with 100 mg/day, 59 with 200-400 mg/day, and 4 children with 50 mg/day. Three patients switched to potassium iodide, 2 to terbinafine, and 4 to thermotherapy. Twenty-six were lost to follow-up. Clinical adverse events occurred in 18.1% of patients using 100 mg/day and 21.9% of those using 200-400 mg/day. The most frequent clinical adverse events were nausea and epigastric pain. Laboratory adverse events occurred in 24.1%; the most common was hypercholesterolemia, followed by hypertriglyceridemia. Four hundred sixty-two patients (71.6%) completed clinical follow-up, and all remained cured. Only 2 variables were significant in explaining the cure: patients with erythema nodosum healed faster, and lymphocutaneous form took longer to cure. CONCLUSIONS In the current series, the therapeutic response was excellent with the minimum dose of itraconazole, and there was a low incidence of adverse events and treatment failure.

Diffusion Magnetic Resonance Imaging of the Breast

Several studies have investigated the role of advanced magnetic resonance imaging (MRI) techniques, such as diffusion-weighted imaging (DWI), to improve the specificity of MRI for the evaluation of breast lesions. Potential roles for DWI and the apparent diffusion coefficient in characterizing breast tumors and distinguishing malignant from benign tissues have been reported. This article discusses the clinical applications of breast DWI, including literature results, technical issues and limitations, and the potential applications. The analysis of DWI at our institution is also discussed. The establishment of standard DWI protocols and diagnostic criteria is necessary to ensure accuracy and reproducibility at different centers.

Consumo de álcool entre estudantes universitários

Consumption of alcoholic beverages is widely encouraged by the mass media, despite the related health risks. Todays students in the health fields are the professionals of tomorrow who will be providing advice and serving as role models for patients. The aim of this study was to analyze alcohol consumption and related factors among these students. A total of 608 male and female university students from Maceio, the capital of Alagoas State, Brazil, completed a self-administered questionnaire. Data analysis included Poisson regression and multinomial logistic models. Prevalence of lifetime use of alcohol was 90.4%. Prevalence of alcohol abuse was 18.3% in men and 6.1% in women. Heavier alcohol consumption and alcohol abuse were observed in males, older students, non-natives of Maceio, smokers, and those exposed to alcohol advertising. The results emphasized the vulnerability of these young people to risky health behaviors. Their future social role highlights distinct needs in their university education to enable them to act professionally in this area.

Impacto das atividades profissionais na saúde física e mental dos policiais civis e militares do Rio de Janeiro (RJ, Brasil)

In this article, we analyze the physical and mental stress and illness of military and civil police force officers in the State of Rio de Janeiro (Brazil) due to their working conditions and professional activities. The same methodology was used for the study of two categories, namely a quantitative approach (simple random sampling by conglomerates, involving a total of 1,458 civil police officers and 1,108 military police officers, who answered questionnaires anonymously) and a qualitative approach (focal groups involving 143 professionals and 18 interviews with managers of both police forces). The data presented here are all original. Disorders identified were: overweight and obesity in both forces but mainly in the Military Police; low frequency of physical exercise and high levels of cholesterol, especially in the Civil Police. The main health complaints are neck, back or spinal cord pain, eyesight complaints and headaches/ migraines. Sixteen point two per cent of officers of both forces reported physical lesions that were more prevalent in the Military Police, among whom psychic suffering was also more frequent (SRQ20). The need for changes in the individual and professional dimensions and in institutional aspects regarding the conditions and organization of work and of health services is emphasized.

