Vania Del´Arco Paschoal

Spatial analysis of leprosy incidence and associated socioeconomic factors

OBJECTIVE To identify clusters of the major occurrences of leprosy and their associated socioeconomic and demographic factors. METHODS Cases of leprosy that occurred between 1998 and 2007 in São José do Rio Preto (southeastern Brazil) were geocodified and the incidence rates were calculated by census tract. A socioeconomic classification score was obtained using principal component analysis of socioeconomic variables. Thematic maps to visualize the spatial distribution of the incidence of leprosy with respect to socioeconomic levels and demographic density were constructed using geostatistics. RESULTS While the incidence rate for the entire city was 10.4 cases per 100,000 inhabitants annually between 1998 and 2007, the incidence rates of individual census tracts were heterogeneous, with values that ranged from 0 to 26.9 cases per 100,000 inhabitants per year. Areas with a high leprosy incidence were associated with lower socioeconomic levels. There were identified clusters of leprosy cases, however there was no association between disease incidence and demographic density. There was a disparity between the places where the majority of ill people lived and the location of healthcare services. CONCLUSIONS The spatial analysis techniques utilized identified the poorer neighborhoods of the city as the areas with the highest risk for the disease. These data show that health departments must prioritize politico-administrative policies to minimize the effects of social inequality and improve the standards of living, hygiene, and education of the population in order to reduce the incidence of leprosy.OBJECTIVE: To identify clusters of the major occurrences of leprosy and their associated socioeconomic and demographic factors. METHODS: Cases of leprosy that occurred between 1998 and 2007 in Sao Jose do Rio Preto (southeastern Brazil) were geocodifi ed and the incidence rates were calculated by census tract. A socioeconomic classifi cation score was obtained using principal component analysis of socioeconomic variables. Thematic maps to visualize the spatial distribution of the incidence of leprosy with respect to socioeconomic levels and demographic density were constructed using geostatistics. RESULTS: While the incidence rate for the entire city was 10.4 cases per 100,000 inhabitants annually between 1998 and 2007, the incidence rates of individual census tracts were heterogeneous, with values that ranged from 0 to 26.9 cases per 100,000 inhabitants per year. Areas with a high leprosy incidence were associated with lower socioeconomic levels. There were identifi ed clusters of leprosy cases, however there was no association between disease incidence and demographic density. There was a disparity between the places where the majority of ill people lived and the location of healthcare services. CONCLUSIONS: The spatial analysis techniques utilized identifi ed the poorer neighborhoods of the city as the areas with the highest risk for the disease. These data show that health departments must prioritize politico-administrative policies to minimize the effects of social inequality and improve the standards of living, hygiene, and education of the population in order to reduce the incidence of leprosy.

Quality of Life of Severe Sepsis Survivors After Hospital Discharge

OBJETIVO: Evaluacion de la calidad de vida de los sobrevivientes de sepsis grave con los instrumentos EuroQol-5D y la Escala Analogica Visual (EQ-VAS). METODO: Estudio caso-control anidado en pacientes que recibieron alta de la unidad de cuidados intensivos (UCI) de un hospital de ensenanza despues de la admision con sepsis grave. La seleccion fue realizada a partir del registro de sepsis conteniendo 349 pacientes y cada paciente con sepsis fue considerado como un caso y el que fue hospitalizado inmediatamente despues fue seleccionado como control, desde que no tuviera sepsis y hubiera sobrevivido a la hospitalizacion en la UCI y la sepsis, totalizando 100 sujetos. RESULTADOS: El grupo de sepsis mostro una mayor mortalidad a 1 ano comparado con los pacientes en estado critico pero sin sepsis en el grupo control. Los pacientes ancianos (>60 anos) con sepsis tuvieron una prevalencia significativamente mayor de problemas. No hubo diferencias en EQ-VAS entre los entrevistados de ambos grupos. CONCLUSIONES: Despues del alta de la UCI, los pacientes que sobrevivieron a la sepsis tuvieron una tasa de mortalidad mas alta que los pacientes sin enfermedad critica. Pacientes ancianos con sepsis tuvieron problemas moderados y graves en todas las cinco dimensiones de calidad de vida evaluadas.AIMS to evaluate the quality of life in severe sepsis survivors, using specific QoL questionnaires: the EuroQol-5 Dimensions and the Visual Analogue Scale (EQ-VAS). METHOD This case-control study was performed in patients discharged from a teaching hospital after being admitted to the ICU with severe sepsis. Medical records from 349 patients were retrieved from the hospital sepsis registry. Each patient with sepsis was considered as a case. Patients who were admitted immediately after the sepsis episode were considered as controls, provided that they did not have sepsis and survived the ICU admission. This specific study population included 100 patients. RESULTS The sepsis group showed higher mortality at 1 year compared with critically ill patients. However, the control group showed no sepsis. Older patients (>60 years) in the sepsis group had a significantly higher prevalence of problems. There were no differences in EQ-VAS between respondents from both groups. CONCLUSIONS After discharge from ICU, sepsis survivors of sepsis had a higher mortality rate than critically ill patients without sepsis. Older patients with sepsis had more moderate and severe problems in all five quality of life dimensions evaluated.

