Factores asociados a casos de malaria y plantas medicinales empleadas para su tratamiento en habitantes de Corozal, Colombia / Factors associated with cases of malaria and medicinal plants used for its treatment in inhabitants of Corozal, Colombia

Introducción: La malaria es una de las enfermedades infecciosas más importantes y para tratarla además de medicamentos, la población emplea plantas medicinales. El objetivo fue establecer los factores asociados a malaria y las plantas empleadas para su tratamiento en habitantes de Corozal. Método: Se aplicó una encuesta con preguntas sociodemográficas, de la vivienda, de conocimiento y de actitudes y las plantas medicinales empleadas para tratarla. Resultados: El 48% emplean plantas medicinales solas o con medicamentos, siendo el Gliricidia sepium (matarratón) y el Acmella oppositifolia (yuyo) las plantas más empleadas. En el 48% de las casas ha habido malaria. Por regresión logística se estableció que la malaria se asoció con conocer cómo se adquiere, consultar al médico tradicional y tener más de 15 años en Corozal. Conclusiones: Las plantas que la población de este estudio reportan no muestran evidencia científica como antimalaricos. Es importante una mayor presencia de las autoridades de salud y su trabajo conjunto con el médico tradicional para lograr estrategias más efectivas(AU)

Introduction: Malaria is one of the most important infectious disease and to treat it in addition to medicines the population uses medicinal plants. The objective was to establish the factors associated with malaria and the plants used for its treatment in inhabitants of Corozal. Method: A survey was applied with sociodemographic questions about housing, knowledge and attitudes, in addition to the medicinal plants used to treat it. Results: 48% use medicinal plants alone or with medicines, Gliricidia sepium (rat poisson) and Acmella oppositifolia (Opposite-leaf Spotflower) are the most used. In 48% of the homes there has been malaria. By logistic regression it was established that malaria was associated with knowing how it is acquired, consulting the traditional doctor and living in Corozal for more than 15 years. Conclusions: The plants that the population of this study report usimg do not show scientific evidence antimalarials. A greater presence of health authorities and their joint work with the traditional doctor for more effective strategies is important(AU)

Guía de práctica clínica para el tratamiento farmacológico de nefritis lúpica / Clinical practice guideline for the pharmacological treatment of lupus nephritis

La nefritis lúpica (NL) es un tipo de glomerulonefritis que se desarrolla como consecuencia del lupus eritematoso sistémico (LES), una enfermedad autoinmune sistémica de presentación clínica variable (1, 2). La NL se clasifica histológicamente en seis clases(I-VI) (3), las cuales poseen diferentes manifestaciones clínicas y expresan diferentes grados de gravedad del daño renal (1). En este documento no se abordará a pacientes con clase VI pues solo son tributarios a terapia de reemplazo renal. La NL se presenta aproximadamente en el 50 a 60% de las personas con LES, en quienes es una de las principales causas de morbimortalidad puesto que progresa a falla renal o muerte (1, 2). En suma, la prevalencia, gravedad y mortalidad de la NL son mayores en hispanos, afroamericanos, y asiáticos (4). El tratamiento farmacológico de la NL consta de las fases de inducción y mantenimiento (1). Entre los fármacos principalmente utilizados durante estas fases, se encuentran los antimaláricos, glucocorticoides (GC), inmunosupresores como micofenolato mofetilo (MMF) y ciclofosfamida (CYC) endovenosa, entre otros (1, 2). Sin embargo, la incidencia de respuesta renal completa suele ser baja (~20 a 30%) (1, 5, 6), y tanto las recaídas como los eventos adversos pueden ser frecuentes con estas terapias (1). Por ello, actualmente se ha propuesto el uso de diferentes dosis de dichos fármacos y otros inmunosupresores ya sea solos o en combinación. La evaluación de los beneficios y daños de estos fármacos permitirá conocer cuáles son las opciones más eficaces y seguras que logren inducir la remisión de la enfermedad, prevenir las recaídas, prevenir la progresión a falla renal y disminuir la mortalidad de los adultos con diagnóstico reciente de NL. Por ello, el Seguro Social de Salud (EsSalud) priorizó la realización de la presente guía de práctica clínica (GPC) para establecer lineamientos basados en evidencia con el fin de gestionar de la mejor manera los procesos y procedimientos asistenciales de la presente condición. Esta GPC fue realizada por la Dirección de Guías de Práctica Clínica, Farmacovigilancia y Tecnovigilancia del Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) de EsSalud.

