Evolução da infecção pelo HIV entre os povos indígenas do Brasil Central / Evolution of HIV infection in indigenous peoples in Central Brazil / Evolución de la infección por VIH entre los pueblos indígenas de Brasil Central

A distribuição da epidemia de aids no Brasil está associada a uma ampla gama de fatores que definem maior ou menor vulnerabilidade de grupos populacionais. O estudo teve como objetivo analisar as características clínicas e laboratoriais dos casos de infecção pelo HIV/aids em indivíduos com 13 anos de idade ou mais, e sua evolução para o óbito na população indígena assistida pelo Distrito Sanitário Especial Indígena de Mato Grosso do Sul. Realizou-se um estudo descritivo e retrospectivo sobre a condição clínica e evolução da doença entre 2001 e 2014, a partir de três bases de dados secundários. Foram avaliados o tempo de evolução para a aids, o tempo de evolução ao óbito, a carga viral, a contagem de linfócitos T-CD4+ e o tempo de sobrevida. Foram identificados 103 casos de infecção pelo HIV, dos quais 48,5% evoluíram para aids, sendo 60% em menos de um ano desde o diagnóstico. Foram registrados 40 óbitos, sendo 77,5% em decorrência da infecção pelo HIV. Desses que morreram, apenas 30% tiveram sobrevida maior do que um ano. Este estudo sugere que o diagnóstico da infecção pelo HIV se deu nas fases avançadas da doença, revelando-se tardio e apontando uma cobertura diagnóstica deficiente. A rápida evolução ao óbito e curto período de sobrevida também podem indicar fragilidade no acesso aos serviços de saúde de referência, assim como desarticulação e pactuações insuficientes entre Distrito, municípios e estado.

Distribution of the AIDS epidemic in Brazil is associated with a wide range of factors that determine different population groups' greater or lesser vulnerability. The study's objective was to analyze clinical and laboratory characteristics of HIV/AIDS in individuals 13 years or older and the evolution to death in the indigenous population assisted by the Special Indigenous Health District of the State of Mato Grosso do Sul, Brazil. A descriptive and retrospective study was performed on the clinical conditions and evolution of the disease from 2001 to 2014, based on three secondary databases. The study assessed time in progression to AIDS, time in progression to death, viral load, CD4+ T-lymphocyte count, and survival time. A total of 103 cases of HIV infection were identified, of which 48.5% progressed to AIDS, 60% in less than a year since diagnosis. Forty deaths were recorded, 77.5% of which due to HIV infection. Of those who died, only 30% had survived for more than a year. The study suggests that diagnosis of HIV infection occurred in advanced stages of the disease (i.e., late), and points to deficient diagnostic coverage. Rapid progression to death and short survival time are indicative of insufficient access to specialized health services, as well as disconnection and deficient collaboration between the Indigenous Health District, municipalities, and the state.

La distribución de la epidemia de sida en Brasil está asociada a una amplia gama de factores que definen mayor o menor vulnerabilidad de grupos poblacionales. El objetivo del estudio fue analizar las características clínicas y de laboratorio de los casos de infección por el VIH/sida en individuos con 13 años de edad o más, y su evolución hacia el óbito en la población indígena, asistida por el Distrito Sanitario Especial Indígena de Mato Grosso do Sul. Se realizó un estudio descriptivo y retrospectivo sobre la condición clínica y la evolución de la enfermedad entre 2001 y 2014, a partir de tres bases de datos secundarios. Se evaluó el tiempo de evolución para el sida, el tiempo de evolución para el óbito, la carga viral, el cálculo de linfocitos T-CD4+ y el tiempo de supervivencia. Se identificaron 103 casos de infección por VIH, de los cuales un 48,5% evolucionaron hacia sida, siendo 60% en menos de un año desde el diagnóstico. Se registraron 40 óbitos, siendo un 77,5% derivados de la infección por VIH. De esos que murieron, solamente un 30% tuvieron una supervivencia mayor que un año. Este estudio sugiere que el diagnóstico de la infección por VIH se produjo en fases avanzadas de la enfermedad, revelándose tardío y apuntando una cobertura diagnóstica deficiente. La rápida evolución al óbito y corto período de supervivencia, también pueden indicar fragilidad en el acceso a los servicios de salud de referencia, así como la descoordinación y acuerdos insuficientes entre distrito, municipios y estado.

Update on the treatment of musculoskeletal manifestations in chikungunya fever: a guideline

Abstract Since the emergence of the chikungunya virus in Brazil in 2014, more than 700,000 cases have been reported throughout the country, corresponding to one-third of all cases reported in the Americas. In addition to its high attack rates, resulting in hundreds of thousands of cases, the disease has high chronicity rates with persistent joint manifestations for more than 3 months, which can spread to more than half of the patients affected in the acute phase. Pain associated with musculoskeletal manifestations, often disabling, has an effect on patients' quality of life at different stages of the disease. Currently, the challenge faced by specialists is identifying the best therapy to be instituted for symptom relief despite the limited number of published intervention studies. In 2016, a multidisciplinary group published pharmacological treatment protocols for pain in patients with chikungunya, which was incorporated into the guidelines for clinical management of the Brazilian Ministry of Health in 2017; in that same year, a consensus was published by the Brazilian Society of Rheumatology about diagnosis and treatment. After 5 years of experience with chikungunya epidemics, in 2019, specialists involved in the protocols of the Brazilian Society of Rheumatology and Brazilian Ministry of Health prepared an update with the main objective of developing flowcharts for the therapeutic approach of musculoskeletal manifestations in adult patients to enable specialists at different levels of healthcare to spread and apply this guideline in a systematic and simplified manner.

