High prevalence of syphilis among recyclable waste collectors in Central Brazil

ABSTRACT Background: Syphilis is associated with social and behavioral factors. Methods: This cross-sectional study determined the prevalence of syphilis and its associated risk factors among recyclable waste collectors in Central Brazil. Results: A lifetime syphilis prevalence rate of 7.91% (95% confidence interval: 5.25-11.75) was found among 278 participants. Low educational level, history of sexually transmitted infection, and age ≥ 36 years were associated with a high prevalence of lifetime syphilis. Conclusions: These findings emphasize the need for syphilis prevention, screening, and treatment among recyclable waste collectors, highlighting the potential for the spread of infection in vulnerable populations.

Importance of vaccination against human papillomavirus in a rural settlement in Terenos, Mato Grosso do Sul / Importância da vacinação contra o papilomavírus humano em um assentamento rural em Terenos, Mato Grosso do Sul

ABSTRACT OBJECTIVE To understand health professionals' perceptions about vaccination against human papillomavirus (HPV) in the Santa Mônica rural settlement in Terenos, Mato Grosso do Sul. METHODS Quantitative and qualitative methodologies, consultations on vaccination cards, records of community health agents and the focus group technique were used. The main factors of hesitation and vaccine refusal were analyzed, as well as the health team's strategies for the process of immunization against HPV, from June to August 2018. RESULTS Of 121 children and adolescents, 81 (66.94%) received the complete vaccination schedule. Complete vaccination coverage for women was 73.17% (60/82) and for men, 53.8% (21/39). It was observed that, although strategies are adopted for vaccine promotion, such as mobile actions, the public is resistant due to superficial knowledge about the vaccine and its use in an early age group, showing itself to be susceptible to the negative influence of the media and to society's taboos. In addition, difficulties regarding the use of the Unified Health System card and the shortage of professionals were also observed. CONCLUSION The results explain the immunization coverage below the target and reinforce the need to strengthen the family health strategy, as well as the permanent and continuing education of professionals, in order to increase parental confidence and adherence to vaccination.

RESUMO OBJETIVO Compreender as percepções dos profissionais de saúde acerca da vacinação contra o papilomavírus humano (HPV) no Complexo de assentamentos Santa Mônica, em Terenos, Mato Grosso do Sul. MÉTODOS Foram utilizadas metodologias quanti-qualitativas, consultas em cartões vacinais, registros de agente comunitários de saúde e a técnica de grupo focal. Foram analisados os principais fatores de hesitação e recusa vacinal, bem como as estratégias da equipe de saúde para o processo de imunização contra o HPV, de junho a agosto de 2018. RESULTADOS De 121 crianças e adolescentes, 81 (66,94%) receberam o esquema vacinal completo. A cobertura vacinal completa feminina foi de 73,17% (60/82) e a masculina de 53,8% (21/39). Observou-se que, embora sejam adotadas estratégias para a promoção da vacina, como ações volantes, o público encontra-se resistente devido ao conhecimento superficial sobre a vacina e sua utilização em faixa etária precoce, mostrando-se suscetível à influência negativa da mídia e aos tabus da sociedade. Além disso, dificuldades quanto ao uso do cartão do Sistema Único de Saúde e a escassez de profissionais também foram observadas. CONCLUSÃO Os resultados justificam a cobertura vacinal abaixo da meta e reforçam a necessidade de fortalecimento da estratégia de saúde da família, bem como da educação permanente e continuada dos profissionais, a fim de aumentar a confiança dos pais e a adesão à vacinação.

