Measles epidemiological profile in Brasil from 2013 to 2018

SUMMARY BACKGROUND To determine the epidemiological profile of measles in Brasil from 2013 to 2018, and to evaluate the possible association between increased number of cases and vaccination coverage. METHODS This is an observational, descriptive, cross-sectional, retrospective study with quantitative approach, carried out through analysis of secondary data collected through the Notifiable Diseases Information System (SINAN), in the National Immunization Program (PNI). RESULTS The total number of reported cases was 10,886, with the year 2018 having the highest number (10,185). In the North macro-region (93.4%), male (55.53%), autochthonous cases from the city of residence (94.42%) and laboratory confirmation (99.09%) predominated. Regarding the age group, it was observed that in the period from 2013 to 2015 the highest prevalence occurred in <1 year, with 44.5%, 40.6% and 29.0%, respectively, while in 2018, the highest rate was in the 20-29 age group with 24.2%. Vaccination coverage was below 95%, except for SCR - D1 (first dose of triple viral) in the years 2013 to 2016. Regarding the outcome, there was a limited number of deaths secondary to measles (0.12%). CONCLUSIONS There was an exponential growth in the number of measles cases in Brasil in 2018, which represents a public health problem. In view of this, it is necessary to implement measures such as broad vaccination coverage and sanitary control at the borders, in order to reduce the incidence of this disease and, consequently, the number of deaths.

RESUMO OBJETIVO Determinar o perfil epidemiológico do sarampo no Brasil no período de 2013 a 2018, além da possível correlação entre incidência de casos e cobertura vacinal. MÉTODO Trata-se uma pesquisa observacional, com delineamento descritivo, transversal, retrospectivo e com abordagem quantitativa, feita por meio de análises de dados secundários coletados no Sistema Nacional de Agravos de Notificação (Sinan), no Programa Nacional de Imunizações (PNI). RESULTADOS O total de casos confirmados foi 10.886, sendo o ano de 2018 com o maior número (10.185). Predominou a macrorregião Norte (93,4%), sexo masculino (55,53%), casos autóctones do município de residência (94,42%) e confirmação laboratorial (99,09%). Com relação à faixa etária, observou-se que, no período de 2013 a 2015, a maior prevalência ocorreu em <1 ano, com 44,5%, 40,6% e 29,0%, respectivamente, enquanto que, em 2018, o maior índice foi na faixa de 20-29 anos, com 24,2%. A cobertura vacinal ficou abaixo de 95%, exceto a SCR - D1 (primeira dose da tríplice viral) nos anos de 2013 a 2016. Quanto ao desfecho, houve limitado número de óbitos secundários ao sarampo (0,12%). CONCLUSÃO Verifica-se um crescimento exponencial no número de casos de sarampo no Brasil em 2018, o que representa um problema de saúde pública. Diante disso, carece que medidas como ampla cobertura vacinal e controle sanitário, nas fronteiras, sejam implementadas, a fim de reduzir a incidência dessa enfermidade e, consequentemente, o número de óbitos.

Safety and effectiveness of laparoscopic Y-en-Roux gastric bypass surgery in obese elderly patients

Abstract Purpose To analyze, in aged obese patients, the weight loss, comorbidity control, and safety postoperative complications of bariatric surgery by Roux-en-Y gastric bypass technique. Methods Twenty-seven patients who underwent laparoscopic weight-reducing gastroplasty with Roux-en-Y gastric bypass to treat obesity were included. All patients were ≥ 60 years old at the time of surgery. The Wilcoxon test was used for statistical analysis, and a p-value ≤0.05it was considered significant. Results Ten (90.9%) patients with dyslipidemia were cured (p < 0.001). Nine (81.8%) patients with type 2 diabetes mellitus had total improvement and 2 (18.2%) had partial improvement (p = 0.003). In 23 patients with systemic arterial hypertension, 9 (39.1%) achieved total improvement and 14 (60.9%) partial improvement (p = 0.140). Five (71.4%) patients with obstructive sleep apnea syndrome were cured (p = <0.001). For other comorbidities, no partial improvement or cure was shown. Conclusions Roux-en-Y gastric bypass surgery in obese elderly patients can be performed safely and with low morbidity and mortality rates. The benefits of weight loss and reduced comorbidities are promising and like those of the younger population.