Epidemiological aspects of HIV infection and AIDS among indigenous populations / Aspectos epidemiológicos da infecção pelo HIV e da aids entre povos indígenas

ABSTRACT OBJECTIVE To describe the epidemiological aspects of HIV infection and AIDS among indigenous peoples of the state of Mato Grosso do Sul, Brazil. METHODS This is a descriptive epidemiological study on the occurrence and distribution of HIV infection and AIDS in the indigenous population assisted by the Distrito Sanitário Especial Indígena (Indigenous Special Health District) Mato Grosso do Sul between 2001 and 2014, based on three secondary databases. Annual rates of HIV and AIDS detection and prevalence were calculated, considering case distribution according to village, Health Base Pole and sociodemographic variables. Accumulated rates of detection, mortality and case fatality were calculated by ethnic group and for the Health Base Pole with the highest number of cases. RESULTS The HIV detection rate fluctuated between 0.0 and 18.0/100 thousand people in the study period. For AIDS, there was no notification before 2007, but in 2012 its rate reached 16.6/100 thousand. HIV prevalence grew between 2001 and 2011, and it continuously grew for AIDS starting from 2007. The highest HIV detection rates occurred among Guarani peoples (167.1/100 thousand) and for AIDS, among the Kaiowá peoples (79.3/100 thousand); mortality and fatality rates were higher among the Kaiowá. Regarding the Dourados Health Base Pole, the AIDS detection rate increased, and the mortality and fatality rates decreased. CONCLUSIONS HIV infection and AIDS have been increasing among indigenous peoples, with distribution of the disease mainly in the Health Base Poles of the southern region of the state, where greater economic and social vulnerability are also observed. The endemic character of HIV and AIDS can become epidemic in some years given the existence of cases in other villages in the state. Its occurrence among the Guarani and Kaiowá populations indicates the need for expanded diagnosis, access to treatment and prevention measures.

RESUMO OBJETIVO Descrever os aspectos epidemiológicos da infecção pelo HIV e da aids entre povos indígenas do Mato Grosso do Sul. MÉTODOS Estudo epidemiológico descritivo sobre ocorrência e distribuição da infecção pelo HIV e aids na população indígena assistida pelo Distrito Sanitário Especial Indígena Mato Grosso do Sul, entre 2001 e 2014, a partir de três bases de dados secundários. Calcularam-se as taxas anuais de detecção e de prevalência de HIV e aids, com distribuição dos casos segundo aldeia, Polo Base e variáveis sociodemográficas. As taxas acumuladas de detecção, mortalidade e letalidade foram calculadas por etnia e para os Polos Base com o maior número de casos. RESULTADOS A taxa de detecção de HIV flutuou entre 0,0 e 18,0/100 mil pessoas no período. Para a aids, não houve notificação antes de 2007, mas em 2012 sua taxa chegou a 16,6/100 mil. A prevalência de HIV indicou crescimento entre 2001 e 2011, e para a aids observou-se aumento contínuo a partir de 2007. As maiores taxas de detecção de HIV ocorreram entre os Guarani (167,1/100 mil) e de aids, entre os Kaiowá (79,3/100 mil); as taxas de mortalidade e letalidade foram superiores entre os Kaiowá. Para o Polo Base de Dourados, observou-se elevação da taxa de detecção de aids e diminuição das taxas de mortalidade e letalidade. CONCLUSÕES A infecção pelo HIV e a aids mostraram-se crescentes entre povos indígenas, com distribuição da doença principalmente nos Polos Base da região sul do estado, onde observa-se também maior vulnerabilidade econômica e social. O caráter endêmico do HIV e da aids pode se tornar epidêmico em alguns anos, considerando a existência de casos em outras aldeias do estado. Sua ocorrência entre os Guarani e Kaiowá sinaliza a necessidade de ampliação do diagnóstico, do acesso ao tratamento e de medidas de prevenção.

Avaliação da implantação do Programa de Controle da Dengue em dois municípios fronteiriços do estado de Mato Grosso do Sul, Brasil, 2016 / Evaluación de la implantación del Programa de Control del Dengue en dos municipios fronterizos en el Estado de Mato Grosso do Sul, Brasil, 2016 / National Dengue Control Program implementation evaluation in two border municipalities in Mato Grosso do Sul State, Brazil, 2016

Objetivo: avaliar o grau de implantação do Programa Nacional de Controle da Dengue (PNCD) em dois municípios fronteiriços de Mato Grosso do Sul - Corumbá e Ponta Porã -, Brasil, em 2016. Métodos: avaliação normativa, baseada em indicadores da estrutura e do processo de trabalho; foram aplicados questionários a profissionais envolvidos na prevenção e controle da dengue; os pontos de corte utilizados para determinar o grau de implantação foram 'implantado' (>75% das atividades implantadas), 'parcialmente implantado' (50 a 75%), 'baixo nível de implantação' (25 a 49%) e 'não implantado' (<25%). Resultados: participaram do estudo 383 profissionais da Saúde, 227 de Corumbá e 156 de Ponta Porã; o grau de implantação do PNCD foi de 63,1% e 66,4% para Corumbá e Ponta Porã, respectivamente, classificado como parcialmente implantado nos dois municípios. Conclusão: a implantação do PNCD foi parcial em ambos os municípios; os problemas identificados remetem à necessidade de aprimoramento do programa.