Desigualdades socioeconômicas e saúde mental infantil

OBJETIVO: Analisar a associacao de determinantes sociodemograficos com o desenvolvimento de problemas de comportamento e de competencia social em criancas. METODOS: Estudo transversal realizado com 479 escolares entre seis e 13 anos de idade, da primeira serie do ensino fundamental de escolas publicas em Sao Goncalo (RJ), em 2005. Foram investigadas variaveis socioeconomicas, estrutura familiar, escolaridade dos pais, cor da pele da crianca, problemas de comportamento e competencia social. Foram calculadas razoes de prevalencia com respectivo intervalo com 95% de confianca. Os dados apresentados foram expandidos para a populacao de alunos da rede de ensino investigada. RESULTADOS: Criancas abaixo da linha de pobreza, de cor da pele negra, com pais com baixa escolaridade, e vivendo em familias monoparentais ou compostas por madrasta/padrasto apresentaram mais precaria competencia social e mais problemas de comportamento. A medida que se elevavam os fatores de risco, crescia a prevalencia das criancas com baixa competencia social e problemas de comportamento. CONCLUSOES: A associacao entre os determinantes sociodemograficos com a maior prevalencia de problemas de comportamento e com mais precaria competencia social em criancas requer que acoes preventivas e de assistencia sejam tomadas como prioridade para as politicas publicas, minorando a existencia de dificuldades sociais e emocionais infantis graves, que podem se manter ate a vida adulta.

Evaluation of serological cross-reactivity between canine visceral leishmaniasis and natural infection by Trypanosoma caninum

In order to evaluate if the presence of Trypanosoma caninum can lead to a confuse diagnosis of canine visceral leishmaniasis (CVL), we investigated the serological status of dogs infected by T. caninum and assessed the serological cross-reactivity with CVL. A set of 117 serum samples from dogs infected by T. caninum, Leishmania chagasi and not infected dogs (n=39 in each group) was tested using commercial kits--indirect immunofluorescence (IFI-LVC), ELISA (EIE-LVC) and immunochromatographic test (DPP)--and in house tests with T. caninum (IIF-Tc and ELISA-Tc) and L. chagasi antigens (IIF-Lc and ELISA-Lc). IIF-Tc and ELISA-Tc presented sensitivity of 64.1% and 94.9% and specificity of 23.1% and 35.9%, respectively. The sensitivity of the IFI-LVC, EIE-LVC and DPP tests was 100% and the specificity was 70.5%, 68% and 97.5% respectively. The concordance between the tests was considered as satisfactory. The specificities of IFI-LVC, EIE-LVC and DPP were higher when the group Tc was excluded, with significant values for IFI-LVC (χ2=4.36, P-value=0.036), thus suggesting that the infection by T. caninum can confuse the diagnosis of CVL.

Influence of the nutritional status in the clinical and therapeutical evolution in adults and elderly with American Tegumentary Leishmaniasis

The objective of this study is to describe the nutritional status of adult and elderly patients with American Tegumentary Leishmaniasis (ATL). It was conducted a longitudinal study in 68 adult and elderly patients with ATL treating at the Surveillance Leishmaniasis Laboratory at the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation (Fiocruz), from 2009 to 2012. The nutritional assessment included the body mass index (BMI) and serum albumin levels. The clinical evolution (epithelialization and wound healing) was measured up to two years after ATL treatment. Most of the sample was composed of men (71%), adults (73%), with household income of 1-5 minimum wages (79%), and incomplete elementary school (48.5%). The predominant ATL form was cutaneous (72%), and 39% presented comorbidities, the most frequent was hypertension (30.8%). The most prevalent clinical and nutritional events were: recent decrease in food intake (23.9%); nasal obstruction (22.1%); oral ulcer (14.7%), anorexia and dysphagia (13.2% each) and odynophagia (10.3%). The total healing time was 115.00 (IR=80-230) days for skin lesions, and 120.00 (IR=104.50-223.50) days for mucous membrane lesions. Low body weight in 10%, and hypoalbuminemia in 12% of the patients have been observed. Low body weight was associated with age, mucosal leishmaniasis (ML), nasal obstruction, recent decrease in food intake and hypoalbuminemia. As for serum albumin depletion, association with the ML, dyspnea, dysphagia, odynophagia, recent decrease in food intake, absence of complete healing of the skin lesions, and increased healing time for mucous membrane lesions, was observed. The ML and their events that affect the alimentary intake have been related to the impairment of the nutritional status. Additionally, serum albumin depletion negatively affected the healing of the lesions, suggesting that a nutritional intervention can increase the effectiveness of the ATL treatment.