Primer consenso cubano sobre el uso de terapia convencional y biológica en pacientes con artritis reumatoide / First Cuban consensus on the use of conventional and biological therapy in patients with rheumatoid arthritis

resumen está disponible en el texto completo

Introduction: The development of recommendations for the treatment of rheumatoid arthritis (RA) in the Cuban context may be one of the ways to achieve better control of this disease. Objective: To reach a consensus and update relevant aspects of conventional and biological RA modifier therapy in Cuba. Methods: 18 specialists from 8 Cuban provinces, experts in RA care, were summoned, according to the years of dedication to the specialty, the conferences on this topic and their publications. The first meeting took place in March 2016 in the provincial hospital of Villa Clara, Cuba, with the participation of all the experts. A review of the literature on conventional and biological therapy previously collected by the participants was developed, and two teams were formed: the first would address everything related to conventional therapy in RA (HRCT) and the other, biological therapy in RA (TBAR). Three questionnaires related to the use of corticosteroids, HRCT and TBAR, were prepared, answered by the participants via email. In a second meeting, held in October 2016 in Havana, the analysis of all the responses provided was carried out. Questions with a response of 90% or more votes were considered as recommendations. Results: The questionnaires were answered by 95% of the participants. 9 recommendations and 1 algorithm were established. The recommendations are as follows: methotrexate is the drug of choice in the treatment of RA after diagnosis; The administration of another conventional drug (DMARDc) (azathioprine, salazosulfapyridine, antimalarials and leflunomide) is recommended in patients with a diagnosis of active RA in whom methotrexate is contraindicated or there is a failure in response - consider the administration of low doses of prednisone or equivalent (<7.5 mg/d) associated with DMARDc in patients with active moderate to severe RA, for the shortest possible time; perform serological control including tests for hepatitis B and C viruses and screening for HIV in all patients diagnosed with RA before starting treatment with DMARDc and biologics; in patients in remission or, at least, with a DAS-28 below 3.2, consideration should be given to withdrawing one of the DMARDs or reducing, to the minimum possible expression, the dose of both disease modifiers; if methotrexate fails, tocilizumab in combination with methotrexate or as monotherapy will be indicated. Conclusions: Aspects related to conventional therapy with methotrexate, azathioprine, salazosulfapyridine, antimalarials and leflunomide were agreed. The value of early diagnosis and immediate initiation of DMARDc therapy and the use of glucocorticoids was analyzed. Treatment with tocilizumab, the only biological available in Cuba against RA, will be administered when there is a failure in the response to conventional therapy and combinations between these drugs. It is recommended to hold educational conferences through the mass media aimed at patientshttp(AU)

Malaria congénita por Plasmodium falciparum / Congenital malaria by Plasmodium falciparum

INTRODUCCIÓN: La malaria congénita (MC) es la infección por Plasmodium spp adquirida in útero o durante el parto y sus manifestaciones clínicas son inespecíficas. Puede causar enfermedad grave en la embaraza da y en el recién nacido. OBJETIVO: describir dos casos de MC causados por Plasmodium falciparum, diagnóstico diferencial de sepsis en recién nacidos de gestantes que hayan visitado o residan en áreas endémicas para malaria. CASOS CLÍNICOS: Neonatos de sexo femenino, nacidos en área no endémica para malaria, diagnosticados con sepsis neonatal y tratados con antibióticos sin respuesta clínica. Después de la primera semana de vida la gota gruesa identificó trofozoítos de Plasmodium falciparum y los neonatos recibieron tratamiento con quinina intravenosa con mejoría. Las madres de las recién nacidas tuvieron malaria en el embarazo, una de ellas recibió tratamiento y estaba asintomática y otra tenía malaria complicada al momento del parto. CONCLUSIONES: La MC puede causar enfermedad neonatal grave con manifestaciones clínicas inespecíficas y similares a la sepsis, el tratamiento oportuno disminuye el riesgo de malaria complicada. Es un diagnóstico diferencial en recién nacidos de mujeres con malaria durante el embarazo o gestantes que visiten o residan en áreas endémicas.

