Características poblacionales y placentarias asociadas a óbito en infección asintomática por SARS-CoV-2 / Population characteristics and placental findings associated with stillbirth in asymptomatic SARS-CoV-2 infection

Resumen Objetivo: Comparar características poblacionales y hallazgos placentarios asociados a óbito, en mujeres con infección asintomática por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) al momento de la resolución del embarazo. Material y métodos: Estudio transversal analítico, mujeres con diagnóstico de óbito e infección asintomática por SARS-CoV-2. Se excluyeron pacientes con patología ginecológica y aquellas con más de una prueba RT-PCR. Resultados: No hay diferencia estadísticamente significativa entre las pacientes con infección asintomática por SARS-CoV-2 comparadas con pacientes sin infección para las características poblacionales como edad materna, antecedentes obstétricos, edad gestacional, escolaridad, estado civil, hábito tabáquico y enfermedades crónico-degenerativas. Tampoco hubo diferencia en los hallazgos placentarios de corioamnionitis, vasculitis, deciduitis, trombosis, aterosis aguda y necrosis fibrinoide. Conclusiones: No hay diferencia estadísticamente significativa en las características poblacionales y placentarias en embarazadas con diagnóstico de óbito, con y sin infección asintomática por SARS-CoV-2. Tenemos datos insuficientes para afirmar alguna característica asociada a óbito en pacientes con infección por SARS-CoV-2 asintomática.

Abstract Objective: To compare population characteristics and placental findings associated with stillbirth, in women with asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at the time of delivery. Materials and methods: Analytical cross-sectional study women with a diagnosis of stillbirth and with asymptomatic SARS-CoV-2 infection. Patients with gynecological pathology and those with more than one RT-PCR test were excluded. Results: There is no statistically significant difference between patients with asymptomatic SARS-CoV-2 infection compared to patients without infection for population characteristics such as maternal age, obstetric history, gestational age, education, marital status, smoking habit, chronic-degenerative diseases. There was no difference in placental findings of chorioamnionitis, vasculitis, deciduitis, thrombosis, acute atherosis, and fibrinoid necrosis. Conclusions: There is no statistically significant difference in the population and placental characteristics, in pregnant women diagnosed with stillbirth with and without confirmed asymptomatic SARS-CoV-2 infection. For the moment, we have insufficient data to affirm any population characteristic associated with stillbirth in patients with asymptomatic SARS-CoV-2 infection.

Trajectory of the development of caries in the permanent dentition of 12- to 16-year-old students based on a latent class growth model analysis in Liuyang / 口腔疾病防治

Objective@# To explore the trajectory of the development of permanent caries in 12- to 16-year-old students in Liuyang and to provide a reference for the prevention and management of caries.@*Methods@#Primary and secondary school students who were registered within the Liuyang jurisdiction were screened for caries from September to November by the Liuyang Center for Disease Control and Prevention. A total of 7 297 students between the ages of 12 and 16 years with complete permanent dentition caries monitoring records and traceable deciduous dentition caries monitoring records were selected from 2013 to 2019, and a zero-inflated negative binomial-latent class growth model (ZINB-LCGM) was established to describe the trajectory of the development of individual caries using the decayed missing filled teeth (DMFT) indicators. @*Results@# DMFT of 12- to 16-year-old students in Liuyang were mainly decayed teeth (DT), with the majority occurring in the first permanent molar. According to the ZINB-LCGM model, the students were classified into three latent categories, "slow growth pattern" (28.55%), "rapid growth pattern" (6.59%), and "stable pattern" (64.86%), which followed different nonlinear caries growth trajectories. Females with deciduous teeth caries were more likely to have trajectories showing a “rapid growth pattern” and a “slow growth pattern”. There were significant differences in the trajectories between men and women, as well as between those with and without primary dentition caries. @*Conclusion @# The trajectory of the development of caries in 12-16-year-old students shows heterogeneity in terms of different developmental patterns of latent categories, suggesting that females with deciduous dental caries should receive more attention.

Necesidades de atención en salud mental y uso de servicios en población mexicana con trastornos mentales graves / Mental health care needs and use of services in Mexican population with serious mental disorders

Resumen: Objetivo: Analizar las demandas de atención de los trastornos mentales graves (TMG) y factores asociados con la utilización de servicios en México. Material y métodos: Se llevó a cabo un estudio analítico transversal en dos fases: la primera con una base de datos nacional de servicios disponibles y su utilización; la segunda, una muestra de registros médicos de un hospital psiquiátrico. Resultados: La esquizofrenia es el TMG más prevalente; más de 50% de hospitalizados fueron hombres, con edad promedio 37 años. La utilización de servicios estuvo asociada con la edad (β=1.062; p=.000), ingreso familiar (β=1.000, p=.000) y no tener ocupación (β=3.407; p=.000). La población con esquizofrenia tiene cuatro veces más la probabilidad de requerir estar exenta de pago (β=4.158; p=.000). Conclusiones: La población con TMG es más vulnerable por la discapacidad funcional y social asociada; requiere de intervenciones específicas de salud acompañadas de una política de protección financiera adaptada a sus necesidades de atención.