Objetivo: evaluar el grado de implantación del Programa Nacional de Control del Dengue (PNCD) en dos municipios fronterizos de Mato Grosso do Sul - Corumbá y Ponta Porã -, Brasil, en 2016. Métodos: evaluación normativa basada en indicadores de la estructura y del proceso de trabajo; se aplicaron cuestionarios a profesionales involucrados en la prevención y control del dengue; los puntos de corte utilizados para determinar el grado de implantación fueron 'implantado' (>75% de las actividades implantadas), 'parcialmente implantado' (50 a 75%), 'bajo nivel de implantación' (25 a 49%) y 'no implantado' (<25%). Resultados: participaron del estudio 383 profesionales de la Salud, 227 de Corumbá y 156 de Ponta Porã; el grado de implantación del PNCD fue de 63,1% y 66,4% para Corumbá y Ponta Porã, respectivamente, clasificado como parcialmente implantado en ambos municipios. Conclusión: la implantación del PNCD fue parcial en ambos municipios; los problemas identificados remiten a la necesidad de perfeccionamiento del programa.

Objective: to evaluate the degree of implementation of the National Dengue Control Program (PNCD) in two border municipalities in Mato Grosso do Sul State (Corumbá and Ponta Porã), Brazil, 2016. Methods: This was a normative evaluation based on indicators of service structure and work process; questionnaires were answered by health professionals involved in dengue prevention and control; the cut-off points used to determine the degree of implementation were 'implemented' (>75% of the activities implemented), 'partially implemented' (50 to 75%), 'low level of implementation' (25 to 49%), and 'not implemented' (<25%). Results: 383 health professionals participated in this study, 227 of whom were from Corumbá and 156 from Ponta Porã; the degree of PNCD implementation was 63.1% and 66.4% for Corumbá and Ponta Porã, respectively, thus being classified as partially implemented in both municipalities. Conclusion: PNCD implementation was partial in both municipalities; problems observed indicate the need for program enhancement.

Yellow fever outbreak in Brazil: the puzzle of rapid viral spread and challenges for immunisation

We discuss the complex eco-social factors involved in the puzzle of the unexpected rapid viral spread in the ongoing Brazilian yellow fever (YF) outbreak, which has increased the reurbanisation risk of a disease without urban cases in Brazil since 1942. Indeed, this rapid spatial viral dissemination to the Southeast and South regions, now circulating in the Atlantic Forest fragments close to peri-urban areas of the main Brazilian megalopolises (São Paulo and Rio de Janeiro) has led to an exponential increase in the number of yellow fever cases. In less than 18 months, 1,833 confirmed cases and 578 deaths were recorded most of them reported in the Southeast region (99,9%). Large epizooties in monkeys and other non-human primates (NHPs) were communicated in the country with 732 YF virus (YFV) laboratory confirmed events only in the 2017/2018 monitoring period. We also discuss the peculiarities and similarities of the current outbreak when compared with previous great epidemics, examining several hypotheses to explain the recent unexpected acceleration of epizootic waves in the sylvatic cycle of the YFV together with the role of human, NHPs and mosquito mobility with respect to viral spread. We conclude that the most feasible hypothesis to explain this rapidity would be related to human behavior combined with ecological changes that promoted a significant increase in mosquito and NHP densities and their contacts with humans. We emphasize the urgent need for an adequate response to this outbreak such as extending immunisation coverage to the whole Brazilian population and developing novel strategies for immunisation of NHPs confined in selected reserve areas and zoos. Finally, we stress the urgent need to improve the quality of response in order to prevent future outbreaks and a catastrophic reurbanisation of the disease in Brazil and other South American countries. Continuous monitoring of YFV receptivity and vulnerability conditions with effective control of the urban vector Aedes aegypti and significant investments in YF vaccine production capacity and research and development for reduction of adverse effects are of the highest priority.

Desafios da prevenção e controle da dengue na fronteira Brasil/Bolívia: representações sociais de gestores e profissionais da saúde / Challenges of the prevention and control of dengue fever in Brazil/Bolivia border: social representations of health managers and professionals

Resumo Este estudo tem por objetivo identificar e analisar as representações sociais dos gestores e profissionais da saúde sobre os desafios da prevenção e controle da dengue em Corumbá, Mato Grosso do Sul, fronteira Brasil/Bolívia. Trata-se de uma pesquisa qualitativa fundamentada na teoria das representações sociais. Para a coleta de dados foram entrevistados cinco gestores e 63 profissionais da saúde atuantes na estratégia Saúde da Família e na Santa Casa de Misericórdia de Corumbá; a análise do conteúdo se fez pela técnica do Discurso do Sujeito Coletivo. Os resultados apontam que o município possui grandes dificuldades de enfrentamento da dengue pelo fato de ficar na fronteira. Na análise dos discursos foram identificadas quatro ideias centrais: insuficiência de recursos financeiros, mobilidade transfronteiriça, reduzida cooperação fronteiriça e cultura dos bolivianos. O estudo reforça a necessidade de cooperação bilateral ou multilateral para melhor atendimento à saúde nos territórios de fronteira.