Use of dupilumab on the treatment of moderate-to-severe asthma: a systematic review

SUMMARY OBJECTIVE The objective of this article was to conduct a systematic review of the treatment of moderate-to-severe asthma by administrating Dupilumab. METHODS A search on the online databases EBSCO, Scielo, PubMed, Medline Bireme, Lilacs, and The New England Journal of Medicine was conducted, publications from 2010 to 2018 were selected. The inclusion criteria were articles which contained control groups, tested the validity of Dupilumab, and verified the response of patients through controlled tests. For the search of such articles, the following keywords were used: "Dupilumab", "asthma", "Bronchial Asthma" AND "Asthma, Bronchial" AND their correspondent in Portuguese "asma", "Asma brônquica" and "Asma brônquica". The exclusion criteria were literature reviews, news, articles without control groups, articles on different subjects, Dupilumab studies on other diseases, articles concerning asthma without the use of Dupilumab, and repeated articles on the databases were discarded. RESULTS The literature considers that the medication shows a good response for the treatment of moderate-to-severe asthma and assists in the improvement of lung function, aside from resulting in few side effects. It presents good efficacy, safety, and tolerance by patients. CONCLUSIONS Dupilumab is promising for the treatment of asthma, whereas conventional therapy is deemed to be insufficient. More additional studies are needed to confirm the long-term safety and effectiveness.

RESUMO OBJETIVO Este artigo teve como objetivo fazer uma revisão sistemática sobre o tratamento da asma moderada a grave, administrando Dupilumabe. MÉTODOS Foi realizada uma busca nas plataformas on-line Ebsco, SciELO, PubMed, Medline Bireme, Lilacs e New England Journal of Medicine. Foram selecionadas publicações de 2010 a 2018 referentes a artigos que continham grupos controle, que testaram a validade de Dupilumabe e verificaram a resposta dos pacientes por meio de testes controlados. Para a busca desses artigos, foram utilizadas as seguintes palavras-chave: "Dupilumab", "asthma", "Bronchial Asthma" and "Asthma, Bronchial". E o correspondente em português: "asma", "Asma brônquica" and "Asma brônquica". Os critérios de exclusão, revisões de literatura, notícias, artigos sem grupos de controle, artigos sobre diferentes assuntos, estudos de Dupilumabe sobre outras doenças, artigos sobre asma sem uso de Dupilumabe e artigos repetidos em plataformas de busca foram descartados. RESULTADOS A literatura aponta que a medicação apresenta boa resposta no tratamento da asma moderada a grave e auxilia na melhora da função pulmonar, além de resultar em poucos efeitos colaterais. Apresenta boa eficácia, segurança e tolerância pelos pacientes. CONCLUSÕES Dupilumabe é promissor para o tratamento da asma em que a terapia convencional se revela insuficiente. Maiores estudos adicionais são necessários para confirmar a segurança e a eficácia em longo prazo.

Respiratory exercise program for elderly individuals with asthma

INTRODUCTION: Asthma in older adults is frequently underdiagnosed, as reflected by approximately 60 percent of asthma deaths occurring in people older than age 65. OBJECTIVE: The present study evaluates the effects of a respiratory exercise program tailored for elderly individuals with asthma. We are not aware of any other reports examining breathing exercises in this population. METHODS: Fourteen patients concluded the 16-week respiratory exercise program. All the patients were evaluated with regard to lung function, respiratory muscle strength, aerobic capacity, quality of life and clinical presentation. RESULTS: After 16 weeks of this open-trial intervention, significant increases in maximum inspiratory pressure and maximum expiratory pressure (27.6 percent and 20.54 percent, respectively) were demonstrated. Considerable improvement in quality of life was also observed. The clinical evaluations and daily recorded-symptoms diary also indicated significant improvements and fewer respiratory symptoms. A month after the exercises were discontinued, however, detraining was observed. DISCUSSION: In conclusion, a respiratory exercise program increased muscle strength and was associated with a positive effect on patient health and quality of life. Therefore, a respiratory training program could be included in the therapeutic approach in older adults with asthma.

Teste de provocação em indivíduos com suspeita de hipersensibilidade a anestésicos locais - Proposta de uma abordagem prática / Provocatíon test in patíents wíth suspected local anesthetícs hypersensítívíty - A practícal proposal approach

Objetivo: Os anestésicos locais (AL) podem desencadear grande variedade de eventos adversos, mas raramente são responsáveis por hipersensibilidade alérgica IgE mediada. Ainda são causa de grande preocupação para profissionais de saúde e para pacientes. O teste de provocação com a droga (TPD) constitui método de escolha para prover alternativa se¬gura para estes pacientes. Outras causas de hipersensibilidade alérgica, como a alergia ao látex, podem mimetizar as reações aos AL e devem ser investigadas. Propomos uma abordagem prática para a realização do TPD diante da suspeita de hiper¬sensibilidade alérgica aos AL. Pacientes e Métodos: Foram estudados 33 pacientes com suspeita de hipersensibilidade a AL, submetidos a TPD. Estes pacientes foram atendidos em nosso serviço entre julho de 2003 e julho de 2006. Os TPD foram indicados e realizados de acordo com as orientações da European Network for Orug Allergy (ENDA) e a droga testada foi escolhida a partir da his¬tória clínica. Todos os pacientes foram avaliados (história clí¬nica e testes in vivo e vitro) para se verificar alergia ao látex previamente à realização do TPD. Foi procedido contato telefó¬nico com estes pacientes em abril de 2007 a fim de verificar se a droga disponibilizada havia sido utilizada e se houve intercor¬rências com a sua utilização. Resultados: Foram realizadas 33 provocações em pacien¬tes com suspeita de reação a AL (18 com Bupivacaína e 15 com Lidocaína), todos negativos. Dois desses pacientes tive¬ram avaliação para látex positiva. Foi verificado por contato telefónico que todos os pacientes utilizaram sem intercorrên¬cias o AL testado...