Abstract: Objective: To analyze the mental health care needs of the serious mental disorders (SMD) and factors associated with the use of services in Mexico. Materials and methods: A cross-sectional analytical study was conducted in two phases, the first with a national database of available services and its utilization; the second, a sample of medical records of a psychiatric hospital. Results: Schizophrenia is the most prevalent MDS; more than 50% of those hospitalized were male, with an average age of 37 years. The use of services was associated with age (β=1.062, p=.000), family income (β=1.000, p=.000) and no laboral occupation (β=3.407, p=.000). The population with schizophrenia is four times more likely to require to be exempt from payment (β=4.158, p=.000). Conclusions: The population with SMD as schizophrenia is more vulnerable due to the associated functional and social disability and it requires specific heath interventions and a financial protection policy adapted to their mental health care needs.

Analysis of the clinical characteristics of perianal fistulising crohn's disease in a single center / Análise das características clínicas da doença de crohn fistulizante perianal em um único centro

ABSTRACT Background: Clinical characteristics are keys to improve identification and treatment of Crohn´s disease (CD) so that large sample analysis is of great value. Aim: To explore the clinical characteristics of perianal fistulising CD. Methods: Analysis of 139 cases focused on their clinical data. Results: The proportion of males and females is 3.3:1; the mean age is 28.2 years; 47.5% of patients had anal fistula before CD diagnosis. Patients with prior perianal surgery and medication accounted for 64.7% and 74.1% respectively. The L3 type of lesion was present in 49.6% and the B1 and B2 types for 51.8% and 48.2% respectively; complex anal fistula was diagnosed in 90.6%. Symptoms of diarrhea were found in 46% and perianal lesions alone in 29.5% of patients. Abnormal BMI values was present in 44.6%; active CD activity index in 64.7%; and 94.2% had active perianal disease activity index. A proportion of patients manifest abnormal C-reactive protein, erythrocyte sedimentation rate, platelet, hemoglobin and albumin. Conclusion: We suggest that patients with anal fistula associated to these clinical features should alert the medical team to the possibility of CD, which should be further investigated through endoscopy and imaging examination of alimentary tract to avoid the damage of anal function by routine anal fistula surgery.

RESUMO Racional: As características clínicas são fundamentais para melhorar a identificação e o tratamento da doença de Crohn (DC), de modo que a análise da amostra seja de grande valor. Objetivo: Explorar as características clínicas da DC fistulizante perianal. Métodos: Análise de 139 casos focados em seus dados clínicos. Resultados: A proporção de homens e mulheres foi de 3,3: 1; a média de idade de 28,2 anos; 47,5% dos pacientes tiveram fístula anal antes do diagnóstico de DC. Pacientes com cirurgia perianal prévia e medicação representaram 64,7% e 74,1%, respectivamente. O tipo de lesão L3 estava presente em 49,6% e os tipos B1 e B2, em 51,8% e 48,2%, respectivamente; fístula anal complexa foi diagnosticada em 90,6%. Sintomas de diarréia foram encontrados em 46% e lesões perianais isoladas em 29,5% dos pacientes. Valores anormais de IMC estavam presentes em 44,6%; índice de atividade DC ativa em 64,7%; e 94,2% tinham índice de atividade de doença perianal ativo. Proporção significativa de pacientes tinha proteína-C reativa, taxa de sedimenta do eritrócito, plaquetas hemoglobina e albumina anormais. Conclusão: Sugere-se que pacientes com fístula anal associada às essas características clínicas alertem a equipe médica para a possibilidade de DC, que deve ser investigada por endoscopia e exame de imagem do trato digestivo para evitar dano na função anal pela operação que rotineiramente é realizada no tratamento da fístula anal.

Diagnóstico comunitário da área de abrangência da unidade de saúde da família da prainha - Florianópolis - Santa Catarina / Community diagnosis in the catchment area of the prainha health unit - Florianópolis - Santa Catarina

Este artigo apresenta os principais resultados encontrados na realização do diagnóstico comunitário na unidade de saú-de da Prainha pela equipe do Programa Saúde da Família. O método utilizado foi a descrição de indicadores locais relativos à demografia e ao meio ambiente, à situação socioeconômica, aos serviços de saúde e aos indicadores de saúde subdivididos em saúde da criança, saúde da mulher, saúde do adulto e produção ambulatorial. Os principais resultados encontrados apontam para a necessária adequação do nú-mero de equipes vis a vis as características da população e maiores investimentos em educação e infraestrutura urbana. Em relação aos indicadores, faz-se necessário observar em relação à saúde da criança, fatores relacionados ao baixo peso ao nascer e cobertura de vacinação; na saúde da mulher, a gestação na adolescência, início tardio do pré-natal, imunização para o tétano e cobertura de papanicolau; na saúde do adulto, a prevalência de hipertensão e diabetes mellitus; em relação à produção ambulatorial, o trabalho dos Agentes Comunitários de Saúde. Espera-se que este diagnóstico subsidie o planejamento das ações em saúde da unidade de saúde da Prainha.

This article presents the main results of a community diagnosis of the 131 area of the Prainha health center. The method used was the description of indicators of the local population and environment, socio-economic situation, and health services and health indicators divided into child health, women?s health, adult health and ambulatory production. The main results point to the need to adequate staff number to the characteristics of the population and of greater investment in education and urban infrastructure. As for the indicators, the following must be observed: concerning child health, it is necessary to observe factors related to low birth weight and immunization coverage; concerning women`s health: adolescent pregnancy, late beginning of prenatal care, tetanus immunization and pap smear coverage; concerning adult health: prevalence of hypertension and diabetes mellitus; concerning ambulatory production: the work of community health agents. This diagnosis is expected to help with the planning of health actions in the Prainha health unit.