Abstract This study aims to identify and analyze the social representations of health managers and professionals on challenges of combating dengue fever in Corumba, Mato Grosso do Sul state, Brazil/Bolivia border. It is a qualitative research based on the theory of social representations. For data collection were interviewed five managers and 63 health professionals active in the Family Health Strategy and Santa Casa de Misericordia, whose content analysis was done using the Collective Subject Discourse technique. The results indicate that the municipality has great difficulties to combat dengue fever because it is a border. In the discourse analysis, four main ideas were identified: insufficient financial resources, cross-border mobility, border cooperation reduced and Bolivian culture. The study reinforces the need for bilateral or multilateral cooperation for better health care in border areas.

Subnotificação de sífilis em gestantes, congênita e adquirida entre povos indígenas em Mato Grosso do Sul, 2011-2014 / Sub-notificación de sífilis gestacional, congénita y adquirida entre pueblos indígenas en Mato Grosso do Sul, Brasil, 2011-2014 / Underreporting of gestational, congenital and acquired syphilis among indigenous peoples in Mato Grosso do Sul State, Brazil, 2011-2014

OBJETIVO: descrever a distribuição, incidência e subnotificação de sífilis entre povos indígenas de Mato Grosso do Sul, Brasil. MÉTODOS: estudo descritivo, com dados secundários do Sistema de Informação de Agravos de Notificação (Sinan) e do Distrito Sanitário Especial Indígena de Mato Grosso do Sul (DSEI-MS) referentes ao período 2011-2014; os dados das duas fontes foram relacionados manualmente, para identificar subnotificações. RESULTADOS: as maiores taxas de incidência de sífilis em gestante foram observadas em 2014 (41,1/1000 nascidos vivos) e de sífilis congênita em 2013 (10,7/1000 nascidos vivos); observou-se importante subnotificação, de 45/79 casos de sífilis em gestante no Sinan em 2014, 8/17 casos de sífilis congênita no DSEI-MS em 2014, e 5/9 e 10/18 casos de sífilis adquirida no Sinan em 2011 e 2013, respectivamente. CONCLUSÃO: a sífilis apresenta elevada incidência; a subnotificação de casos nos sistemas de informações oculta a magnitude da doença entre indígenas de Mato Grosso do Sul.

OBJETIVO: estimar la distribución, incidencia y subregistro de sífilis entre pueblos indígenas de Mato Grosso do Sul, Brasil. MÉTODOS: estudio descriptivo con datos secundarios del Sistema de Información de Enfermedades de Declaración Obligatoria (Sinan) y del Distrito Sanitario Especial Indígena de Mato Grosso do Sul (DSEI-MS), en el período 2011-2014; se compararon los datos de las dos fuentes para identificar el subregistro. RESULTADOS: las tasas más altas de incidencia de sífilis en embarazadas se observaron en 2014 (41,1/1.000 nacidos vivos) y de sífilis congénita en 2013 (10,7/1.000 nacidos vivos); los mayores números de subestimaciones fueron de casos de sífilis en mujeres embarazadas en el Sinan (45/79) y de sífilis congénita en DSEI-MS (8/17), en 2014, y de sífilis adquirida en el Sinan en 2011 y 2013 (5/9 y 10/18, respectivamente). CONCLUSIÓN: es alta la incidencia de sífilis, cuya magnitud se encuentra oculta debido a las subnotificaciones de los casos en esta población.

OBJECTIVE: to describe the distribution, incidence, and underreporting of syphilis among indigenous peoples from Mato Grosso do Sul, Brazil. METHODS: descriptive study performed with secondary data of the Information System for Notifiable Diseases (Sinan) and of the Special Indigenous Sanitary District of Mato Grosso do Sul (DSEI-MS), from 2011 to 2014; the data from both sources were compared to identify underreporting. RESULTS: the highest incidence rates of syphilis in pregnant women were observed in 2014 (41.1/1,000 live births) and of congenital syphilis, in 2013 (10.7/1,000 live births); the highest numbers of underreporting of cases were for syphilis in pregnant women on Sinan (45/79), of congenital syphilis at DSEI-MS (8/17) in 2014, and of acquired syphilis on Sinan in 2011 and 2013 (5/9 and 10/18, respectively). CONCLUSION: syphilis has a high incidence; underreporting hides the extent of the disease in indigenous peoples from Mato Grosso do Sul.

Chikungunya virus: clinical aspects and treatment: a review

Chikungunya is a severe and debilitating disease. Currently, Brazil is experiencing an epidemic caused by three arboviruses, which has changed the way health professionals have diagnosed and treated infected patients. The difficulty of diagnosis and the lack of a protocol for patient treatment, which fits Brazilian health system models, have made it difficult to manage this disease. It is necessary to implement a multidisciplinary network of patient care, in which primary care units play the main role. This review aims to present current information regarding the clinical aspects and treatment of Chikungunya virus infection.

Surveillance of deaths caused by arboviruses in Brazil: from dengue to chikungunya

Did death occur DUE TO dengue, or in a patient WITH dengue virus infection? It seems a matter of semantics, but in fact, it underscores how challenging it is to distinguish whether the disease contributed to death, or was itself the underlying cause of death. Can a death be attributed to chikungunya virus, when some deaths occur after the acute phase? Did the virus decompensate the underlying diseases, leading to death? Did prolonged hospitalisation lead to infection, resulting in the patient's progression to death? Were there iatrogenic complications during patient care? The dengue question, for which there has not yet been a definitive response, resurfaces prominently under the chikungunya surveillance scenario. We are facing an epidemic of a disease that seems to be more lethal than previously thought. The major challenge ahead is to investigate deaths suspected of occurring due to arbovirus infections and to understand the role of each infection in the unfavourable outcome.