Identification of Urban Leprosy Clusters

Overpopulation of urban areas results from constant migrations that cause disordered urban growth, constituting clusters defined as sets of people or activities concentrated in relatively small physical spaces that often involve precarious conditions. Aim. Using residential grouping, the aim was to identify possible clusters of individuals in São José do Rio Preto, Sao Paulo, Brazil, who have or have had leprosy. Methods. A population-based, descriptive, ecological study using the MapInfo and CrimeStat techniques, geoprocessing, and space-time analysis evaluated the location of 425 people treated for leprosy between 1998 and 2010. Clusters were defined as concentrations of at least 8 people with leprosy; a distance of up to 300 meters between residences was adopted. Additionally, the year of starting treatment and the clinical forms of the disease were analyzed. Results. Ninety-eight (23.1%) of 425 geocoded cases were located within one of ten clusters identified in this study, and 129 cases (30.3%) were in the region of a second-order cluster, an area considered of high risk for the disease. Conclusion. This study identified ten clusters of leprosy cases in the city and identified an area of high risk for the appearance of new cases of the disease.

Diagnosis and medical treatment of neuropathic pain in leprosy

Objetivo: identificar las dificultades de diagnosticar y tratar el dolor neuropatico causado por la lepra, asi como determinar las caracteristicas principales de esa situacion. Metodos: se examinaron 85 pacientes tratados en ambulatorio de referencia para lepra y que refirieron dolor. Se aplico el cuestionario test Douleur Neuropathic 4, y se hizo un minucioso examen neurologico a traves del cual se excluyeron 42 pacientes por no haberse comprobado dolor. Resultados: de los 37 pacientes con dolor, 22 (59,5%) tenian dolor neuropatico o mixto y, de esos, 90,8% caracterizaban ese dolor como de intensidad moderada o severa, siendo que 81,8% sufrian de el hace mas de 6 meses. Apenas 12 (54,5%) pacientes habian sido diagnosticados con dolor neuropatico y casi mitad de los casos (45,5%) estaba sin reconocimiento. En cuanto al tratamiento medicamentoso (n=12) para el dolor neuropatico, 5 (41,6%) respondieron que tuvieron mejoria; en los otros 7 (58,4%) no hubo alteracion del dolor o empeoraron cuando se comparo con el cuadro inicial. El analisis estadistico, comparando la mejoria del dolor entre los pacientes tratados (n=12) y aquellos no tratados (n=10), fue significativa (valor-p=0,020). Conclusion: se identifico dificultad en diagnosticar el dolor neuropatico en la lepra, considerando que casi la mitad de los pacientes estudiados estaban sin reconocimiento de ese cuadro. Se atribuyeron como factores asociados la no adopcion de protocolo apropiado para un efectivo diagnostico y tratamientos inadecuados que pudieron haber enmascarar el cuadro.ABSTRACT Objective: to identify the difficulties in diagnosing and treating neuropathic pain caused by leprosy and to understand the main characteristics of this situation. Methods: 85 patients were treated in outpatient units with reference to leprosy and the accompanying pain. We used a questionnaire known as the Douleur Neuropathic 4 test and we conducted detailed neurological exams. As a result, 42 patients were excluded from the study for not having proved their pain. Results: Out of the 37 patients that experienced pain, 22 (59.5%) had neuropathic pain (or a mixture of this pain and their existing pain) and of these 90.8% considered this pain to be moderate or severe. 81.8% of the sample suffered with this pain for more than 6 months. Only 12 (54.5%) of the patients had been diagnosed with neuropathic pain and in almost half of these cases, this pain had not been diagnosed. With reference to medical treatment (n=12) for neuropathic pain, 5 (41.6%) responded that they became better. For the other 7 (58.4%) there were no changes in relation to the pain or in some cases the pain worsened in comparison to their previous state. Statistical analysis comparing improvements in relation to the pain amongst the patients that were treated (n=12) and those that were not, showed significant differences (value p=0.020). Conclusion: we noted difficulties in diagnosing neuropathic pain for leprosy in that almost half of the patients that were studied had not had their pain diagnosed. We attributed this to some factors such as the non-adoption of the appropriate protocols which led to inadequate diagnosis and treatment that overlooked the true picture.