INTRODUCTION: Congenital malaria (CM) is a Plasmodium spp infection acquired in utero or during delivery with nonspecific clinical manifestations. Plasmodium falciparum can cause severe illness in pregnant wo men and newborns. OBJECTIVE: to describe two cases of CM caused by Plasmodium falciparum, di fferential diagnosis of sepsis in newborns of pregnant women who live in or have visited endemic malaria zones. CLINICAL CASES: Female neonates born in a non-endemic malaria area, diagnosed with neonatal sepsis and treated with antibiotics without clinical response. After the first week of life, the peripheral blood smear identified trophozoites of Plasmodium falciparum thus the newborns were treated with intravenous quinine, improving their condition. The mothers of the two newborns who had malaria in pregnancy, one of them received treatment and she was asymptomatic, and the other one had severe malaria at the time of delivery. CONCLUSIONS: CM can cause severe neonatal disease with non-specific, sepsis-like clinical manifestations in which early treatment decreases the risk of complicated malaria. It is a differential diagnosis in newborns of women with a history of malaria during pregnancy or pregnant women visiting or living in endemic malaria areas.

Informe diário de evidências COVID-19: busca realizada em 17 de junho de 2020 / COVID-19 daily evidence report: search conducted on June 17, 2020

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 15 artigos.

Informe diário de evidências COVID-19: busca realizada em 13 de maio de 2020 / COVID-19 daily evidence report: search conducted on May 13, 2020

Essa é uma produção do Departamento de Ciência e Tecnologia (Decit) da Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde (SCTIE) do Ministério da Saúde (Decit/SCTIE/MS), que tem como missão promover a ciência e tecnologia e o uso de evidências científicas para a tomada de decisão do SUS, tendo como principal atribuição o incentivo ao desenvolvimento de pesquisas em saúde no Brasil, de modo a direcionar os investimentos realizados em pesquisa pelo Governo Federal às necessidades de saúde pública. Informar sobre as principais evidências científicas descritas na literatura internacional sobre tratamento farmacológico para a COVID-19. Além de resumir cada estudo identificado, o informe apresenta também uma avaliação da qualidade metodológica e a quantidade de artigos publicados, de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, entre outros). Foram encontrados 15 artigos e 10 protocolos.

Malaria and tuberculosis as diseases of neglected populations: state of the art in chemotherapy and advances in the search for new drugs

Malaria and tuberculosis are no longer considered to be neglected diseases by the World Health Organization. However, both are huge challenges and public health problems in the world, which affect poor people, today referred to as neglected populations. In addition, malaria and tuberculosis present the same difficulties regarding the treatment, such as toxicity and the microbial resistance. The increase of Plasmodium resistance to the available drugs along with the insurgence of multidrug- and particularly tuberculosis drug-resistant strains are enough to justify efforts towards the development of novel medicines for both diseases. This literature review provides an overview of the state of the art of antimalarial and antituberculosis chemotherapies, emphasising novel drugs introduced in the pharmaceutical market and the advances in research of new candidates for these diseases, and including some aspects of their mechanism/sites of action.

Evaluación de la proteólisis en células aisladas vivas de Plasmodium falciparum aisladas durante los estadios asexuales sanguíneos / Proteolysis assessment in isolated Plasmodium falciparum living cells at the asexual blood stages

It has been demonstrated that proteases play crucial roles in Plasmodium falciparum infection and therefore have been considered as targets for the development of new therapeutic drugs. The aim of this study was to describe the specific proteolytic activity profile in all blood stages of P. falciparum isolated parasites in order to explore new antimalarial options. For this purpose, we used the fluorogenic substrate Z-Phe-Arg-MCA (Z: carbobenzoxy, MCA: 7-amino-4-methyl coumarine) and classic inhibitors for the different classes of proteolytic enzymes, such as phenylmethylsulfonyl fluoride (PMSF), 1.10-phenantroline, pepstatin A and E64 to study the inhibition profiles. As expected, due to the high metabolic activity in mature stages, the substrate was mostly degraded in the trophozoite and schizont, with specific activities ~ 20 times higher than in early stages (merozoite/rings). The major actors in substrate hydrolysis were cysteine proteases, as confirmed by the complete hydrolysis inhibition with E64 addition. Proteolytic activity was also inhibited in the presence of PMSF in all but the schizont stage. However, PMSF inhibition was the result of unspecific interaction with cysteine proteases as demonstrated by reversion of inhibition by dithiotreitol (DTT), indicating that serine protease activity is very low or null. To our knowledge, this is the first report aiming to describe the proteolytic profile of P. falciparum isolated parasites at all the erythrocytic cycle stages. The results and protocol described herein can be useful in the elucidation of stage specific action of proteolysis-inhibiting drugs and aid in the development of antimalarial compounds with protease inhibitory activity(AU)