Montenegro skin test and age of skin lesion as predictors of treatment failure in cutaneous leishmaniasis.

A case-control study was conducted to examine the association among the Montenegro skin test (MST), age of skin lesion and therapeutic response in patients with cutaneous leishmaniasis (CL) treated at Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. For each treatment failure (case), two controls showing skin lesion healing following treatment, paired by sex and age, were randomly selected. All patients were treated with 5 mg Sb5+/kg/day of intramuscular meglumine antimoniate (Sb5+) for 30 successive days. Patients with CL were approximately five times more likely to fail when lesions were less than two months old at the first appointment. Patients with treatment failure showed less intense MST reactions than patients progressing to clinical cure. For each 10 mm of increase in MST response, there was a 26% reduction in the chance of treatment failure. An early treatment - defined as a treatment applied for skin lesions, which starts when they are less than two months old at the first appointment -, as well as a poor cellular immune response, reflected by lower reactivity in MST, were associated with treatment failure in cutaneous leishmaniasis.

Itraconazole vs. trimethoprim-sulfamethoxazole: A comparative cohort study of 200 patients with paracoccidioidomycosis

Paracoccidioidomycosis (PCM) is a systemic mycosis endemic to Latin America. Brazil accounts for approximately 80% of cases, where it represents a major public health issue due to its disabling impact and the number of premature deaths it causes. We present a retrospective cohort study that was conducted in order to better understand factors that relate to cure of the infection in the treatment of 200 patients with PCM. We evaluated the influence of sociodemographic and clinical factors as well as therapeutic regimen (trimethoprim-sulfamethoxazole [TMP-SMX] and itraconazole) on the progress of PCM (cure and noncure). There was a higher incidence of cure (83%) among patients who regularly received treatment for their infections and completed the treatment protocol. Moreover, itraconazole (86.4%) was significantly superior to TMP-SMX (51.3%) in terms of cure rate and had a median treatment period that was significantly shorter (12 months) than that for TMP-SMX (23 months). A Cox proportional hazard regression model showed that use of itraconazole increased the hazard of cure, regardless of sex, age, education, clinical form, completion of treatment, and regularity. Although the results of this study show that itraconazole was the best treatment option for PCM patients, a double-blind, randomized, controlled trial is necessary to confirm this conclusion.

Socioeconomic inequalities and child mental health

OBJETIVO: Analisar a associacao de determinantes sociodemograficos com o desenvolvimento de problemas de comportamento e de competencia social em criancas. METODOS: Estudo transversal realizado com 479 escolares entre seis e 13 anos de idade, da primeira serie do ensino fundamental de escolas publicas em Sao Goncalo (RJ), em 2005. Foram investigadas variaveis socioeconomicas, estrutura familiar, escolaridade dos pais, cor da pele da crianca, problemas de comportamento e competencia social. Foram calculadas razoes de prevalencia com respectivo intervalo com 95% de confianca. Os dados apresentados foram expandidos para a populacao de alunos da rede de ensino investigada. RESULTADOS: Criancas abaixo da linha de pobreza, de cor da pele negra, com pais com baixa escolaridade, e vivendo em familias monoparentais ou compostas por madrasta/padrasto apresentaram mais precaria competencia social e mais problemas de comportamento. A medida que se elevavam os fatores de risco, crescia a prevalencia das criancas com baixa competencia social e problemas de comportamento. CONCLUSOES: A associacao entre os determinantes sociodemograficos com a maior prevalencia de problemas de comportamento e com mais precaria competencia social em criancas requer que acoes preventivas e de assistencia sejam tomadas como prioridade para as politicas publicas, minorando a existencia de dificuldades sociais e emocionais infantis graves, que podem se manter ate a vida adulta.