Study of the Nuclear Volume of Testicular Cells of Rats Receiving Ofloxacin Through Lactation

El ofloxacin presenta un amplio espectro de accion antimicrobiana, incluyendo el combate a.Mycobacterium leprae, y es frecuentemente empleado como un sustituto cuando el uso de la rifampicina es imposible. El objetivo del trabajo fue estudiar las alteraciones en el nucleo de las celulas testiculares en ratas que se encontraban amamantando y que fueron sometidas a la aplicacion oral de ofloxacin. El metodo utilizado fue la tecnica morfometrica de la cariometria. Las principales estructuras observadas en las preparaciones histologicas fueron las celulas intersticiales, espermatogenias y celulas sustentaculares. Se utilizaron 10 ratas Wistar, cinco fueron el grupo control y cinco sometidas al tratamiento, cuyas madres recibieron ofloxacin en dosis oral diaria de 12 mg/Kg de peso corporal los primeros 25 dias de vida, para luego ser sacrificadas al dia 25 despues del nacimiento. El estudio cariometrico de las celulas intersticiales y de la espermatogenesis revelaron que no hubo cambios en la forma de sus nucleos (p > 0,05). Las celulas sustentaculares presentaron un incremento en su diametro mayor, diametro menor, diametro geometrico promedio, volumen, area, razon volumen/area y perimetro, tambien hubo aumento con una diferencia de la excentricidad estadisticamente significativa (p < 0,05) en las crias amamantadas, a las cuales se les administro ofloxacin. Los nucleos presentaron un gran tamano y una forma mas alargada. Esto concluye que las celulas sustentaculares son mas sensibles al efecto de la administracion de ofloxacin

PROFISSIONAIS DE UM LABORATÓRIO DE SAÚDE PÚBLICA ESTIMULAM ESTUDANTES NA PREVENÇÃO DE DOENÇAS TRANSMITIDAS POR ALIMENTOS

Introduction: Educational activities focused on prevention are important tools to reduce outbreaks of foodborne illness. Objective: To verify whether, after educational lectures, students changed their habits to prevent foodborne diseases. Patients and Methods: Over four years, the staff and students of the Institute Adolfo Lutz, through the project “Itinerant Circuit of Lectures”, presented 41 talks and distributed a folder detailing the etiological agents, symptoms, and measures of prevention, conservation and handling of food to 1906 students in 12 private schools. Two months after the lectures an assessment tool comprising ten statements was applied to the students to see if they had changed their daily habits. Results: A total of 1555 students answered the questionnaire, with 81.5% having changed their habits, in particular students of the 6th, 7th and 8th grades of elementary school compared to students of the 9th grade, and 1st and 3rd grade of high school (p-value <0.05). The mean number of changes in habits related to the four personal hygiene items was 2.42 (SD 1.07), and for the six items on food care the mean number was 3.37 (SD 1.41). Conclusion: Popularization of science with educative actions proved to be effective, as 81.5% of young people changed their daily habits of personal hygiene and food care. Descriptors: Foodborne Diseases; Health Education; Food Contamination.