e ha demostrado que las proteasas desempeñan funciones vitales en la infección por Plasmodium falciparum, y por lo tanto se consideran dianas en la elaboración de nuevos medicamentos terapéuticos. El objetivo del estudio era describir el perfil de actividad proteolítica específica de todas las etapas sanguíneas de parásitos aislados de P. falciparum con vistas a explorar nuevas opciones antimaláricas. Con ese propósito, utilizamos el sustrato fluorogénico Z-Phe-Arg-AMC (Z: carbobenzoxi, AMC: 7-amino-4-metilcumarina) e inhibidores clásicos para las diferentes clases de enzimas proteolíticas, tales como el fluoruro de fenilmetilsulfonilo (PMSF), 1,10-fenantrolina, pepstatina A y E64 para estudiar los perfiles de inhibición. Como se esperaba, debido a la elevada actividad metabólica de las etapas de madurez, el sustrato fue degradado mayormente en el trofozoíto y el esquizonte, con actividad específica ~ 20 veces superior a la de las etapas tempranas (merozoíto/ anillos). Los principales actores en la hidrólisis del sustrato fueron las cisteínas proteasas, lo que fue confirmado por la inhibición completa de la hidrólisis con la adición de E64. La actividad proteolítica también fue inhibida en presencia de PMSF en todas las etapas excepto el esquizonte. Sin embargo, la inhibición del PMSF fue resultado de una interacción inespecífica con las cisteínas proteasas, según lo demuestra la reversión de la inhibición con el ditiotreitol (DTT), lo que indica que la actividad de la serina proteasa es muy baja o inexistente. Que sepamos, este es el primer informe dirigido a describir el perfil proteolítico de parásitos aislados de P. falciparum en todas las etapas del ciclo eritrocítico. Los resultados y el protocolo que aquí se describen pueden ser útiles para dilucidar la acción específica de los medicamentos inhibidores de proteólisis en cada etapa, así como contribuir al desarrollo de compuestos antimaláricos con actividad inhibidora de la proteasa(AU)

Adherence to malaria prophylaxis among travelers from a middle-income country

Abstract INTRODUCTION: Malaria is the main cause of death by infection among travelers and is preventable through a combination of chemoprophylaxis and personal protective measures. METHODS: Travelers were interviewed by phone 28-90 days after returning, to assess adherence to pre-travel advice for malaria prevention. RESULTS: A total 57 travelers were included. Adherence to chemoprophylaxis was significantly higher among participants prescribed mefloquine (n=18; 75%) than doxycycline (n=14; 45%). Adherence to mosquito repellent and bed net use was 65% and 67%, respectively. CONCLUSIONS: Adherence to malaria prophylaxis was lower than expected. Further studies testing innovative approaches to motivate travelers' compliance are required.

Decreased uric acid levels in the acute phase of Plasmodium vivax malaria

Abstract INTRODUCTION Uric acid is one of the compounds associated with the inflammatory process in malaria. It acts as an indicator of cellular damage by activating the immune response and inflammatory process. METHODS: We measured serum concentrations of uric acid in 60 symptomatic patients before and after treatment for malarial infections caused by Plasmodium vivax. RESULTS: Lower serum concentrations of uric acid were found during the acute phase of P. vivax malaria compared to those in its convalescent phase (p < 0.0001). CONCLUSIONS: Patients in the acute phase of malaria had lower uric acid levels than those in its convalescent phase.