Práticas parentais: reflexões sobre relatos de familiares de usuários de crack / Parenting practices: reflections on family members of crack cocaine users reports / Prácticas parentales: reflexiones sobre informes de familiares de usuarios de crack

As características na dinâmica familiar podem influenciar no consumo de drogas. O estudo objetivou compreender práticas parentais em famílias de usuários de crack. Este é um estudo qualitativo, realizado por meio de entrevistas individuais com 20 familiares de usuários de crack cadastrados em um serviço público de saúde mental de um município do Mato Grosso do Sul. A coleta de dados ocorreu entre novembro-dezembro/2014 e os dados foram analisados pela técnica de análise de conteúdo. Na maioria das famílias, as regras são estabelecidas pela mãe e seu descumprimento acarreta punição física. Os filhos são descritos como muito obedientes, porém as ordens ditadas são vagas ou ambíguas, o que resulta na ausência de limites claros a serem seguidos. Conclui-se que tal dinâmica dificulta o desenvolvimento da regulação emocional, tolerância à contrariedade, resistência à frustração e habilidades de negociação e solução de problemas, que podem influenciar no consumo do crack (AU)

Features of family dynamics may influence drug consumption. This study aimed to comprehend parenting practices in families of crack cocaine users. This is a qualitative research, carried out through individual interviews applied to 20 family members of crack cocaine addicts enrolled at a mental health public service in city of Mato Grosso do Sul/Brazil. Data were collected from November to December of 2014 and analyzed by the content analysis technique. In most families, rules are established by mother and their break leads to physical punishment. Children are described as obedient, but the dictated orders are vague or ambiguous, resulting in the absence of clear limits to be respected. We conclude that such dynamics hinder the development of emotion regulation, tolerance to opposition, resistance to frustration, and skills of negotiation and problem solving, what may influence the consumption of crack (AU)

Características en la dinámica familiar pueden influir en el consumo de drogas. El estudio tuvo como objetivo comprender prácticas parentales en familias de usuarios de crack. Este es un estudio cualitativo, realizado mediante entrevistas individuales con 20 familiares de usuarios de crack registrados en un servicio público de salud mental de un municipio de Mato Grosso do Sul. Los datos fueron recolectados entre noviembre-diciembre/2014, y analizados según la técnica de análisis de contenido. En gran parte de las familias, la madre determina las reglas y no cumplirlas causa castigo físico. A los hijos se los describe como muy obedientes, pero las órdenes son vagas o ambiguas, lo que resulta en ausencia de límites claros a los cuales atenerse. Se concluye que tal dinámica dificulta el desarrollo de regulación emocional, tolerancia a contrariedad, resistencia a frustración y capacidad para negociar y solucionar problemas, y puede influir en el consumo de crack (AU)

Pharmacologic management of pain in patients with Chikungunya: a guideline

Abstract From the arrival of Chikungunya virus in the Americas in 2013 until March 2016, approximately two million cases of the disease have been reported. In Brazil, the virus was identified in 2014 and thousands of people have been affected. The disease has high attack rates, infecting 50% of a population within a few months. Approximately 50% of infected people develop chronic symptoms lasting for months or years. Joint involvement is the main clinical manifestation of Chikungunya. It is characterized by swelling and intense pain that is poorly responsive to analgesics, both in the acute and chronic phase of the disease. This significantly compromises quality of life and may have immeasurable psychosocial and economic repercussions, constituting therefore, a serious public health problem requiring a targeted approach. Physicians are often not familiar with how to approach the management of pain, frequently prescribing limited analgesics, such as dipyrone, in sub-therapeutic doses. In addition, there are few published studies or guidelines on the approach to the treatment of pain in patients with Chikungunya. Some groups of specialists from different fields have thus developed a protocol for the pharmacologic treatment of Chikungunya-associated acute and chronic joint pain; this will be presented in this review.

Decrease in hepatitis B prevalence among blood donors in Central-West Brazil

The aim of the present study was to estimate hepatitis B virus seroprevalence among first-time blood donors in the city of Campo Grande, Mato Grosso do Sul State, in the central-western region of Brazil. Findings A retrospective analysis of first-time voluntary blood donor records, from January 2010 to December 2010, was conducted at the Hematology Center of Mato Grosso do Sul. The prevalence of the HBsAg and anti-HBc serological markers and their respective 95% confidence intervals were calculated. Chi-square analysis was performed between the seroprevalence previously found in 2001 and the one determined by the current study. Results were considered statistically significant if p< 0.05. Among 8,840 subjects, 269 (3.04%, 95% CI: 2.7-3.4) were positive for HBV markers. The prevalence rate of HBsAg was 0.19% (95% CI: 0.1-0.3) and anti-HBc alone was 2.85% (95% CI: 2.5-3.2). Conclusions There was no statistically significant difference regarding gender. However, an important association was observed between HBV infection and older age (p< 0.01). The seroprevalence of HBV infection in first-time blood donors diminished from 2001 to 2010 (p< 0.01). Such decrease suggests an improvement in the recruitment of safe donors, the positive impact of vaccination programs and the decreasing of HBV infection prevalence in the general population.