Human T cell lymphotropic virus type 1 infection among men who have sex with men in Central Brazil

ABSTRACT Human T cell lymphotropic virus type 1 (HTLV-1) was the first retrovirus discovered in humans and is endemic in several parts of the world. Because of risk behaviors, mainly sexual, men who have sex with men (MSM) are at high risk of acquiring HTLV-1 infection. A cross-sectional study was performed to estimate the prevalence of HTLV-1 infection, to characterize genetically HTLV-1 sequences and to identify risk behaviors associated with this infection among MSM in Central Brazil. A total of 430 MSM were enrolled in this study and three were shown to be HTLV-1 infected, prevalence of 0.7% (95% confidence interval: 0.4-0.9). Phylogenetic analysis showed that all HTLV-1 positive samples belonged to Cosmopolitan subtype Transcontinental subgroup A. Although the prevalence rate of HTLV-1 infection found in this study was similar to that observed among Brazilian blood donors, additional HTLV-1 preventive interventions need to be further implemented because this population is engaged in high-risk sexual behavior.

High-risk behaviors for hepatitis B and C infections among female sex workers

Abstract INTRODUCTION: The prevalence of hepatitis B and hepatitis C and risk behaviors among 402 female sex workers in Central Brazil were investigated by respondent-driven sampling. METHODS: Blood samples were tested for hepatitis B and C markers by enzyme-linked immunosorbent assay. Two hepatitis B vaccination schedules were performed. RESULTS: The prevalence of hepatitis B and C infections were 9.3% and 0.5%, respectively. Susceptibility to hepatitis B infection was observed in 61.5% of subjects. There was no significant difference in adherence index (p=0.52) between vaccination schedules and all participants had protective antibody titers. CONCLUSIONS: This hard-to-reach population requires hepatitis B and C surveillance.

Hiv and hcv coiffection: prevalence, associatedfactors and genotype characteriization in the midwest region of Brazil / Coinfecção HIV e HCV: prevalência, fatores associados e caracterização dos genótipos na Região Centro-Oeste do Brasil

A cross-sectional study on prevalence, associated factors and genotype distribution of HCV infection was conducted among 848 HIV-infected patients recruited at reference centers in the Midwest Region of Brazil. The prevalence rate of HIV-HCV coinfection was 6.9% (95% CI: 5.2 to 8.6). In multivariable analysis, increasing age, use of illicit drugs (injection and non-injection), a history of blood transfusion before 1994, and the absence of a steady partnership were significant independent associated factors for HIV-HCV coinfection. The phylogenetic analysis based on the NS5B region revealed the presence of two major circulating genotypes of HCV: genotypes 1 (58.3%) and 3 (41.7%). The prevalence of HIV-HCV coinfection was lower than those reported in studies conducted with HIV-infected patients in different regions of Brazil, due to the fact that illicit drug use is not a frequent mode of HIV transmission in this region of Brazil. Serologic screening of HIV-patients for HCV before initiating antiretroviral treatment, a comprehensive identification of associated factors, and the implementation of effective harm reduction programs are highly recommended to provide useful information for treatment and to prevent HCV coinfection in these patients.

Estudo transversal sobre a prevalência, fatores associados e distribuição dos genótipos do HCV foi realizado em 848 pacientes infectados pelo HIV, recrutados em centros de referência na Região Centro-Oeste do Brasil. A taxa de prevalência de coinfecção HIV-HCV foi de 6,9% (IC 95%: 5,2-8,6). Na análise multivariada, o aumento da idade, o uso de drogas ilícitas (injetáveis e não injetáveis), história de transfusão de sangue antes de 1994, e ausência de companheiro constante foram fatores associados independentes e significativos para a coinfecção HIV-HCV. A análise filogenética baseada na região NS5B revelou a presença de dois principais genótipos do HCV em circulação: genótipos 1 (58,3%) e 3 (41,7%). A prevalência da coinfecção HIV-HCV foi menor do que as relatadas em estudos realizados com pacientes infectados pelo HIV em diferentes regiões do Brasil, devido ao fato de que o uso de drogas ilícitas não é modo frequente de transmissão do HIV neste Estado do Brasil. Triagem sorológica de pacientes HIV-positivos para HCV antes de iniciar o tratamento antirretroviral, identificação completa dos fatores associados e a implementação de programas eficazes de redução de danos são altamente recomendados para fornecer informações úteis, para o tratamento e para evitar a coinfecção com HCV nestes pacientes.