Effect of artemisinin-piperaquine treatment on the electrocardiogram of malaria patients

Abstract INTRODUCTION: Concern regarding the cardiotoxicity of antimalarials has been renewed because of their potential to cause QT/QTc interval prolongation related to torsade de pointes (TdP). Artemisinin-piperaquine (AP) is considered an effective artemisinin-based combination therapy (ACT) for malaria. METHODS: This study involved a retrospective analysis of clinical data of 93 hospitalized malaria patients who had received AP orally. Electrocardiograms (ECGs) were obtained at specific time points in the original study. RESULTS: Some cases of QT prolongation were observed. However, no TdP was found. CONCLUSIONS: AP may cause QT interval prolongation in some malaria patients but may not lead to TdP.

Therapeutic failure after regimen with artemether-lumefantrine combination therapy: a report of three cases in Benin City, Nigeria

Abstract Artemisinin-based combination therapy (ACT) is recommended by the World Health Organization for the treatment of uncomplicated malaria. Currently, there appears to be a downward trend in the efficacy of ACT in some parts of sub-Saharan Africa because some patients have been positive for Plasmodium parasite 3 days after artemether-lumefantrine treatment. We reported three cases of possible parasite resistance to artemether-lumefantrine therapy. All subjects had complete parasite clearance when treated with other antimalarial drugs. This observation necessitates the urgent need to re-evaluate artemether-lumefantrine medication in Nigeria since it is one of the most commonly used ACT drug.

Glomerulopatía colapsante en lupus eritematoso sistémico con respuesta positiva a tratamiento con mofetil micofenolato / Collapsing Glomerulopathy in systemic lupus erythematosus with positive response to the treatment with mycophenolate mofetil

La glomerulonefritis colapsante es una enfermedad poco frecuente que puede estar asociada a distintas causas, una de ellas son las enfermedades autoinmunes y dentro de estas el lupus eritematoso sistémico (LES). De manera frecuente se presenta con un cuadro de severas alteraciones renales que tienden a progresar la enfermedad renal terminal, con escasa respuesta a los tratamientos. Se presenta un caso de glomerulonefritis colapsante asociado a lupus eritematoso sistémico que tuvo una respuesta completa al tratamiento de inducción con la combinación de glucocorticoides, antimaláricos y mofetil micofenolato iniciado precozmente por el diagnóstico temprano realizado por biopsia renal(AU)

Collapsing glomerulonefritis is a slightly frequent disease that can be associated to different causes. Autoimmune diseases are part of those, and inside these, the systemic lupus erythematosus (SLE). It frequently appears with manifestations of severe renal alterations that tend to develop the renal terminal disease, with scanty response to the treatments. It is presented a case of collapsing glomerulonefritis associated to systemic lupus erythematosus that had a complete response to the treatment of induction with the combination of glucocorticoids, antimalarials and mycophenolate mofetil used prematurely after the early diagnosis performed by renal biopsy(AU)

Prescripción de antipalúdicos en hospitales centrales y provinciales de Angola / Antimalarials prescription in central and provincial hospitals in Angola

Introducción: La malaria constituye la primera causa de morbilidad y mortalidad en Angola y se desconocen las características de la prescripción de antipalúdicos en los hospitales. Objetivo: Caracterizar la prescripción de antipalúdicos en pacientes internados en hospitales centrales y provinciales de Angola. Método: Estudio de Utilización de Medicamentos, tipo indicación-prescripción, con elementos de esquema terapéutico. La muestra fue de 2 634 pacientes. La variable principal: evaluación de la prescripción, se operacionalizó como adecuada o no en función de la indicación, pauta terapéutica y contraindicaciones. Resultados: Predominó la malaria complicada (66,6 por ciento) y el sexo femenino en niños (51,7 por ciento) y adultos (51,0 por ciento). Se indicaron 4 518 prescripciones. La quinina endovenosa (20,4 por ciento) fue el tratamiento más utilizado en la malaria complicada y la quinina tabletas (26,5 por ciento) en la malaria simple. El 94,8 por ciento de las prescripciones no presentaron contraindicaciones, mientras que el 69,0 por ciento fueron adecuadas en su selección y el 65,1 por ciento en la pauta terapéutica. La evaluación de la prescripción resultó ser adecuada (55,0 por ciento). La malaria complicada presentó mayor número de prescripciones no adecuadas (47,5 por ciento). Conclusiones: Existe prescripción irracional de antipalúdicos, con mayor repercusión en la malaria complicada. Persiste una baja utilización de derivados de la artemisina, por lo que se incumple lo establecido en la Guía de Tratamiento de la Malaria(AU)

