Single lesion as an indicator to monitor the leprosy trend to elimination in hyperendemic areas

INTRODUÇÃO: As taxas de detecção e prevalência de hanseníase não são suficientes para mostrar a real magnitude de mudanças nos padrões epidemiológicos da doença. OBJETIVOS: Avaliar a aplicabilidade e utilidade da medida de proporção de casos de hanseníase com lesão única de pele como potencial indicador de avaliação do progresso da eliminação da hanseníase em áreas hiperendêmicas. METODOLOGIA: Estudo retrospectivo baseado na análise de dados secundários de casos novos de hanseníase notificados entre 1997 e 2002 na cidade de Palmas, estado de Tocantins, Brasil. Os registros de pacientes com lesão única foram comparados àqueles registrados com mais de uma lesão. Odds ratio foi utilizado como medida de associação. RESULTADOS: De um total de 1.303 casos novos de hanseníase notificados, 481 (36,9 por cento) apresentavam lesão única de pele. Verificou-se tendência de incremento na proporção de casos de casos novos diagnosticados com lesão única variando de 20,3 por cento em 1999 para 49,1 por cento em 2002 (p < 0,001), simultaneamente à redução do registro de número de casos novos após 1999. Maior proporção de pacientes com lesão única de pele foi verificada em pacientes do sexo feminino, menores de 15 anos, paucibacilares nas formas clínicas tuberculóide e indeterminada, com baciloscopia negativa, com lesões do tipo mácula, sem incapacidades físicas e diagnosticados em unidades básicas de saúde. CONCLUSÕES: Os resultados confirmam que a proporção de pacientes com lesão única de pele pode ser utilizada como indicador na avaliação do progresso da eliminação da hanseníase em áreas hiperendêmicas.

INTRODUCTION: Prevalence and detection rates of leprosy are not sufficient to show the real magnitude of changes in epidemiological patterns. OBJECTIVES: Evaluate the feasibility and usefulness of the proportion of new leprosy patients with a single skin lesion (SSL) as a potential indicator of the elimination of leprosy. METHODS: We conducted a retrospective study based on secondary data analyzing newly reported cases of leprosy between 1997 and 2002, in the city of Palmas, Tocantins, Brazil. Patients with a single lesion were compared to remaining patients, and the odds ratio was used as measure of association. RESULTS: Out of the 1,303 new cases of leprosy, 481 (36.9 percent) had a SSL. An increasing time-trend was observed in the proportion of new cases detected with a single lesion, which grew from 20.3 percent in 1999 to 49.1 percent in 2002 (linear trend p<.001) while a reduction in the number of new cases was observed simultaneously after 1999. The proportion of patients with a single lesion was higher in women, young age, paucibacillary, tuberculoid and indeterminate clinical forms, residents of urban areas, those with negative baciloscopy, with macular lesions, without physical disabilities, and mainly detected in primary health care units. CONCLUSIONS: These findings confirm that the proportion of patients with a SSL can be used as a sensitive and feasible indicator to assess the progress of the elimination of leprosy in hyperendemic areas.

Prognostic factors of severe asthma in Puerto Rico

Asthma in Puerto Rico is a serious Public Health Problem. This study extends our cross-sectional self-reported asthma prevalence survey of 3,000 volunteers. The purpose of the present study was to analyze the importance of known prognostic factors of asthma severity among 486 self-reported participants. Patients with more than one visit to the emergency room in the previous 12 months due to asthma exacerbations were classified as cases of "severe asthma", and those asthmatic patients who did not visit emergency rooms were classified as "non-severe asthmatic subjects". Severe cases and non-severe asthmatic subjects were compared regarding age, sex, family history of asthma, presence of household pets, and in the previous 12 months: history of hospitalization due to asthma, respiratory infections, tobacco smoking, exposure to passive smoking, and avoidance of passive smoking. Crude and logistic regression adjusted odds ratio was used as a measure of association between each prognostic factor, and the outcome namely severe asthma, while adjusting for all confounders simultaneously. The results clearly showed that previous hospitalizations due to asthma (OR = 7.3, p < 0.0001) and frequent of respiratory infection (OR = 2.5, p = 0.0003) were prognostic factors associated with increased asthma severity. A statistically significant, two percent less likelihood to have severe asthma for each year of age was found. Weak associations were found between asthma severity and male gender, family history of asthma, passive smoking, and presence of household pets. Avoidance of environmental tobacco exposure (passive smoking) was found to be an important and statistically significant protective factor associated with a 47 less likelihood for severe asthma. In conclusion, appropriate management of patients with history of hospitalization due to asthma is very important. The correct management of respiratory infection in asthmatic patients may result in a reduction of up to 60 percent of the odds of having asthma severe enough to require emergency treatment, and may reduced by 86.3 percent hospitalizations.

Age, gender and seasonal patterns of asthma in emergency departments of southern Puerto Rico

We report findings derived from 55,547 emergency department records of asthmatic patients in the city of Ponce, Puerto Rico over a period of six years. The analysis of the data revealed that mean age of the asthmatic cases were 18.7 +/- 17.8 years, with 45 percent of the patients in the 1-9 years age range, and proportionally decreasing with age. In children 1-9 years the percent of males was 1.5 times that of females, and in 10-19 year-old group, admissions to the emergency room for males and females was identical, and between 20-69 years of age, the female ratio ranged from 1.5-2.12. The data also demonstrated that there is a seasonal variation in the asthma attacks reaching its peak in December, and the lowest in June. In conclusion, in the city of Ponce, Puerto Rico, emergency department usage due to asthma attacks show a seasonal variation, and males are more affected by asthma at younger ages while females are more affected at older ages. These findings strongly suggest that emergency department usage due to asthma attacks is highly common and represents an important place where specialized health care delivery is needed. With the implementation of dedicated asthma centers, specialized health care delivery can be easily accomplished. In addition, our data supports the that asthma should be declared a public health problem and a reportable disease.