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.

Embarazo tubario: revisión actualizada de factores de riesgo y diagnóstico / Ectopic pregnancy: the current review risk factors and diagnosis

Debido a diversas variaciones epidemiológicas, la incidencia del embarazo ectópico ha aumentado significativamente llegando a convertirse en prácticamente el 2 por ciento de todas las gestaciones. Si a esto le agregamos su elevada mortalidad entendemos por qué esta patología debe ser manejada tanto por el médico general, como por el especialista. El curso de la enfermedad no complicada es indolente por lo que debemos tener presente un alto índice de sospecha en las pacientes que presentan factores de riesgo, como son: el antecedente de cirugía tubaria, de EE previo y la presencia de un embarazo producto de TRA. Cuando la enfermedad debuta por su complicación el diagnóstico debe establecerse a la brevedad y debe considerarse a una paciente en edad fértil con un abdomen agudo, portadora de EE hasta demostrar lo contrario. Además de la sospecha clínica, los 2 elementos más importante en el diagnóstico de la enfermedad son la determinación de beta-HCG y la USTV. La mayor disponibilidad de estas dos herramientas en los servicios de urgencia, ha permitido establecer un diagnóstico precoz del EE agilizando su tratamiento, el que clásicamente ha sido quirúrgico. Actualmente la laparoscopía es la pieza clave del manejo quirúrgico de la enfermedad, sea este radical o conservador. Sin embargo dada la precocidad de los diagnósticos, hemos visto como el tratamiento farmacológico es actualmente una alternativa segura y eficaz en grupos seleccionados. De esta manera el EE inicial no complicado, en algunos centros, es considerado una patología de tratamiento médico.

Due to many epidemiologic variations, the incidence of the ectopic pregnancy has increased its significance tobecome practically 2 percent of all the gestations. Its high mortality allows us to understand why this pathologymust be handled by general doctor, and by the specialist. The course of the noncomplicated disease is indolent so we must strongly suspect in the patients who present risk factors: the antecedent of surgery, previous ectopic pregnancy and fertility treatment due pregnancy. When the disease starts with its complication, the diagnosis must be quickly done and must be considered to all female in fertile age presenting an acute abdomen, until discarding. Inaddition to the clinical suspicion, the 2 elements more important in the diagnosis of the disease are thedetermination of beta-HCG and ultrasound. The greater availability of these two tools in the urgency services,has allowed to establish a precocious diagnosis of EE facilitating its treatment, the one that classically has been surgical. At the moment, laparoscopy is the key piece of the surgical handling of the disease, radical or conservative. Nevertheless, given the precocity of thediagnoses, pharmacologic treatment may be a safe and effective alternative in selected groups. Initial, noncomplicated EE , in some centers, is considered a medical treatment pathology.

Síndrome de hombro doloroso / The painful shoulder syndrome

El hombro doloroso es una patología cuyo síntoma principal es el dolor, asociada generalmente a limitación funcional de cualquiera de los distintos movimientos que realiza la articulación. Su prevalencia es alta y es motivo de consulta frecuente para el médico general. Se presenta habitualmente después de la cuarta década de la vida, aunque puede aparecer en edades más precoces, asociada principalmente a traumas y actividad deportiva intensa. Este cuadro clínico puede ser producido por diversas patologías, originadas tanto en las múltiples estructuras anatómicas del hombro, como en ubicaciones fuera de la articulación; a pesar de la complejidad que esto pudiera significar, una anamnesis detallada y un examen físico acucioso, asociado en algunos casos a exámenes complementarios, nos permitirán hacer un diagnóstico adecuado e instaurar precozmente un tratamiento efectivo, que evite las secuelas funcionales y la perpetuación del cuadro