Introduction: The characteristics of the prescription of antimalarials in hospitals, where malaria is the first cause of mortality and morbidity, are unknown. Objective: To characterize the prescription of antimalarials in patients admitted to central and provincial hospitals in Angola. Methods: A Study of Drug's Use was made, type indication-prescription, with elements of a therapeutic scheme. The sample was of 2 634 patients. The main variable (evaluation of the prescription) was operationalized in adequate or not according to the indication, therapeutic guideline and contraindications. Absolute frequency and percentage were used as summary measures. Results: The most represented patients were adults (54.1 percent) and those admitted in general hospitals (82.6 percent). Complicated malaria was predominant (66.6 percent) and female sex in children (51.7 percent) and adults (51.0 percent). There were 4 518 prescriptions. Intravenous quinine (20.4 percent) was the most used treatment in complicated malaria and quinine tablets (26.5 percent) in simple malaria. 94.8 percent of the prescriptions had no contraindications, while 69.0 percent were adequate in their selection and 65.1 percent in the therapeutic regimen. The evaluation of the prescription was adequate (55.0 percent). Complicated malaria had a greater number of inappropriate prescriptions (47.5 percent). Conclusions: The existence of irrational prescription of antimalarials is evidenced with more repercussion in complicated malaria. There is still a low use of artemisinin derivatives, in breach of the Guide for Malaria's Treatment(AU)

Qualidade de vida em tratamento de lúpus eritematoso sistêmico com antimaláricos / Quality of life in treatment of systemic lupus erythematosus with antimalarials

OBJETIVO: Avaliar se o bem-estar global de pacientes com lúpus eritematoso sistêmico é afetado pelo uso de antimaláricos. MÉTODOS: Estudo transversal observacional analítico, realizado com 118 indivíduos do sexo feminino, sendo que 51 faziam uso de antimaláricos por, no mínimo, 2 anos (Grupo 1), 17 não utilizavam esse método terapêutico (Grupo 2) e 50 não tinham lúpus eritematoso sistêmico (Grupo 3). Dados epidemiológicos, clínicos e sorológicos das pacientes lúpicas foram obtidos por meio da análise de prontuários médicos, e a qualidade de vida foi avaliada pelo questionário Medical Outcomes Study Short-Form Health Survey version 2 (SF-12v2). RESULTADOS: O uso de antimaláricos foi associado à menor ocorrência de psicose e lesões renais, apesar de levar a uma frequência maior de convulsões. Quanto à percepção individual da qualidade de vida, não houve diferença significativa entre os três grupos. Porém, quando considerado o tabagismo entre as usuárias de antimaláricos, o SF-12v2 de saúde mental de fumantes foi menor do que de não fumantes. CONCLUSÃO: Pacientes lúpicas em uso de antimaláricos tiveram menor incidência de psicose e glomerulonefrite, mas não houve diferença significativa em relação à qualidade de vida e ao uso de antimaláricos, com exceção de fumantes em uso da medicação, que tiveram escore do SF-12v2 de saúde mental menor do que não fumantes em uso da mesma medicação.(AU)

OBJECTIVE: To evaluate whether global quality of life of Systemic Lupus Erythematosus patients is affected by the use of antimalarials. METHODS: This is an observational, analytical cross-sectional study carried out with 118 female individuals, of whom 51 have been on antimalarials for at least 2 years (group 1), 17 were not using this therapy (group 2), and 50 did not have Systemic Lupus Erythematosus (group 3). Epidemiological, clinical and serological data of Systemic Lupus Erythematosus patients were obtained through the review of medical records, and quality of life was assessed using the SF-12 questionnaire. RESULTS: Antimalarial use was associated with a lower occurrence of psychosis and renal lesions, although it led to a higher prevalence of seizures. Regarding the individual perception of quality of life, there was no significant difference among the 3 groups. However, when smoking habits were considered among antimalarial users, mental health score in the SF-12 was lower in smokers than in non-smokers. CONCLUSION: Systemic Lupus Erythematosus female patients using antimalarials had a lower incidence of psychosis and glomerulonephritis, but no significant differences were found regarding antimalarial use and quality of life, except for the group of smokers using antimalarials, who had lower mental scores in the SF-12 than non-smokers using the same medication.(AU)