Decrease in hepatitis B prevalence among blood donors in Central-West Brazil

Background: The aim of the present study was to estimate hepatitis B virus seroprevalence among first-time blood donors in the city of Campo Grande, Mato Grosso do Sul State, in the central-western region of Brazil. Findings: A retrospective analysis of first-time voluntary blood donor records, from January 2010 to December 2010, was conducted at the Hematology Center of Mato Grosso do Sul. The prevalence of the HBsAg and anti-HBc serological markers and their respective 95% confidence intervals were calculated. Chi-square analysis was performed between the seroprevalence previously found in 2001 and the one determined by the current study. Results were considered statistically significant if p < 0.05. Among 8,840 subjects, 269 (3.04%, 95% CI: 2.7-3.4) were positive for HBV markers. The prevalence rate of HBsAg was 0.19% (95% CI: 0.1-0.3) and anti-HBc alone was 2.85% (95% CI: 2.5-3.2). Conclusions: There was no statistically significant difference regarding gender. However, an important association was observed between HBV infection and older age (p < 0.01). The seroprevalence of HBV infection in first-time blood donors diminished from 2001 to 2010 (p < 0.01). Such decrease suggests an improvement in the recruitment of safe donors, the positive impact of vaccination programs and the decreasing of HBV infection prevalence in the general population.

Diagnóstico da tuberculose em indígenas menores de quinze anos por meio de um sistema de pontuação em Mato Grosso do Sul / Scoring system for the diagnosis of tuberculosis in indigenous children and adolescents under 15 years of age in the state of Mato Grosso do Sul, Brazil

OBJETIVO: Avaliar o processo diagnóstico da tuberculose pulmonar em indígenas menores de 15 anos, por meio do Sistema de Pontuação do Ministério da Saúde Modificado (SP-MSm), em crianças e adolescentes com resultados negativos na baciloscopia. MÉTODOS: Estudo descritivo retrospectivo de 49 casos de tuberculose em indígenas menores de 15 anos no estado do Mato Grosso do Sul entre 2007 e 2010. RESULTADOS: Dos 49 pacientes, 27 (56%) eram menores de 5 anos, 33 (67%) apresentavam sintomas sugestivos de tuberculose, 24 (49%) tinham baixo peso, e 36 (73,5%) haviam sido vacinados com BCG. O teste tuberculínico foi reator em 28 pacientes (57%). Dentre esses, 18 (64%) apresentaram enduração > 10 mm. Foram realizadas radiografias de tórax em 37 pacientes (76%), sendo que 31 (84%) fizeram apenas um exame. Desses 37 pacientes, os achados radiológicos eram sugestivos de tuberculose em 16 (43%), de infiltrado/condensação em 10 (27%) e normais em 4 (11%). As Equipes de Saúde Indígena foram responsáveis pelo diagnóstico em 31 (63%) dos casos, mas o SP-MS original só foi utilizado em 14 (45%). Os escores do SP-MSm foram determinados em 30 pacientes (61%). Dos 30 casos pontuados, os resultados dos escores indicaram diagnóstico de tuberculose muito provável, possível e pouco provável em 16 (53%), 11 (37%) e 3 (10%), respectivamente. CONCLUSÕES: A proporção de diagnóstico muito provável e possível foi concordante com o diagnóstico padrão do serviço (90%), evidenciando a aplicabilidade epidemiológica do SP-MSm para o diagnóstico da tuberculose pulmonar em indígenas, de forma compatível com a realidade do serviço de saúde prestado.

OBJECTIVE: To evaluate the process of diagnosing pulmonary tuberculosis in smear-negative indigenous children and adolescents under 15 years of age with the modified Brazilian National Ministry of Health Scoring System (mBNMH-SS). METHODS: This was a retrospective descriptive study involving 49 indigenous patients under 15 years of age with tuberculosis, treated between 2007 and 2010 in the state of Mato Grosso do Sul, Brazil. RESULTS: Of the 49 patients, 27 (56%) were under 5 years of age, 33 (67%) had symptoms suggestive of tuberculosis, 24 (49%) were underweight, and 36 (73.5%) had been BCG vaccinated. The tuberculin skin test was positive in 28 patients (57%), 18 (64%) of whom had an induration > 10 mm. Chest X-rays were performed in 37 (76%) of the patients, 31 (84%) of whom had only one chest X-ray taken. Among those 37 patients, the radiological findings were suggestive of tuberculosis in 16 (43%), infiltration/condensation in 10 (27%), and normal in 4 (11%). The Indigenous Health Care Teams made the diagnosis in 31 (63%) of the cases, using the original BNMH-SS in only 14 (45%). We calculated the mBNMH-SS scores for 30 (61%) of the 49 patients. Among the 30 cases scored, a diagnosis of tuberculosis was found to be highly likely, possible, and unlikely in 16 (53%), 11 (37%), and 3 (10%), respectively. CONCLUSIONS: The proportion of highly likely and possible diagnoses was consistent with the standard proportion of cases diagnosed by the teams (90%), demonstrating the epidemiological applicability of the mBNMH-SS for the diagnosis of pulmonary tuberculosis in the indigenous population, within the scenario of the health care provided.