Diagnóstico e tratamento medicamentoso da dor neuropática em hanseníase

Objetivo: identificar las dificultades de diagnosticar y tratar el dolor neuropatico causado por la lepra, asi como determinar las caracteristicas principales de esa situacion. Metodos: se examinaron 85 pacientes tratados en ambulatorio de referencia para lepra y que refirieron dolor. Se aplico el cuestionario test Douleur Neuropathic 4, y se hizo un minucioso examen neurologico a traves del cual se excluyeron 42 pacientes por no haberse comprobado dolor. Resultados: de los 37 pacientes con dolor, 22 (59,5%) tenian dolor neuropatico o mixto y, de esos, 90,8% caracterizaban ese dolor como de intensidad moderada o severa, siendo que 81,8% sufrian de el hace mas de 6 meses. Apenas 12 (54,5%) pacientes habian sido diagnosticados con dolor neuropatico y casi mitad de los casos (45,5%) estaba sin reconocimiento. En cuanto al tratamiento medicamentoso (n=12) para el dolor neuropatico, 5 (41,6%) respondieron que tuvieron mejoria; en los otros 7 (58,4%) no hubo alteracion del dolor o empeoraron cuando se comparo con el cuadro inicial. El analisis estadistico, comparando la mejoria del dolor entre los pacientes tratados (n=12) y aquellos no tratados (n=10), fue significativa (valor-p=0,020). Conclusion: se identifico dificultad en diagnosticar el dolor neuropatico en la lepra, considerando que casi la mitad de los pacientes estudiados estaban sin reconocimiento de ese cuadro. Se atribuyeron como factores asociados la no adopcion de protocolo apropiado para un efectivo diagnostico y tratamientos inadecuados que pudieron haber enmascarar el cuadro.ABSTRACT Objective: to identify the difficulties in diagnosing and treating neuropathic pain caused by leprosy and to understand the main characteristics of this situation. Methods: 85 patients were treated in outpatient units with reference to leprosy and the accompanying pain. We used a questionnaire known as the Douleur Neuropathic 4 test and we conducted detailed neurological exams. As a result, 42 patients were excluded from the study for not having proved their pain. Results: Out of the 37 patients that experienced pain, 22 (59.5%) had neuropathic pain (or a mixture of this pain and their existing pain) and of these 90.8% considered this pain to be moderate or severe. 81.8% of the sample suffered with this pain for more than 6 months. Only 12 (54.5%) of the patients had been diagnosed with neuropathic pain and in almost half of these cases, this pain had not been diagnosed. With reference to medical treatment (n=12) for neuropathic pain, 5 (41.6%) responded that they became better. For the other 7 (58.4%) there were no changes in relation to the pain or in some cases the pain worsened in comparison to their previous state. Statistical analysis comparing improvements in relation to the pain amongst the patients that were treated (n=12) and those that were not, showed significant differences (value p=0.020). Conclusion: we noted difficulties in diagnosing neuropathic pain for leprosy in that almost half of the patients that were studied had not had their pain diagnosed. We attributed this to some factors such as the non-adoption of the appropriate protocols which led to inadequate diagnosis and treatment that overlooked the true picture.

Diagnóstico y tratamiento medicamentoso del dolor neuropático en la lepra

Objetivo: identificar las dificultades de diagnosticar y tratar el dolor neuropatico causado por la lepra, asi como determinar las caracteristicas principales de esa situacion. Metodos: se examinaron 85 pacientes tratados en ambulatorio de referencia para lepra y que refirieron dolor. Se aplico el cuestionario test Douleur Neuropathic 4, y se hizo un minucioso examen neurologico a traves del cual se excluyeron 42 pacientes por no haberse comprobado dolor. Resultados: de los 37 pacientes con dolor, 22 (59,5%) tenian dolor neuropatico o mixto y, de esos, 90,8% caracterizaban ese dolor como de intensidad moderada o severa, siendo que 81,8% sufrian de el hace mas de 6 meses. Apenas 12 (54,5%) pacientes habian sido diagnosticados con dolor neuropatico y casi mitad de los casos (45,5%) estaba sin reconocimiento. En cuanto al tratamiento medicamentoso (n=12) para el dolor neuropatico, 5 (41,6%) respondieron que tuvieron mejoria; en los otros 7 (58,4%) no hubo alteracion del dolor o empeoraron cuando se comparo con el cuadro inicial. El analisis estadistico, comparando la mejoria del dolor entre los pacientes tratados (n=12) y aquellos no tratados (n=10), fue significativa (valor-p=0,020). Conclusion: se identifico dificultad en diagnosticar el dolor neuropatico en la lepra, considerando que casi la mitad de los pacientes estudiados estaban sin reconocimiento de ese cuadro. Se atribuyeron como factores asociados la no adopcion de protocolo apropiado para un efectivo diagnostico y tratamientos inadecuados que pudieron haber enmascarar el cuadro.ABSTRACT Objective: to identify the difficulties in diagnosing and treating neuropathic pain caused by leprosy and to understand the main characteristics of this situation. Methods: 85 patients were treated in outpatient units with reference to leprosy and the accompanying pain. We used a questionnaire known as the Douleur Neuropathic 4 test and we conducted detailed neurological exams. As a result, 42 patients were excluded from the study for not having proved their pain. Results: Out of the 37 patients that experienced pain, 22 (59.5%) had neuropathic pain (or a mixture of this pain and their existing pain) and of these 90.8% considered this pain to be moderate or severe. 81.8% of the sample suffered with this pain for more than 6 months. Only 12 (54.5%) of the patients had been diagnosed with neuropathic pain and in almost half of these cases, this pain had not been diagnosed. With reference to medical treatment (n=12) for neuropathic pain, 5 (41.6%) responded that they became better. For the other 7 (58.4%) there were no changes in relation to the pain or in some cases the pain worsened in comparison to their previous state. Statistical analysis comparing improvements in relation to the pain amongst the patients that were treated (n=12) and those that were not, showed significant differences (value p=0.020). Conclusion: we noted difficulties in diagnosing neuropathic pain for leprosy in that almost half of the patients that were studied had not had their pain diagnosed. We attributed this to some factors such as the non-adoption of the appropriate protocols which led to inadequate diagnosis and treatment that overlooked the true picture.