Llega la primavera y florecen los eritemas polimorfos solares / Spring arrives and with it the polymorphous light eruption

El eritema polimorfo solar es la fotodermatosis más frecuente y suele aparecer en primavera con la primera exposición intensa al sol. Sus manifestaciones cutáneas son variadas y el diagnóstico se basa en la clínica junto al antecedente de exposición solar. En los casos leves, la fotoprotección suele ser suficiente para el control de la enfermedad, pero en formas más graves se requieren otras terapéuticas, como corticoides, antihistamínicos, o fototerapia, que genera una "fotoadaptación" de las áreas de piel afectadas. Presentamos un caso típico de erupción polimorfa solar que respondió de forma adecuada a medidas de fotoprotección. (AU)

The polymorphic solar eruption is the most frequent photodermatosis, and usually appears in spring with the first intense exposure to the sun. It has multiple cutaneous manifestations, and its diagnosis is based on the clinic and the antecedent of solar exposition. In mild cases, photoprotection is usually enough to control the disease, but in more severe forms, other therapies are required, such as corticosteroids, antihistamines, or phototherapy to generate a "photo-adaptation" of the affected skin areas. We present a typical case of polymorphic solar eruption that responded adequately to photoprotection measurements. (AU)

Factors associated with timely treatment of malaria in the Brazilian Amazon: a 10-year population-based study / Factores asociados con el tratamiento oportuno de la malaria en la Amazonia brasileña: estudio de 10 años basado en la población / Fatores associados ao tratamento precoce da malária na Amazônia brasileira: um estudo populacional de 10 anos

ABSTRACT Objective To identify factors associated with timely treatment of malaria in the Brazilian Amazon. Malaria, despite being treatable, has proven difficult to control and continues to be an important public health problem globally. Brazil accounted for almost half of the 427 000 new malaria cases notified in the Americas in 2013. Methods This was a cross-sectional study using secondary data on all notified malaria cases for the period from 2004 - 2013. Timely treatment was considered to be all treatment started within 24 hours of symptoms onset. Multivariate logistic regression was used to identify independent factors associated with timely treatment. Results The proportion of cases starting treatment on a timely basis was 41.1%, tending to increase in more recent years (OR = 1.40; 95%CI: 1.37 - 1.42 in 2013). Furthermore, people starting within < 24 hours were more likely to: reside in the states of Rondônia (OR = 1.50; 95%CI: 1.49 - 1.51) or Acre (OR = 1.53; 95%CI: 1.55 - 1.57); be 0 - 5 years of age (OR = 1.39; 95%CI: 1.34 - 1.44) or 6 - 14 years of age (OR = 1.34; 95%CI: 1.32 - 1.36); be indigenous (OR = 1.41; 95%CI: 1.37 - 1.45); have a low level of schooling (OR = 1.20; 95%CI: 1.19 - 1.22); and be diagnosed by active detection (OR = 1.39; 95%CI: 1.38 - 1.39). Conclusion In the Brazilian Amazon area, individuals were more likely to have timely treatment of malaria if they were young, residing in Acre or Rondônia states, have little schooling, and be identified through active detection. Identifying groups vulnerable to late treatment is important for preventing severe cases and malaria deaths.