Responsabilização do outro: discursos de enfermeiros da Estratégia Saúde da Família sobre ocorrência de dengue / Accountability of the other: discourses of nurses of the Family Health Strategy on the occurrence of dengue / Responsabilización del otro: discursos de enfermeros de la Estrategia Salud de la Familia sobre la ocurrencia del dengue

O objetivo desta pesquisa foi conhecer, a partir do discurso dos enfermeiros da Estratégia Saúde da Família, os comportamentos da população em relação ao dengue, com a finalidade de melhorar a comunicação entre profissionais e população. Foi realizado um estudo qualitativo com enfermeiros da Estratégia Saúde da Família de seis municípios selecionados, sendo os dados analisados pela técnica do Discurso do Sujeito Coletivo. Os resultados mostraram quatro ideias centrais sobre o comportamento da população, a quem os enfermeiros atribuem parte importante da responsabilidade pela ocorrência da dengue. Conclui-se que o discurso dos enfermeiros aponta para a responsabilização do outro, seja um ente público ou privado, individual ou coletivo. Generalizam os comportamentos, apontando para aqueles negativos, que contribuem para a ocorrência da doença. Entende-se ser necessário implementar ações especificas com o objetivo de mudar condutas e mantê-las a longo prazo.

The aim of this investigation was to know, from the discourse of Family Health Strategy nurses, what are the behaviors of the population in relation to dengue, to improve communication between professionals and the population. A qualitative study was conducted with nurses in the Family Health Strategy of six selected cities, and the data were analyzed by the technique of the Collective Subject Discourse. The results showed four central ideas about the population's behavior, to who nurses attribute important part of the responsibility for the occurrence of dengue. The conclusion is that the discourse of nurses is very close to common sense, generalizing inadequate behaviors. Thus, it is necessary to implement specific actions to change behaviors and keep them in the long term.

El objetivo de esta investigación fue conocer, desde el discurso de los enfermeros de la Estrategia Salud de la Familia, cuales son los comportamientos de la población en relación al dengue, con la finalidad de mejorar la comunicación entre los profesionales y la población. Se llevó a cabo un estudio cualitativo con los enfermeros de la Estrategia Salud de la Familia de seis ciudades seleccionadas. Los datos fueran analizados por la técnica del Discurso del Sujeto Colectivo. Los resultados mostraron cuatro ideas centrales acerca de la conducta de la populación, a quién los enfermeros atribuyen grande parte de la responsabilidad por la ocurrencia de dengue. Llegamos a la conclusión de que el discurso de los enfermeros es muy cercano del sentido común, con generalización de los comportamientos inadecuados. Por lo tanto, considera-se que es necesario aplicar medidas concretas encaminadas a cambiar las conductas y a mantener-las al largo plazo.

Aliados do A. Aegypti: fatores contribuintes para a ocorrência do dengue segundo as representações sociais dos profissionais das equipes de saúde da família / Allies of A. Aegypti: factors contributing to the occurrence of dengue according to social representations of professionals of family health teams

Historicamente as políticas de saúde e as ações de combate ao dengue são pautadas no controle vetorial, com atividades de campo, deixando em segundo plano as atividades de educação em saúde. Conhecer as representações sociais de profissionais de unidades de saúde da família, sobre os fatores que contribuem para a manutenção dos índices de ocorrência do dengue é o objetivo desta pesquisa de forma a contribuir para a melhoria da comunicação entre profissionais de saúde e população, visando o controle da doença. Foi realizado estudo qualitativo com profissionais da estratégia de saúde da família de seis municípios selecionados, sendo os dados tabulados pela técnica do Discurso do Sujeito Coletivo. Os resultados mostraram quatro discursos referentes a aspectos que foram levantados através da pergunta sobre qual a causa da ocorrência de dengue. Conclui-se que os profissionais atribuem à população parte importante da responsabilidade pela ocorrência do dengue, mas também observam a falta de estrutura e organização dos serviços, bem como percebem dificuldades para que ocorra a mudança dos comportamentos observados com os recursos disponíveis.

Historically, health policies and actions to combat dengue have been based on vector control and field activities, while neglecting health education activities. Establishing the social representations of family health unit professionals about the factors that contribute to the sustained level of the occurrence rates of dengue is the scope of this research, in order to contribute to improved communication between health professionals and citizens, seeking to control the disease. A qualitative study was conducted with family health strategy professionals in six selected cities, with data tabulated by the Collective Subject Discourse technique. The results showed four discourses about the issues that were raised by the question of what caused the incidence of dengue. The conclusion drawn is that the professionals attribute the major share of responsibility for the incidence of dengue to the population, but also note the lack of structure and organization of services as well as perceiving difficulties for changes in observed behavior to occur with the resources available.

Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study / Avaliação das alterações clínicas e hepáticas em pacientes adultos com dengue: estudo prospectivo em um período de dois meses

INTRODUCTION: To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. METHODS: A prospective cohort study was conducted in Campos dos Goytacazes, Rio de Janeiro, Brazil, from January to July, 2008. The evolution of laboratory and clinical manifestations of 90 adult dengue patients was evaluated in five scheduled visits within a two-month follow-up period. Twenty controls were enrolled for the analysis of liver function. Patients with hepatitis B, hepatitis C, those known to be human immunodeficiency virus (HIV) seropositive and pregnant women were excluded from the study. RESULTS: At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90) of dengue patients. We also observed that, 57.7% (15/26) of the symptoms persisted at the end of the second month. The most persistent symptoms were arthralgia, fatigue, weakness, adynamia, anorexia, taste alteration, and hair loss. Prior dengue virus (DENV) infection did not predispose patients to a longer duration of symptoms. Among hepatic functions, transaminases had the most remarkable elevation and in some cases remained elevated up to the second month after the disease onset. Alanine aminotransferase (ALT) levels overcame aspartate aminotransferase (AST) during the convalescent period. Male patients were more severely affected than females. CONCLUSIONS: Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month.