Objective: Although local anesthetic (LA) drugs can elicit variety of adverse reactions, but true allergic hypersensitivi' reactions are uncommon. It still constitutes a concern fi health professionals and for patients. The drug provocation te (DPT) is a determinant method to provide a safe alternative these patients. Other allergic hypersensitive causes (eg. lats allergy) can mimic LA reactions and must be investigated. VI suggest a practical approach based on DPT to be used when LA allergic hypersensitivity is suspected. Pacients and Methods: We stud ied 33 patients with SUSI: cion of local anesthetic hypersensitivity evaluated in our clin between July 2003 and July 2006. Ali of them underwent DP which was performed based on European Network for OrL Allergy (EN DA) orientations and the choice of the drug to t tested was based on the clinical history. Ali patients we avallied (clinical history and in vivo and in vitro tests) in ord to investigate latex allergy before the drug provocation. VI proceeded phone contact to ali these patients in April 2007 order to check if the medication we tested was used and if thr had reactions with it. Results: We proceeded 33 drug provocation tests in pai ents with suggestive history of local anesthetic reaction (: with Bupivacaine and 15 with Lidocaine), ali negative. Two these patients, who underwent DPT with Bupivacaine and wi Lidocaine, had positive evaluation to latex allergy. We conta ted ali patients and verified that the tested drug was used I ali of them with no problems. Conclusion: We demonstrated that DPT is an importa method to provide a safe alternative drug to patients with su picion of allergic hypersensitivity to LA and latex allergy Inve tigation has always to be proceeded. Therefore, the practic approach we use helps us to provide a correct, safe and inc vidualized orientation to each patient.

Teste de provocação em indivíduos com hipersensibilidade aos antiinflamatórios não-esteroidais - Proposta de uma abordagem prática / Drug provocation test in non-steroid anti-inflamatory drug (NSAID) hypersensitivity patients - suggestion of a practical approach

As reações de hipersensibilidade aos AINE são comuns. O teste de provocação com droga (TPD) é o método de escolha para determinar alternativas terapêuticas seguras nestes pa¬cientes. Sugerimos uma abordagem prática para a realização do TPD. Métodos: Avaliamos 52 pacientes com suspeita de reação imediata (urticária, angioedema, broncoespasmo e anafilaxia) aos AIN Es em nosso serviço durante 2006. Os pacientes foram testados com diferentes drogas, de acordo com sua história clínica e gravidade da reação. O TPD foi realizado de acordo com os protocolos sugeridos pela ENDA. Resultados: Realizamos 33 provocações (14 com viminol, sete com paracetamol, sete com etoricoxibe, quatro com ben¬zidamina e uma com tramadol), todas com resultados negati¬vos, exceto uma com etoricoxibe. Um paciente provocado com viminol apresentou reação duvidosa confirmada como negativa após uma segunda provocação. Conclusão: Demonstramos que o teste de provocação com AINEs é um procedimento simples e seguro, que permite me¬lhorar a qualidade de vida do paciente, proporcionando drogas alternativas para o uso.

Rational: Non-allergic hypersensitivity reaction to NSAID are common. The drug provocation test (DPT) is the procedure of choice to determine safety alternative drugs to these pati¬ents. We suggest a practical approach to be used in the DPT. Methods: We evaluated 52 patients with suspicion of im¬mediate reaction (urticaria, angioedema, bronchoconstriction and/or anaphylaxis) to NSAID in our c1inic during 2006. The patients were challenged with different drugs, according to their clinical history and severity of the reaction. The DPT was performed following the ENDA protocols. Results: We performed 33 challenges (14 with viminol, 07 with paracetamol, 07with etoricoxib, 04 with benzidamine and 01 with tramadol), ali of them with negative results, except one with etoricoxib. Another patient challenged with viminol had a doubtful event, confirmed as negative after a second challenge. Conclusion: We demonstrated that the DPT is a practical and safety method that helps us to improve the quality of life of our patients, giving them the possibility to use alternative drugs.