RESUMEN Objetivo Determinar los factores asociados con el tratamiento oportuno de la malaria en la Amazonia brasileña. La malaria, a pesar de que es tratable, ha resultado difícil de controlar y sigue siendo un problema importante de salud pública mundial. En Brasil se notificaron casi la mitad de los 427 000 nuevos casos de malaria en la Región de las Américas en el 2013. Métodos Se realizó un estudio transversal que utilizó datos secundarios de todos los casos notificados de malaria en el período 2004-2013. Se entendió como tratamiento oportuno todo tratamiento iniciado en las 24 horas posteriores a la aparición de los síntomas. Para determinar los factores independientes asociados con el tratamiento oportuno, se usó el método de regresión logística multifactorial. Resultados La proporción de casos en los que se inició el tratamiento oportunamente fue de 41,1%, con una tendencia ascendente en los últimos años (razón de posibilidades [OR] = 1,40; IC 95%: 1,37 - 1,42 en el 2013). Además, en las personas que comenzaron el tratamiento menos de 24 horas después de la aparición de los síntomas era mayor la probabilidad de que residieran en los estados de Rondônia (OR = 1,50; IC 95%: 1,49 - 1,51) o Acre (OR = 1,53; IC 95%: 1,55 - 1,57); también era mayor la probabilidad de que tuvieran entre 0 y 5 años (OR = 1,39; IC 95%: 1,34 - 1,44) o entre 6 y 14 años (OR = 1,34; IC 95%: 1,32 - 1,36); fueran indígenas (OR = 1,41; IC 95%: 1,37 - 1,45); tuvieran un nivel bajo de escolarización (OR = 1,20; IC 95%: 1,19 - 1,22) y hubieran sido diagnosticadas por detección activa (OR = 1,39; IC 95%: 1,38 - 1,39). Conclusiones En la zona de la Amazonia brasileña, era más probable que las personas que iniciaban oportunamente el tratamiento contra la malaria fueran jóvenes, residieran en los estados de Acre o Rondônia, tuvieran un nivel bajo de escolarización y fueran detectadas mediante la detección activa. La identificación de los grupos vulnerables al tratamiento tardío es importante para prevenir los casos graves y las muertes por malaria.

RESUMO Objetivo Identificar os fatores associados ao tratamento precoce da malária na Amazônia brasileira. Embora seja tratável, a malária tem sido difícil de controlar e continua a representar um importante problema de saúde pública em escala mundial. Em 2013, o Brasil registrou quase a metade dos 427.000 novos casos de malária notificados nas Américas. Métodos Este foi um estudo transversal que utilizou dados secundários sobre todos os casos de malária notificados no período de 2004 a 2013. O tratamento precoce foi definido como todo tratamento iniciado nas primeiras 24 horas desde o surgimento dos sintomas. Utilizamos a regressão logística multivariada para identificar fatores independentes associados ao tratamento precoce. Resultados A proporção de casos que iniciaram tratamento precoce foi de 41,1%, tendendo a aumentar em anos mais recentes (odds ratio [OR] = 1,40; IC 95%: 1,37 - 1,42 em 2013). Além disso, as pessoas que iniciaram o tratamento em menos de 24 horas tiveram maior probabilidade de: residir nos estados de Rondônia (OR = 1,50; IC 95%: 1,49 - 1,51) ou Acre (OR = 1,53; IC 95%: 1,55 - 1,57); ter entre 0 e 5 anos de idade (OR = 1,39; IC 95%: 1,34 - 1,44) ou entre 6 e 14 anos de idade (OR = 1,34; IC 95%: 1,32 - 1,36); ser indígena (OR = 1,41; IC 95%: 1,37 - 1,45); ter um baixo nível de escolaridade (OR = 1,20; IC 95%: 1,19 - 1,22); e ser diagnosticado por meio da detecção ativa (OR = 1,39; IC 95%: 1,38 - 1,39). Conclusão Na região da Amazônia brasileira, as pessoas têm uma maior probabilidade de receber tratamento precoce para a malária se forem jovens, residirem nos estados do Acre ou de Rondônia, tiverem um baixo nível de escolaridade e forem identificadas através da detecção ativa. A identificação de grupos vulneráveis ao tratamento tardio é importante para prevenir os casos graves e as mortes decorrentes da malária.

Lupus tumidus: a report of two cases

Abstract Lupus tumidus is considered a rare subtype of chronic cutaneous lupus erythematosus, characterized by erythema and bright urticarial erythematous-violaceous lesions that leave no scars after regression. Histopathology reveals perivascular and periannexal lymphohistiocytic infiltrates in the papillary and reticular dermis and interstitial mucin deposition. Treatment is based on photoprotection, topical corticosteroids and antimalarials. We report two cases of lupus tumidus, which deserve attention for their low frequency in the literature, in addition to their relevance as a differential diagnosis among dermatologic disorders.