INTRODUÇÃO: Analisar prospectivamente a disfunção hepática e a evolução dos sinais e sintomas em pacientes adultos com dengue durante um período de dois meses. MÉTODOS: Realizamos um estudo prospectivo em Campos dos Goytacazes, Rio de Janeiro, Brasil, de janeiro a julho de 2008. Foi avaliada a evolução das manifestações clínicas e laboratoriais em 90 pacientes adultos com dengue, em um período de dois meses. Vinte controles foram arrolados para análise da função hepática. Em ambos os grupos foram realizadas coletas de dados e sangue nos primeiros cinco dias da doença, e aos 8, 15, 30 e 60 dias após o início da doença. Foram excluídos pacientes com hepatite B, hepatite C, gestantes e aqueles sabidamente soropositivos para HIV. RESULTADOS: No final do segundo mês do início da dengue, 33,3% (30/90) dos pacientes apresentaram persistência de pelo menos um sinal ou sintoma. Estavam presentes no final do segundo mês 57,7% (15/26) dos sinais ou sintomas. Os maiores percentuais de persistência foram: artralgia, adinamia, fraqueza, fadiga, anorexia, alteração do paladar e queda de cabelo. A infecção prévia pelo vírus da dengue (DENV) não predispôs a uma maior duração dos sintomas. Da função hepática, observamos alterações relevantes somente nos níveis das transaminases, que em alguns casos permaneceram elevados até o final do segundo mês. Os níveis de ALT ultrapassaram os de AST na convalescença. Homens apresentaram níveis mais elevados de transaminases quando comparados aos de mulheres. CONCLUSÕES: Dengue apresenta grande número de sintomas e transaminases elevadas no final do segundo mês de doença.

Rosuvastatina e ciprofibrato no tratamento da dislipidemia em pacientes com HIV / Rosuvastatin and ciprofibrate in the treatment of dyslipidemia in patients with HIV

FUNDAMENTO: A dislipidemia secundária à terapia antirretroviral potente nos pacientes com HIV está associada à significativa elevação da morbimortalidade cardiovascular por doença aterosclerótica, sendo, portanto, necessário tratamento imediato e eficaz. OBJETIVO: Demonstrar a efetividade e a segurança da rosuvastatina e do ciprofibrato no tratamento da dislipidemia associada à terapia antirretroviral potente em pacientes com HIV. MÉTODOS: Trezentos e quarenta e seis pacientes com dislipidemia foram submetidos a tratamento farmacológico: 200 pacientes com hipertrigliceridemia receberam ciprofibrato (Grupo I); 79 pacientes com hipercolesterolemia receberam rosuvastatina (Grupo II); e 67 pacientes com dislipidemia mista receberam ciprofibrato associado a rosuvastatina (Grupo III). O perfil lipídico foi avaliado antes e após o tratamento hipolipemiante, sendo feita comparação estatística pelo teste de Wilcoxon. Transaminases hepáticas e creatinofosfoquinase foram dosadas para controle de toxicidade hepática e muscular. RESULTADOS: As concentrações séricas de triglicérides e de colesterol total foram significativamente menores do que as obtidas antes do tratamento, para os três grupos experimentais (p < 0,002). Observou-se aumento significativo do HDL colesterol nos grupos experimentais I e III (p < 0,002). Nos grupos I e II, o LDL-colesterol foi significativamente menor (p < 0,001). Nenhum dos pacientes apresentou elevações de transaminases ou de creatinofosfoquinase a níveis de toxicidade significativa. CONCLUSÃO: Os resultados deste estudo demonstram que ciprofibrato, rosuvastatina ou a combinação de ambos pode ser considerada tratamento hipolipemiante efetivo, seguro e com boa tolerância nos pacientes com Aids submetidos à terapia antirretroviral potente.

BACKGROUND: Dyslipidemia secondary to highly active antiretroviral therapy in patients with HIV is associated with a significant increase in cardiovascular morbidity and mortality due to atherosclerotic disease, requiring, thus, immediate and effective treatment. OBJECTIVE: To demonstrate the effectiveness and safety of rosuvastatin and ciprofibrate in the treatment of dyslipidemia associated with highly active antiretroviral therapy in patients with HIV. METHODS: Three hundred and forty-six patients with dyslipidemia underwent pharmacological treatment as follows: 200 patients with hypertriglyceridemia received ciprofibrate (Group I); 79 patients with hypercholesterolemia received rosuvastatin (Group II); and 67 patients with mixed dyslipidemia received ciprofibrate associated with rosuvastatin (Group III). The lipid profile was assessed before and after the lipid-lowering treatment, and the Wilcoxon test was used for statistical comparison. Liver transaminases and creatine phosphokinase were measured to assess liver and muscle toxicity. RESULTS: The serum concentrations of triglycerides and total cholesterol were significantly lower than those obtained before the lipid-lowering treatment in the three experimental groups (p < 0.002). A significant increase in HDL-cholesterol was observed in Groups I and III (p < 0.002). In Groups I and II, LDL-cholesterol was significantly lower (p < 0.001). None of the patients experienced elevations in transaminases or creatine phosphokinase to significantly toxic levels. CONCLUSION: The results of this study show that ciprofibrate and rosuvastatin or a combination of both can be considered an effective, safe and well-tolerated lipid-lowering treatment for patients with AIDS on highly active antiretroviral therapy.