Prevalence of skin reactions to aeroallergens in asthmatics of Puerto Rico

In Puerto Rico, although a high prevalence of asthma has been reported, the sensitization rates to aeroallergens in these patients is unknown. The purpose of this study using a case control design, was to determine and compare the rates of sensitization to common aeroallergens in an asthmatic population of 576 asthmatics and 144 healthy controls. A skin prick test was conducted using standardized extracts of Dermatophagoides farinae (Df) and D. pteronyssinus (Dp), house dust (HD), cat hair and epithelium (CT), dog hair and dander (DG), grass pollen mix (PG), tree pollen mix (PT), weed pollen mix (PW), Aspergillus mix (AM), mold mixes A (MA) and B (MB), Periplaneta americana (PA) and Alternaria-Hormodendrum mix (AH). In addition, an extract from the domestic mite Blomia tropicalis (Bt) was also used. A wheal > or = 3 mm2 was considered a positive reaction. In addition, a standardized questionnaire was administered and a preliminary domestic mite identification survey was conducted. The analysis of the data showed that 85.8 of the asthmatics had at least one positive reaction and 61.6 of them had positive skin reactions to atleast one mite species. Asthmatics reacted to domestic mites 6.19 times more than the control group (p < 0.0001) and was the largest significant difference found in this study for any allergen tested. Preliminary identification of the acarologic fauna in southern Puerto Rico demonstrated that Blomia tropicalis, Dermatophagoides pteronyssinus, D. farinae and E.maynei are the dominant domestic mite species found in homes of asthmatic individuals. These results demonstrate that domestic mites are a very important source of sensitizing aeroallergens for asthmatic patients in Puerto Rico. Based upon the mite survey, Blomia tropicalis plays an important role in allergic sensitization, in addition to Dermatophagoides pteronyssinus and D. farinae. The skin prevalence to pollens and to molds may not reflect the true prevalence of sensitization to these allergens. Pollen identification and counts, and a survey of microflora of Puerto Rico are needed in order to identify and validate important allergens that eventually could be incorporated into a more appropria).te panel for testing sensitization in susceptible individuals

Paucibacilar ou multibacilar? Uma contribuiçäo para os serviços de saúde / Paucibacillary or multibacillary? A contribution to health services

A principal conseqüência de uma incorreta classificação operacional refere-se aos pacientes MB quando classificados como PB. Esse trabalho tem como proposta estudar a aplicabilidade das recomentações da Coordenação Nacional de Dermatologia Sanit ria/Ministério da Saúde (CNDS/MS) quanto aos procedimentos para a classificação operacional comparando primeiro os procedimentos para a classificação operacional efetuados pelo Instituto Estadual de Dermatologia Sanit ria - IEDS (Centro de referência) com o recomendado pela CNDS/MS. A seguir compara-se a classificação executada pelo IEDS, padrão ouro, com dois diferentes cen rios de serviços de saúde do país e finalmente compara-se os procedimentos da CNDS/MS com os realizados pelos técnicos de saúde do Estado de São Paulo. Esta última comparação foi realizada para demonstrar o grau de aderência dos serviços de saúde do Estado de São Paulo com os procedimentos recomendados pela CNDS/MS. A discordância observada entre a classificação do IEDS e a preconizada pela CNDS/MS é de 3,5 por cento por conta dos casos dimorfos e indeterminados. Se o resultado da baciloscopia fosse o único critério de alocação, 20 por cento dos MB seriam classificados e tratados como PB, e dos PB 5 por cento seriam tratados como MB. Se o teste com Mitsudina fosse usado como critério isolado dos MB 19 por cento seriam classificados e tratados como PB. Nos PB, 10 por cento seriam tratados como MB. A comparação da classificação do Estado de São Paulo contra a CNDS mostrou uma concordância de 95,8 por cento. Os resultados apontam no sentido de que as recomendações da CNDS/MS contituem-se num método de classificação de casos que prescinde de grande variedade de material de consumo, de equipamentos ou técnicas mais elaboradas permitindo que o profissional no nível local decida com segurança se os pacientes são MB e ou PB além de serem plenamente aplic veis numa grande rede de serviços públicos.

Prevalência de HIV1 em pacientes de hanseníase no Rio de Janeiro, Brasil / Prevalence of HIV1 in leprosy patients in Rio de Janeiro, Brazil

A finalidade deste estudo foi a de saber se a infecçao pelo HIVl estaria associada à hanseníase no Rio de Janeiro, Brasil, comparando-se a taxa de prevalência de 1.016 pacientes de hanseníase testados de forma voluntária com 78.482 doadores de sangue. Com esta finalidade um estudo de prevalência de anticorpos anti-HIVl foi realizado no Rio de Janeiro de 1990 a 1992. A prevalência de HIVl em pacientes de hanseníase foi de 2,9 por 1.000 (3 casos) e entre os doadores de sangue a prevalêncía foi de 3,8 por 1.000 (282 casos ). Uma vez que os casos de HIVl entre pacientes de hanseníase se limitaram a homens, as pacientes femininas foram excluídas das análises posteriores. Pacientes de hanseníase do sexo masculino apresentaram um prevalência ligeiramente mais alta para o HIVl do que os doadores de sangue, antes e depois do ajuste por idade. Entretanto, este resultado nao foi estatisticamente significativo (RPC ajustado = 1,38, 95 por cento CI O,25-4,5 p = O,83). Estes resultados nao demonstram que hanseníase e a infecçao pelo HIVl estejam associados no Estado do Rio de Janeiro. Estes achados sao compatíveis com os resultados de investigaçoes semelhantes em outros centros.