HISTÓRIA EM QUADRINHOS PARA ENSINO E PREVENÇÃO DAS DOENÇAS TRANSMITIDAS POR ALIMENTOS

Doencas transmitidas por alimentos (DTA) representam um problema de saude publica, contudo, sao passiveis de prevencao. Os surtos alimentares ocorrem em grande parte nas residencias, devido manipulacao ou armazenagem inadequada dos alimentos; assim, estrategias de educacao em saude voltadas a populacao podem colaborar na diminuicao dos riscos relacionados. Considera-se que a criacao de um material impresso voltado para o publico infanto-juvenil pode colaborar para o interesse e facil disseminacao do conhecimento.

Calidad de vida de sobrevivientes de sepsis grave después del alta hospitalar

OBJETIVO: Evaluacion de la calidad de vida de los sobrevivientes de sepsis grave con los instrumentos EuroQol-5D y la Escala Analogica Visual (EQ-VAS). METODO: Estudio caso-control anidado en pacientes que recibieron alta de la unidad de cuidados intensivos (UCI) de un hospital de ensenanza despues de la admision con sepsis grave. La seleccion fue realizada a partir del registro de sepsis conteniendo 349 pacientes y cada paciente con sepsis fue considerado como un caso y el que fue hospitalizado inmediatamente despues fue seleccionado como control, desde que no tuviera sepsis y hubiera sobrevivido a la hospitalizacion en la UCI y la sepsis, totalizando 100 sujetos. RESULTADOS: El grupo de sepsis mostro una mayor mortalidad a 1 ano comparado con los pacientes en estado critico pero sin sepsis en el grupo control. Los pacientes ancianos (>60 anos) con sepsis tuvieron una prevalencia significativamente mayor de problemas. No hubo diferencias en EQ-VAS entre los entrevistados de ambos grupos. CONCLUSIONES: Despues del alta de la UCI, los pacientes que sobrevivieron a la sepsis tuvieron una tasa de mortalidad mas alta que los pacientes sin enfermedad critica. Pacientes ancianos con sepsis tuvieron problemas moderados y graves en todas las cinco dimensiones de calidad de vida evaluadas.AIMS to evaluate the quality of life in severe sepsis survivors, using specific QoL questionnaires: the EuroQol-5 Dimensions and the Visual Analogue Scale (EQ-VAS). METHOD This case-control study was performed in patients discharged from a teaching hospital after being admitted to the ICU with severe sepsis. Medical records from 349 patients were retrieved from the hospital sepsis registry. Each patient with sepsis was considered as a case. Patients who were admitted immediately after the sepsis episode were considered as controls, provided that they did not have sepsis and survived the ICU admission. This specific study population included 100 patients. RESULTS The sepsis group showed higher mortality at 1 year compared with critically ill patients. However, the control group showed no sepsis. Older patients (>60 years) in the sepsis group had a significantly higher prevalence of problems. There were no differences in EQ-VAS between respondents from both groups. CONCLUSIONS After discharge from ICU, sepsis survivors of sepsis had a higher mortality rate than critically ill patients without sepsis. Older patients with sepsis had more moderate and severe problems in all five quality of life dimensions evaluated.